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Is it time for a new kind of hospital physician?

BMJ 2012; 344 doi: https://doi.org/10.1136/bmj.e2240 (Published 04 April 2012) Cite this as: BMJ 2012;344:e2240

Rapid Response:

Re: Is it time for a new kind of hospital physician?

As a geriatrician who attends on a general medical teaching team located in the Emergency Department, I welcome the stance of Temple et al. that the growth in the numbers of frail older adults who present with acute illness requires that hospitals focus on providing care which meets their needs. An emphasis on the need for generalism, and a recommendation for repatriation of some subspecialty resources, strikes me as remarkable and deserving re-emphasis.

A central problem appears to be that we have come to build acute hospital care on the idea of single system illness. Such hospitals prefer that patients have only one thing acutely wrong at a time, should be well enough otherwise to fend for themselves and should have good social support. To meet this ideal, we continue to train physicians whose skills commonly are irrelevant to most of the people who actually get sick. Such subspecialists now are in relative over-supply compared with generalist physicians.

Going forward, we must train all doctors in the minimum skill set needed to care with competence and enthusiasm for patients with multiple, interacting medical and social problems, especially when they are acutely ill. Ensuring that we offer essential geriatric medicine skills should be the priority if the "future hospital" is to serve future sick people.

Competing interests: No competing interests

27 April 2012
Kenneth Rockwood
Professor of Geriatric Medicine
Dalhousie University
Halifax, Nova Scotia, Canada, B3H 2E1