“Don’t break the acute medicine model on a whim”

By Dr Alistair Douglas, president of the Society for Acute Medicine

We welcome the address by the Secretary of State in yesterday’s speech at Guy’s and St Thomas’ hsopital focussing on patients who have complex health problems which often require expertise across multiple specialties and the importance of clearly identifying a named consultant responsible for each patient’s care.

However, suggesting that the UK should move to a whole scale implementation of a US-style hospitalist model is overlooking what has already been achieved here by consultants in acute medicine.

In the late 1990s, when British physicians recognised that standards of care for medical emergency patients had fallen – partly due to the movement away from the front door by many traditional specialties – the response was to develop the specialty of acute internal medicine, based in acute medical units (AMUs). What we believed then was that getting it right in the first hours of an emergency patient’s stay in hospital, and having consultants specially trained in early management and diagnosis would save lives and ensure patients moved onto the right specialty, first time.

We now have the evidence to support this approach and furthermore we have shown that around half of all medical emergency patients can be managed completely through to discharge by these specialists. 98% of UK hospitals now have AMUs. So we must not break this model.

We acknowledge that issues in downstream wards and it is here that the Royal College of Physicians London’s Future Hospital Commission offers insight into solutions.

We currently have around 1400 junior doctors each year entering core medical training in their third year after graduation. Two years later that number has to supply all the medical specialties and yet we have 22% of these hospital career training posts unfilled each year.

Comparing the UK and US populations to replicate the US hospitalist model would mean over 8000 consultants for a new specialty. Acute internal medicine has been around since 1999 and has around 500 consultants currently in post.

So yes to better continuity of care, yes to a seven-day services, yes to unnecessary ward transfers, but when talking about whole stay doctors and thinking that hospitalists are the whole solution, let’s not overlook what acute internal medicine has achieved and how much worse things would otherwise be.