References

A big proportion of the acute take in less frail patients can be handled by outpatient clinics or with discharge within 48 hours if patients are admitted. Most patients who remain are then either mainstream geriatric medicine or fi t more or less into one of the main organ specialities, without that much unclassifi ed general medicine left. So the relationship between geriatrics and acute medicine is not a sideshow – it is key. Finally, I must express disappointment that Firth feels that those doing general and geriatric medicine are regarded as ‘second rate ’ and of lower status than those focusing on single organs or diseases. This is not a situation we can allow to continue. As NHS doctors, we are trained and paid by the taxpayer. As such we have a duty to embrace the care of the patients who actually come through the door (generally older and medically complex) not those we might fi nd more glamorous. Looking after these patients should be seen as a vital role to be proud of and one which is ‘core business ’ for those of us working in general hospitals. Even tertiary referral centres like Addenbrookes Hospital (Cambridge, UK) are still the district general hospital for their local community. I have to ask, who is giving out the message that expert generalism is a poor relation? I feel our medical schools have a big responsibility with values and curriculae not focusing nearly enough on the care of older people and those with multimorbidity.5 Postgraduate training often reinforces this. I do not think that the Royal College of Physicians’ scheme to make more doctors do medical registrar on calls will make people who are not interested in general medicine or geriatrics any more interested, nor that creating a ‘chief of medicine ’ post, as set out in the Future Hospitals Commission Report, will shift values. We really need to send out the message that care of the unselected medical take and non-elective inpatient work is the key to solving the problems hospitals face, and therefore the most important job of all.