Caring for and about acute general medicine

A seismic change has occurred in the delivery of acute general medicine over the past five years, and nowhere has its impact been more dramatic than on the consultant general physician. Concern has recently been expressed about how consultant physicians are coping with the various demands on them,1 and last year the Royal College of Physicians has commissioned a national survey of all physicians responsible for receiving acute medical emergencies.2 This survey is timely as it not only provides data on the workload of consultants but also evaluates several initiatives that have been tried to address the problems of organising the care of emergency patients. Gone are the days when consultants “on take” might be able to keep a remote hand on the tiller: they are now much more clearly accountable for the emergency service. This has brought with it a range of additional pressures at a time when the expectations of patients are higher, the demands of senior hospital managers greater, and the working patterns of junior doctors radically changed. These additional, external pressures include, in particular, a sustained rise in the number of acute medical admissions across Britain at a time when the number of hospital beds has continued to fall. The ability to squeeze …