General internal medicine is now an essential service, and may in time be the main vehicle of delivery of healthcare to an ageing population, since resources are finite. One model for an equitable system of healthcare delivery may be the integration of General Internal Medicine as the core matrix, around which the various subspecialties deliver quality care. This is now a reality in many hospitals, where all subspecialists serve for varying periods in general medical wards, some even achieving dual accreditation. This promotes integration rather than fragmentation of services. Subspecialties will thrive, for the general workload will also be shared by internists in an equitable fashion. The obvious beneficiaries are the patients, and the health economics will also benefit the funding bodies. The services provided by internists must also be expanded into new fields, e.g. medicine for disasters, so as to promote cost-effective medical care, research and teaching, and also to achieve right-siting of patient care. It must also be emphasised that the specialties remain integral parts of the matrix, so that all departments complement one another, rather than compete with each other. The collegiality engendered is essential for a more congenial workplace, so as to promote staff retention.
Delivery of Health Care ; organization & administration ; Health Expenditures ; trends ; Health Services Research ; methods ; Humans ; Internal Medicine ; manpower ; Physician's Role ; Singapore

Operations Research (OR), also called Operational Research in the United Kingdom (UK), uses various computational tools for solutions to complex problems within a system. It deals with challenges in planning, scheduling, forecasting, process analysis and decision analysis. It also addresses individual components of the system. The methodology used for decisions based upon stochastic (random) processes can also be adapted for the common general medical ward round. Operational Research techniques add speed, efficiency, quality and consistency to the documentation in the case notes, and reduces the time taken for ward rounds. There is obvious benefit to the individual patient. It also acts as a learning tool which can be audited, and lends itself to research questions.
Humans ; Medical Audit ; Operations Research ; Quality Assurance, Health Care ; methods