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It was interesting to read your article and would like to add:
1. I would like to refer to the interface between General Medicine and the sub-specialties. The current situation in many hospitals is that the sub-specialists decide were the new admission should go, often based on the need for procedures NOT whether the case is part of their sub-specialty. Such handling of patients has yielded 2 untoward outcome, turning sub-specialties into procedure workshops and putting extra burden on already busy area.
2. Lack of acute geriatric unit has turned General medicine into integrated medicine model, this attitude is further complicated sometimes when Geriatrician restrict their care to out-patients in many hospital, Again this is another area of "abuse" of general medicine.
3. The above 2 attitude have negative effect on general medicine taking it away from main objectives , exaggerated work burden.