Patient-orientated gastroenterology.

Abstract

SummaryAnalysis of the first year's working of a combined gastroenterology clinic in a district hospital has shown that the major benefit was improved patient management. Hospital attendances were reduced, the diagnostic process accelerated, and unnecessary radiological investigations and surgical operations avoided. There were no obvious major disadvantages. IntroductionFor many years gastroenterology has been regarded as the province of either the general physician or the surgeon, each usually working in isolation. More recently, however, gastroenterology has become accepted as a specialty which derives particular benefit from a multidisciplinary approach. Nevertheless, joint medical and surgical gastroenterological units are comparatively rare, particularly outside teaching centres, and in most hospitals the usual practice is still for gastroenterological problems to be seen initially in either the general medical or the surgical departments with subsequent cross-referral as necessary. This seemed to us an unsatisfactory arrangement, but set against a climate of financial stringency it seemed unlikely that we would obtain support for any scheme to improve the clinic organization which involved significant expenditure or structural alteration.Accordingly, we decided from the beginning of 1973 to launch a combined consultative outpatient clinic for gastroenterological problems with contributions from physician, surgeon, radiologists, and pathologist. This required nothing for its establishment other than the enthusiasm and co-operation of all parties, and the project was made easier by the fact that the physician and surgeon already had a simultaneous outpatient clinic which had the potential for a medicosurgical merger. With the support of the medical division but misgivings from the surgical department referrals to the clinic were invited for the beginning of 1973 and it soon became clear that our plan to hold the clinic fortnightly would cause an unduly long waiting list. It therefore became necessary to hold the clinic at least three times a month.

Gastroenterology: the first 40 years

“…The operation of the clinic has been described previously. Particular emphasis is placed on thorough clinical assessment in order to make a working diagnosis with the minimum of specialised investigations 3 . Details of the patients' age, sex and diagnosis were obtained from the diagnostic index which has been maintained since the clinic's inception.…”