"Letters from CMOs & others"

last updated 8th November 1999

The following letter was written to the MJA supporting Ward CMOs as hospitalists in non-teaching hospitals. (Apparently, the MJA was unable to publish this letter, citing increased pressure of space)

"Hospitalist: Collaboration not Competition" David S Mah Emergency Physician, Department of Emergency Medicine, Sutherland Hospital, Caringbah, NSW To the Editor (of MJA): It amuses me when the Internal Medicine Society (1) would argue over the right to a non-existent specialty (2) in response to an opinion put forward by an intensivist (3). It amazes me when they try to drag Emergency Physicians into the debate. The argument put forward by Scott and Phillips has several major flaws: A hospitalist is not expected to deal with acute medical illness alone; he/she is expected to deal with surgical, orthopaedics, psychiatric, paediatrics, neonatal, obstetric and gynaecological patients that are admitted to the hospital. Currently, only an emergency physician can adequately fill this role if so desired. As for the diagnostic skills of general physicians, I tend to find most recourse to over-investigation. Their hand-on life-saving resuscitation and procedural skills are limited (4). The hospital bed occupancy problems stemmed mainly from medical patients awaiting decision for discharge. This has lead to debate about giving nursing staff the authority for patient discharge from the wards. Currently, there is a group of non-specialist doctors that have been fulfilling the role of hospitalists in non-teaching hospitals for some years. They are called ward career medical officers. All they need are more structured training and recognition. Instead of fighting over the right of a non-existent specialty, the Internal Medicine, Intensive Care and Emergency Medicine Colleges can collaborate to create a new specialty that requires input from the three colleges. 1. Scott IA, Phillips PA. Hospitals and hospitalists: an alternative view. Med J Aust 1999; 171: 312-314. 2. Kelly MA. The Hospitalist: A New Medical Specialty? 3. Hillman K. The changing role of acute-care hospitals. Med J Aust 1999; 170: 325-328. 4. Ende J, Kelly M, Ramsey P, Sox HC, eds. Graduate Education in Internal Medicine: A Resource Guide to Curriculum Development. Philadelphia: American Coll of Physicians; 1997.

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