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NEWS: Bryan Christie Acute medicine needs better standards to guide development of the specialty BMJ 2008; 337: a2609 [Full text]

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Acute medicine is the Foundation of medicine

David G Samuel   (23 November 2008)

Acute medicine is the Foundation of medicine 23 November 2008
David G Samuel, F1 surgery Prince Charles Hospital, Merthyr Tydfil. CF48 2AS Send response to journal: Re: Acute medicine is the Foundation of medicine	As an F1 doctor acute medicine plays a big part in my education and shapes the majority of my training. I welcome the calls to improve the guidelines, monitoring and services offered in acute medicine. My hospital has an early warning system and all F1 doctors receive regular training referring to the system. No longer do I merely write OBS STABLE, APYREXIAL in the notes. I now think what the figures mean, attempt to deduce why the readings may be abnormal and take more time to look at my patient. I have however, been annoyed and agitated at weekend out of hours where it has been difficult to obtain scans or investigations. I find that at times patients are given a CT scan instead of an Ultrasound, not because it is the most appropriate imaging modality but because it may be more convenient for the on-call radiology team who are over stretched with a skeleton staff. At times, this can result in patients undergoing scans with high doses of radiation. Should we putting our patients at risk like this? In addition, the pressures of staffing a Medical Assessment Unit often means our teaching may be limited to on the job and get it while you can situations. While this teaches young doctors what it is like at the sharp end, and seeing real case emergencies is the best way of gaining experience and practicing skills, protected teaching still has its place and is invaluable in installing basic knowledge as well as allowing for practice and learning in a controlled, safe environment. I only hope that funding can be found to ensure that whatever the day or time, the best imaging or investigation can be offered to my patients. Audit and accountability is also crucial and should include data on inappropriate referrals. As an F1 I can rarely turn down a referral even though it seems totally inappropriate. I wonder how many beds are blocked and unnecessary tests are carried out on these patients. This money would be invaluable in securing these recommendations. Competing interests: None declared