Visits to the emergency rooms, including those of metropolitan teaching hospitals, have increased fourfold or more over the past fifteen years. This coupled with the fact that modern medicine permits us to expend more effort on each patient, particularly in resuscitation procedures, has resulted in a critical situation; and the question which must be answered is how the teaching hospital can cope with this fantastic work-load and, at the same time, provide a suitable learning environment for medical students and housestaff.
… The first step is to study the emergency room in its present situation to find out who the patients are, where they originate, why they come, to which socioeconomic and cultural groups they belong, what their problems are, which other sources of medical care they use, and the like. This will permit the hospital and the emergency room to understand better the role they play and to become oriented toward community needs.
The second step is to set up a multidisciplinary diagnostic clinic where the representatives from medicine, surgery, psychiatry, and obstetrics and gynecology can work with ancillary medical personnel to determine what each patient's needs are. Then an orderly program of care must be set in motion with the aid of social workers, family counselors, welfare officers, public health nurses, rehabilitation experts, physical and occupational therapists, and others. The teaching hospital's clinic then becomes a base from which radiates out into the community a coordinated plan of health care.
Gabriel Hilkovitz, MD
Medical College of Virginia