• Vol. 38 No. 2, 163–165
  • 15 February 2009

Right-Siting of Medical Care: Role of the Internist



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General internal medicine is now an essential service, and may in time be the main vehicle of delivery of healthcare to an ageing population, since resources are finite. One model for an equitable system of healthcare delivery may be the integration of General Internal Medicine as the core matrix, around which the various subspecialties deliver quality care. This is now a reality in many hospitals, where all subspecialists serve for varying periods in general medical wards, some even achieving dual accreditation. This promotes integration rather than fragmentation of services. Subspecialties will thrive, for the general workload will also be shared by internists in an equitable fashion. The obvious beneficiaries are the patients, and the health economics will also benefit the funding bodies. The services provided by internists must also be expanded into new fields, e.g. medicine for disasters, so as to promote cost-effective medical care, research and teaching, and also to achieve right-siting of patient care. It must also be emphasised that the specialties remain integral parts of the matrix, so that all departments complement one another, rather than compete with each other. The collegiality engendered is essential for a more congenial workplace, so as to promote staff retention.

Healthcare expenditure, whether in developed or developing countries, is burgeoning, and its provision is also non-negotiable. Productivity is possible only in a state of good health, and is the key to a meaningful life. The aim of this article is to offer a viewpoint about an established practical and economical model of healthcare delivery. However I must emphasise that it remains a viewpoint, rather than stating that this should be an universal policy, because every perspective has a flip side to it. Since the author works in the field of internal medicine, one must view this article objectively for its merits, before coming to conclusions.

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