Changes in the nature of inpatient medical services--impact on medical education and patient care.

One hundred sequential admissions to an internal medicine department in a 765-bed teaching hospital in 1973 were compared to 100 admitted in 1987. Mean age in 1973 was 50.3 years as compared to 57.4 in 1987. Length of stay shortened from 8.8 days in 1973 to 4.7 days in 1987. The overwhelming majority of the admissions during both periods had circulatory and/or respiratory disease. The number of diagnoses on admission increased from 2.3 in 1973 to 3.8 in 1987. In 1973, 22% of the patients received no drugs as compared to 6.3% in 1987. X-ray studies per hospital day doubled and invasive procedures more than quintupled. Intravenous fluids were given on 2.5% of days in 1973 and on 22.3% in 1987. Thus medical patients are now older and sicker, yet stay for much shorter periods of time. This radical change in the intensivity and tempo of work raises serious questions about the appropriateness of these sites as major loci for undergraduate teaching.