Dr. Bruce E. Landon, a physician and health policy professor at Harvard Medical School and one of the paper's authors, says medicine has become more complex, with specialists and subspecialists seen as expert in the latest treatments.
Respondents felt their clinical training was good and were generally confident in most clinical skills although some perceived deficiencies in more complex procedures and specialist areas.
Focusing on the distinct SHI categories, the utilization of routine services increases at higher care levels, but more complex services (medical specialist, hospital, rehabilitation) are utilized less frequently.
The care of patients with HIV will probably become more complex and more specialists will called on to help manage this complex disease.
Finally, imaging may be undertaken for more complex cases that require specialist referral but prior investigations in conjunction with the clinical radiologist and the relevant specialist is undertaken to ensure that the referral is to the correct specialist and that the consultation is productive.
Further, patients who were diagnosed at a primary care facility and opted to initiate ART at QECH may have had more complex clinical problems requiring specialist care that delayed ART initiation.
The original role of GPwSIs, as conceived in the NHS Plan, was that 'specialist GPs' should accept referrals and undertake specific out-patient procedures.[ 1] Both patients and clinicians described a 'referral hierarchy' with generalist clinicians seeking the advice of specialist nurses, whilst more complex problems are referred to hospital specialists.
In addition to assessment and treatment, specialist practitioners (psychologists and psychiatrists) have an important role to play in setting up training for non-specialist staff, to enable them to detect and manage simple cases and refer the more complex ones to the sparse specialist resources in that area [ 58].
A third model blends features of the other two, relying on the ICU team to meet basic palliative care needs of patients and families while engaging specialists for more complex or refractory problems [114].
This is equally true for more complex tasks involving other medical specialists, such as monitoring patient change and informing, alerting, or alarming others in case of abnormalities.
