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Emerg Med J 21:652-653 doi:10.1136/emj.2003.012211
  • Editorial

Acute medicine: past, present, and future

  1. J R Dowdle
  1. Correspondence to:
 Dr J R Dowdle
 Department of Medicine, Royal Glamorgan Hospital, Llantrisant, Rhondda-Cynon-Taf CF72 8XR, UK; rhid.dowdlepr-tr.wales.nhs.uk

    Developments in specialist acute care should lead to better quality of care for patients.

    “Over the past few years there has been a growing realisation that there is a need for a senior medical presence in Medical Assessment and Admission units (MAUs). This has been manifest by the large number of appointments that have been made to MAUs at Consultant and other levels”.1 A significant point in the development of acute medicine was marked on 3 July 2003. It was the day when the Specialist Training Authority recognised acute medicine as a sub-specialty of general (internal) medicine (G(I)M) and subsequently trainees have been appointed to specialist registrar programmes for higher training in both G(I)M and acute medicine. The development of acute medicine however has a much longer history.

    There was a time when all physicians were expected to be competent in both the immediate and subsequent management of all common medical disorders, and thus were general physicians. However, fascination with the disorders of particular organ systems resulted in many clinicians developing more specific expertise and becoming “specialists”. Formalisation of medical training in the 1970s defined specialty training, and facilitated the development of the physician with special interest in a particular specialty. With specialisation came the development of specialist societies and many physicians became more committed to their specialties than to the generalities of the acute intake. The creation of specialties within medicine should have raised concerns about the ability of specialists in one specialty to deliver the best care to patients suffering from the acute disorders of another specialty, but as the physicians involved in the acute intake practised general medicine as well as their specialty, it was assumed that acute medical care in all situations could still be delivered by all physicians. Acute medicine thus remained part of …