Infectious diseases consultations from general internal medicine physicians in Japan: A descriptive single-center study

Abstract

In Japan, general internal medicine (GIM) physicians must be aware of frequently encountered infections because of the shortage of infectious disease (ID) specialists. However, there are currently no epidemiological data on this subject. This study aimed to describe the frequency and pattern of ID consultations requested by GIM physicians in Japan. This is a 3-year retrospective review of the ID consultations requested by GIM physicians in Japan at a community-based acute tertiary care teaching hospital in Tokyo from April 2018 to March 2021. Demographic data, such as reasons for consultation, causative organism, and final diagnoses, were collected. During the study period, ID consultations were requested by GIM physicians 128 times. The incidence rates of bacteremia and 30-day mortality were 65.6% (n = 84) and 3.1% (n = 4), respectively. The most common diagnostic classifications after ID consultation were bone/joint (24.2%, n = 31), respiratory (17.7%, n = 22), and cardiovascular infections (12.5%, n = 16). The most common final diagnoses were bacteremia (11.7%, n = 15), infective endocarditis (9.4%, n = 12), and vertebral osteomyelitis (7.8%, n = 10). This is the first study to describe the ID consultation cases requested by GIM physicians in Japan in a community-based acute tertiary care teaching hospital. Despite the shortage of ID specialists, GIM physicians covered a wide range of IDs, including bone/joint infections and infectious endocarditis, which require long-term care. ID and GIM physicians, including hospitalists, should cooperate to promote the quality of care and clinical management. Future multi-center studies with large numbers of clinical cases are needed to determine the ID clinical knowledge required by GIM physicians in Japan.Abbreviations: GIM = general Internal medicine, HIV = human immunodeficiency virus, ID = infectious diseases, IDS = infectious disease specialist.

Survey of Inpatient Consultations with General Internal Medicine Physicians in a Tertiary Hospital: A Retrospective Observational Study

“…In Japan, in hospitals that do not have either a GIM or infectious disease department, one department tends to cover the area of the other department, especially for patients with unexplained fever, elevated inflammatory marker levels, or infectious diseases. [28][29][30] In the previous studies conducted at hospitals in Japan that had infectious disease departments but not GIM departments (including inpatients and outpatients), infectious disease accounted for over 90% of the consultations from other departments to infectious disease departments for diagnosis of unexplained fever or elevated inflammatory marker levels. 28,29 On the other hand, in this study conducted in a hospital that had a GIM department but not an infectious disease department, infectious causes accounted for 65% of the inpatient consultations from other departments for fever.…”

How Do We Establish the Utility and Evidence of General Medicine in Japan?

“…General Medicine (GM) in Japan is strongly aligned with rural healthcare, 1 , 2 geriatrics (addressing the multi-morbidity in older adults), 3 and infectious diseases. 4 Generalists in Japan are actively engaged in the practice of diagnosis, 3 education, 3 and the management of complex cases, 5 contributing to the streamlining of healthcare processes and enhancing diagnostic capabilities. In response to the growing societal needs, GM was introduced as the 19th specialty in Japan in April 2018.…”