Is it time for a new kind of hospital physician?

Time for the renaissance of the consultant general physician

10 April 2012

Temple et al rightly say we need to look forward and not back to solve the issues of ever expanding medical takes overwhelmed with complex, elderly patients.

Expecting the "med reg" to run the whole hospital is potentially unsafe and increasingly unviable. Unwell medical patients want, need and deserve rapid and frequent consultant input, and there is increasing evidence that this improves outcomes.

As someone with dual CCST in geriatric and general medicine, I recognise the two are clearly distinct. It would be simplistic to suggest that more geriatricians can be anything other than part of a solution.

In my view the relegation in the UK of general internal medicine accreditation to an "add-on" competency additional to a CCT in another specialty has been a huge mistake, compounding the decline of general medicine as a distinct entity.

Acute medicine as a specialty solves some of the issues, but not those of ongoing management and continuity, particularly for a patient population with multiple chronic problems.

The solution seems clear to me - reinstate a CCT in GIM, with a curriculum appropriate for the 21st century, and create meaningful consultant jobs in general medicine. It's time to put the general physician back at the heart of the hospital, not picking up the scraps left by other specialties.

Competing interests: None declared

Lewis G Morrison, Consultant Physician in Geriatric Medicine

Roodlands Hospital, Hospital Road, Haddington, East Lothian EH41 3PF

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