Hospitals need internists with a broader view (and functions)

@varelalaf

Internal medicine is a speciality of long tradition and the mother of almost all non-surgical specialities, so what is expected of it is to provide a general vision in the hospital care of complex patients. The internists are formed under the principle that no adult clinical issue is foreign to them, although they cannot cover in-depth all the knowledge and techniques that are available to modern medicine, so they should lead, more than they do now, multidisciplinary teams, to offer complex patients comprehensive care, instead of having to suffer the sum of multiple often uncoordinated actions.

The ICU model, an example to emulate

The polio epidemic of the 40s and 50s gave rise to the first negative pressure ventilation devices, also known as steel lungs, and then evolved into positive pressure ones. As expected, the indications of intensive respiratory therapy were extended to other cases, such as multi-trauma patients, patients in a coma, patients in complex post-operative, etc. With all this, the managers of the time understood that they could not train all the nurses of the hospital in the management of the ventilators and opted for the creation of specific units with well-trained personnel to take care of patients with needs of mechanical ventilation whatever their illness. After the first step, the need for specialized doctors in a general vision of the management of critical patients soon emerged.

The organizational model of the ICU of today, which should be taken as an example for the management of complex patients in hospitalization departments, is characterized by the following features:

• The staff of critical medical specialists who have full dedication without distractions other than academics.
• The staff of nurses trained in the management of critical patients.
• Multidisciplinary teamwork joined by the required specialists in the framework of the care plan agreed between patients, families and the ICU team.
• Doctors on duty which preserves the continuity of care of the admitted patients.
• Not forgetting that the recent movements to favour the humanization of the ICU, involve many initiatives of patient-centred care.

A new generalist leadership for internists

In a joint academic session between the scientific societies of health management and internal medicine, it was discussed that internists should lead a new organizational model in wards and, for this, it would only be necessary to imitate the model of the ICUs with:

• Continued presence in of hospital doctors with full dedication.
• Multidisciplinary teamwork especially among doctors and nurses.
• Patient-centred care with structured visit passes.
• Collaboration with the required specialists in the framework of individualized plans
• Doctors on duty present on the ward.
• Coordination of actions with primary care to facilitate transfers of complex patients in their community environment.

To combat the fragmentation prevailing in today's hospitals, internists should take sides between their soul of specialists of certain pathologies (infections, systemic, autoimmune) and their generalist soul. Without disparaging the importance of the first, hospitals urgently need leaders in the second, and if the internists don't accept this challenge, who will?

Jordi Varela

Editor