Primary Care of Senile Patients with Mild Acute Abdominal Pain by Non-certified General Physicians with Basic Surgical Expertise in a Small Rural City

Abstract

In Japan, particularly in a small sized hospital, although doctors belonging to various departments are working in the emergency department (ED), there is neither doctor who are specialty in the emergency medicine nor who works excursively in the ED. In this setting, the management of patients with mild acute abdominal pain is often transferred from one department to another department because of mismatch of the specialty of the doctors and the pathophysiology of the patients. In our hospital in a large rural area with few inhabitants, we established the Department of Regional General Medicine (RGM), not opposed to “specialty” or “organ or system specific” departments, but intended to attach importance to “geographic region specific” and “intra-regional conclusion.” Though we are members of the Department of RGM, we simultaneously belong to the department of surgery and primarily work as surgeon. And we supported patients who want to live, to undergo cure and care and to die in their region. We maintain a relationship with doctors belonging to other departments who works in the ED as a primary care physician through accepting referrals from them not as certified general practitioner, but as non-certified general physician. Doctors belonging to various department managing patients in the ED setting, who have not enough knowledge of and technique in general medicine, can easily consult our Department of RGM and surgery at any time. They can also choose to refer their patients to one of two different sections, one is our department and the other is the department of internal medicine. We believe it is most important in the field of general medicine, especially in rural areas, that those specialists in various field should simultaneously have spirit of general medicine even if they are not certified and actively cooperate with each other, and that certified general practitioners should not be exclusive against doctors in other fields having spirit of general medicine.