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The Dichotomy of Inpatient and Outpatient Internal Medicine
1. The hospital environment has transformed dramatically over the past few decades. In more recent times, emergency departments and critical care units have evolved to identify and manage critically ill patients, allowing them to survive formerly fatal diseases. There is increasing pressure to reduce the length of stay in the hospital and to manage complex disorders in the outpatient setting. This transition has been driven not only by efforts to reduce costs but also by the availability of new outpatient technologies, such as imaging and percutaneous infusion catheters for long-term antibiotics or nutrition, and by evidence that outcomes are often improved by minimizing inpatient hospitalization.
2. Hospitals now consist of multiple distinct levels of care, such as the emergency department, procedure rooms, overnight observation units, critical care units, and palliative care units, in addition to traditional medical beds. Clearly, one of the important challenges in internal medicine is to maintain continuity, of care and information flow during these transitions, which threaten the traditional one-to-one relationship between patient and physician.
3. In the current environment, teams of physicians, specialists, and other health care professionals have often replaced the personal interaction between doctor and patient. The patient can benefit greatly from effective collaboration among a number of health care professionals; however, it is the duty of the primary physician to provide cohesive guidance through an illness. In order to meet this challenge, the primary physician must be familiar with the techniques, skills, and objectives of specialist physicians and allied health professionals.
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The problem of internal medicine today …
occurs in the fact that there appeared too many levels of care in hospitals
comes to existence because of necessity of providing a patient all necessary information for effective treatment
consists in the fact that for effective treatment different qualified specialist physicians are needed
consists in the difficulty of cohesive guidance through an illness due to the development of the system of care in hospitals
