General Internal Medicine forms the traditional “hub” of the Department of Medicine, stretching across four hospitals, Groote Schuur Hospital and its surrounding Regional/Large District Hospitals which provide specialist level care in the Metro West of Cape Town: New Somerset Hospital, Mitchells Plain Hospital and Victoria Hospital. George Hospital, a regional hospital 5 hours away also serves as a clinical service/training site. As such, the majority of in-patient beds within Medicine are allocated to General Internal Medicine and it forms the basis of much of the Department’s clinical work and provides the platform for much of the bedside undergraduate and postgraduate teaching within the Department.
General Internal Medicine focuses on Acute Care (in-patient service), Consultation care (for in-patients in hospital), Outpatient care (for patients with complex multi-system needs or with as a diagnostic consultation service) and Outreach to Primary Care. The general physicians on the platform not only aim for excellence of clinical care on an individual patient level, but also take central roles in clinical governance within their respective geographic areas. Equity of access to specialist and subspecialist care for the population of the Metro West of Cape Town and George and a focus on quality and safety of care are central tenets of the service.
The Service is headed by full time specialists in Internal Medicine at all five hospitals, assisted by medical registrars training in Internal Medicine and Medical Officers who are also generally all on a specialist training track. All subspecialist consultants within the Department of Medicine also spend a dedicated amount of time on the “acute service”, either in one of the four Groote Schuur Hospital Acute Medical Firms or at one of the peripheral hospitals. All patients admitted to an acute bed are reviewed by a consultant physician by the following morning latest, seven days a week.
Although the clinical focus of the general physicians, given the large service pressures, is on acute hospital medicine, other areas are also served and new developments are constantly taking place, particularly where no subspecialist care exists. The first in-patient adult palliative care service in the Western Cape public sector were developed at Victoria Hospital and Groote Schuur Hospital under the Governance of General Medicine and are serving as models of care for other areas. Consultation services remain a large part of the service, but for primary care, but also in hospital to other specialties. Close collaboration with perioperative Medicine and Anaesthetics and Surgical Teams, and with Obstetrics regarding maternal medicine remain focus areas. Point of care ultrasound is a focus area for future development for acute and ambulatory medicine.
The Division provides the platform for bedside teaching in Medicine. All consultants in the Division are active teachers and examiners at undergraduate and postgraduate level for the University and many are also examine externally and at College exams. All UCT undergraduate students will spend time on the wards and all registrars training in Internal Medicine will spend > 50% of their training time in acute medicine as the “medical registrar on intake” rotating through all the hospitals. (For more details of the registrar training programme please see under “teaching” in the Department website). The Division has also piloted a scheme of additional training for general specialists post registrar training,
Typical areas of research relate to clinical audit of processes, outcomes, and care pathways in acute care and palliative care. Individuals in the Division are also active in research in their own interest areas outside of general medicine. The bed platform provides for the recruitment of many patients to “organ –specific” trials of members of the Department.
Every hospital is headed by a local Head of Department, on dual contract of employment with the Provincial Public Service and UCT.
Head of Department, New Somerset Hospital: Dr Yakoob Vallie
Head of Department, Mitchells Plein Hospital: Dr Tom Crede
Head of Department, Victoria Hospital: Dr Nasief van der Schyff
Head of Department, George Hospital: Dr Trevor Gould
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Groote Schuur Hospital