General Medicine | Waitematā

Public Service, Internal Medicine

Description

What is General Medicine?

General Medicine is the branch of medicine that deals with the diagnosis and nonsurgical treatment of diseases affecting the internal organs of the body in adults.

Specialists in this field are called specialist general physicians. They are doctors who have trained in various specialties such as diseases of the heart, lungs, brain and other organs. Often people have more than one part of the body involved in an illness or the exact cause of symptoms is not clear. The General Physician is an expert in diagnosing what is wrong and managing illnesses that are complex.

General Medicine will often overlap with other medical services such as:

The General Medical Team

This consists of the consultant (the specialist general physician), the registrar (a doctor who is training to be a specialist) and a house officer (a doctor in training who is more junior than the registrar but is a qualified doctor). Sometimes, as part of the team, there are trainee interns who are medical students who have yet to pass their final exam but are gaining practical experience. More junior medical students may also be part of this team.

You may be seen by the training doctors who then present your case to the registrar or the consultant. On the day of admission you will be seen by the registrar but you won’t usually meet the consultant until the next day when the whole team does a “ward round” to see all the patients who were admitted the day before. The tests that are undertaken and the treatment you receive are always done in consultation with the specialist.

Referral Expectations

Hospital Admissions and the General Medical Team

If you suddenly become unwell and need to be admitted to hospital with a medical rather than a surgical problem, you will most likely be seen by the general medical team (see above). If your GP (General Practitioner) thinks you need to be admitted to hospital they will contact a doctor on the medical team to request admission. There is always a doctor from general medicine on call 24 hours per day.

Your arrival at hospital will be expected but often there will be delays in seeing a doctor. Some examinations and tests will be undertaken by nurses in the admitting department and these help to prioritise how urgently you need to be seen. If blood tests are taken at this time, an IV (intravenous) line may be inserted and left in your arm. This is a small plastic sheath with a needle that sits in a vein. It allows rapid and pain-free access for repeated blood tests and for medication or fluids to be given.

Other tests you may have include a urine test and an ECG (electrocardiogram) to check your heart.

Your First Assessment

The doctor who assesses you will take a detailed history of your symptoms and ask about previous illnesses and what medications you are on. Part of history-taking includes asking questions about what you do for a living, who you live with or what support you have. You will also be asked about smoking, alcohol etc. There will be other questions about your health designed to add helpful information to diagnose what is causing your symptoms. The doctor will then examine you. They will explain to you as they go the reason for the examination and then what tests or treatments are coming. You and your family can ask questions at any time during this assessment.

What Happens Next?

You will be admitted to hospital if you: require treatment that cannot be undertaken at home (this may include medication given into a vein “IV drip”); need investigations that are best carried out with you staying in hospital a few days; or if you are too unwell to manage at home.

On arrival at hospital you will initially stay in the assessment and diagnostic (ADU) area. If you only need to stay 24 hours or less you may stay in this area, but if it looks as though you will need longer you will go to an inpatient ward.

Often the immediate cause of an illness is not known and the general medical team manages the investigation and subsequent treatment of most illness although sometimes in consultation with other specialists. In some cases, you may be transferred to another team if your condition could be better managed by other specialists.

When you are discharged your GP is notified about what has happened in hospital and any follow up plans.

The Medical Ward

Staff on the ward include: Nurses, Doctors, Physiotherapists, Occupational Therapists, Social Workers and Speech Therapists.

Physiotherapists are experts in movement and function. They provide equipment if needed as well as exercises aimed to improve movement, pain, weakness or balance.

Occupational Therapists are experts in function. They look at what you do during the day and what might help to achieve things you are struggling with.

Social Workers provide support for you and your family. They are able to provide counselling to get through difficult times as well as advice about your rights as a patient.

Speech Therapists are experts in problems with speech and communication. They are also experts in swallowing.

General Medical Outpatient Clinic

If your GP wants advice about the diagnosis or management of an illness, they may refer you to this clinic. Your referral is given priority depending on the information in the referral letter. It is important that, if your condition worsens while waiting to be seen, you revisit your GP as we can see you sooner if your situation changes. Our average waiting time for a routine outpatient appointment is 3-4 months. Prior to this appointment you may have some investigations undertaken such as blood tests, ECG (recording of heart beat) or x-rays. These are to help the doctor make a diagnosis or plan treatment when they see you initially.

At the clinic you will be seen by a consultant or registrar (who will discuss your case with the consultant). The doctor will take a detailed history of your symptoms and ask about previous illnesses and what medication you are on. Part of history-taking includes asking questions about what you do for a living, who you live with or what support you have. You will also be asked about smoking, alcohol etc. There will be other questions about your health designed to add helpful information to diagnose what is causing your symptoms. The doctor will then examine you. They will explain to you as they go the reason for the examination and then what tests or treatments are coming.

You may be started on some medications or asked to undergo further testing before being seen or referred back to your GP. A letter will be sent to your GP with any recommendations as well as the results of any tests that are undertaken.

The medical outpatient clinic is also where you may be seen after you have been discharged from hospital to follow up any outstanding investigations or to see how you have improved or tolerated medications. If the investigations are normal, the registrar may call you or write to your GP, to avoid you having to come into the clinic, but it is more common that they wish to see you in person.