TY - JOUR T1 - General medicine in the future perfect JF - Future Hospital Journal JO - Future Hosp J SP - 5 LP - 7 DO - 10.7861/futurehosp.3-1-5 VL - 3 IS - 1 AU - Daniel D Melley Y1 - 2016/02/01 UR - http://www.rcpjournals.org/content/3/1/5.abstract N2 - Those of sufficient seniority are able to look back and reflect on the profound changes that have occurred over the past two decades to influence the way we deliver care to patients in the NHS. Consequently, this issue of Future Hospital Journal attempts to provide some proper accounting of losses and gains to the provision of medical care over this period, with particular relevance to the essential and yet recently neglected role of the general physician. It is unlikely there was any coordinated plan to pull down a former pillar of the medical establishment. However, the unintended consequence of the fortification of parts of the medical superstructure has certainly been the weakening of others. It is perhaps a source of disappointment to some that we have come so far and that it has taken so long before the return to generalism was proposed by the report of the Future Hospital Commission.1 We have yet to hear what changes to medical training may emerge as a consequence of rebalancing of specialist and general roles.A detailed account of the events that have led to our arrival at this point, even if we assume we can identify any, is beyond the scope of this editorial. Chaos theory suggests that even the smallest changes may have profound consequences. Rather than a butterfly raising storms through the flapping of its wings, your editor prefers the introduction of troponin testing and unfractionated heparin at the end of the 1990s as a possible trigger. Overnight, the need for the many patients presenting with chest pain and uncertain ECG changes to wait for three days for a creatine kinase measurement, while tied to an infusion of heparin and suffering 6–12 hourly venesection for APTT assessment, was gone. The time from admission to safe discharge for these … ER -