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ABSTRACT - The medical registrar in the acute on-call and outof- hours setting is usually considered to be one of the busiest and most challenging jobs in the entire hospital. This is perhaps a reflection of the changes in the structure and organisation of acute medicine precipitated by the European Working Time Directive and Modernising Medical Careers. As well as the general feeling that medicine is being increasingly viewed as a default referral option by other specialties who are themselves becoming ever more sub-specialised. This article explores what the pragmatic role of the medical registrar broadly should be. The Medical Workforce Unit at the Royal College of Physicians is launching an initiative, part funded by the Department of Health, to answer this difficult question.
KEY WORDS: acute medicine, European Working Time Directive (EWTD), general internal medicine, hospital at night, medical registrar, out of hours
How does one define the role of the medical registrar, that dynamic action-orientated problem solver, who is charged with leading the acute medical on-call, being the referring doctor for the entire hospital, a general practice helpline, counsellor for distressed relatives and gatekeeper of the medical assessment unit? Some registrars view the on-call day for medicine as a highlight of the working week, an opportunity to see more, do more, turn around acutely sick patients rapidly and see their efforts have a positive effect. They see the hectic and demanding workload as making the experience both more challenging and rewarding.
However, times are changing and this view is anything but widely held. The medical registrar in the acute on-call and outof- hours setting is usually considered to be one of the most difficult jobs in the whole hospital.Medicine is increasingly viewed as a dumping ground by other specialties, eg by surgeons - acute pancreatitis - 'no operation needed, refer to medics'; by accident and emergency - alcohol intoxication - 'observation only, refer to medics'; by...