Consultant physicians working with patients 5th edition - FSEM

Consultant physicians working with patients
by family and friends. The rising number of older
patients, and of patients with chronic conditions,
obesity and damage caused by excess alcohol ingestion,
means that all physicians must have the skills to deal
with these people, who may present with a wide variety
of presentations and illnesses.
There is also a need for consultant physicians to be
involved with patients who are on the surgical wards,
offering expertise in the management of their medical
conditions which may deteriorate when they undergo
surgery. 16 Consultant physicians and doctors in training
are often called to deal with medical problems arising in
pregnant women who are in the hospital. There is a need
for physicians who do not work directly with pregnant
womentoknowmoreabouttheinteractionbetween
the conditions that they are treating and pregnancy. 17
The training and development of the
consultant physician
The reality for many healthcare professionals has
involved coping with continuous change and rising
workload, with more complexity in the patients they
see. The ability to cope with repeated reorganisations of
healthcare, at a time of rising expectations from patients
and the public, needs to be nurtured and supported,
with flexibility of approach and a constant reference to
the underlying values of the profession and focus on the
quality of care.
Clinical practice is enabled and regulated within
frameworks that are common to all consultant
physicians in the UK:
� The GMC is ultimately responsible for registration
and regulation.
� Most physicians in the UK work for the NHS, and
will be employed by an NHS organisation, usually a
hospital or trust, which determines the environment
in which we practise.
� The Departments of Health set strategic objectives
responding to the requirements of the governments
in the devolved administrations.
� In addition, there are regulators and inspectors of
practice, research and education all of which require
attention and performance in their area of activity.
Most medical consultants are employed by the NHS in
hospital and community trusts, but the arrangements
differ in the four nations.
6
They are all accredited specialists. Consultant physicians
hold the Certificate of Completion of Training (CCT)
previously awarded by the PMETB, now by the GMC.
They are, with few exceptions, fellows or members of
the Royal College of Physicians of London, Edinburgh
or Glasgow. Their training and development will have
been supported in whole or part by one of these royal
colleges.
At one time all consultant physicians were classed as
‘general physician with a special interest’, for example
consultant physician with a special interest in
cardiology. However, as specialist subjects developed
and expanded they reflected an increasingly complex
body of knowledge within individual disciplines. There
are now an increasing number of individual specialist
societies associated with the RCP. Now, some
consultants work as generalists with a special interest.
Others, an increasing number, work solely in their
specialty and do not do general medicine or take part in
the general medical intake of patients. As the numbers
of hospital admissions are rising, and there is an ageing
population, there need to be enough physicians who are
able to look after the patients admitted on the
unselected medical intake and manage their care during
their hospital stay. Patients may be transferred to
specialty wards after they have been assessed, but many
people have a number of chronic conditions and do not
neatly fit into one specialty. There is a need for
physicians to be able to treat patients with a number of
interacting conditions, and be skilled in delivering care
to older people, who may have cognitive impairment
and frailty. People over the age of 65 comprise about
15% of the population but account for 60% of acute
hospital admissions. Skills in dealing with these patients
need to be developed in all specialties.
There are also cross-cutting issues, applicable to
patients in many specialties. Obesity, alcohol and
tobacco dependence, and lack of exercise are common.
Malnutrition in hospital patients is common (about
35% of patients are malnourished). Many physicians
will need to have appropriate skills to deal with these
issues.
The employment of a consultant physician
Consultants are employed within the NHS on national
terms and conditions of service. A new contract of
employment was introduced in 2003 resulting in a
majority of job plans being based on a 40-hour
C○ Royal College of Physicians 2011