The working day in general medicine

Abstract

Professor Vallance (May 2005 JRSM1) comments on the decline in status of general medicine by comparison with the 'organ-based silos'. Part of the explanation for its slip down the hierarchy lies in the pressures put upon today's general physicians by other specialties. For example, during our last 'take' day, we had to admit two patients with fractures who would not be needing urgent operation; then casualty asked us to take a patient with acute abdomen into the medical admissions unit, because the surgical registrar was in theatre; then there was a request from the maxillofacial team to admit 'under the medics' a patient who had bled excessively after an extraction; and an hour later surgical colleagues asked us to take over the conservative care of a patient with cholecystitis because they were uncertain how to manage her atrial fibrillation (which she had had for ten years and was well controlled). The continued spate of referrals included a request from a general practitioner to admit a patient with diverticulitis, because he felt that the surgeons would not buy his story. The psychiatry team then wanted to transfer to the medical team a patient on warfarin therapy, which they would find difficult to monitor over the weekend. At the end of the shift the site manager was trying to convince us to discharge two elderly patients to their own homes despite the fact that they lived alone and it was 9 o'clock at night. This was all amidst the five patients who needed decisions on resuscitation status despite the fact that they had been in hospital for more than two weeks under our own medical colleagues. One can only guess how difficult it would be to convince the juniors on the team to pursue general medicine as a career 'full of challenges and variety'.