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November 1984

The General Medicine Clinic Making the Ugly Duckling Fly

Author Affiliations

From the Division of General Medicine, Department of Medicine, Oregon Health Sciences University, Portland (Drs Girard, Elliot, and Linz), and the Ambulatory Care Section, Portland Veterans Administration Medical Center (Drs Girard and Cooney).

Arch Intern Med. 1984;144(11):2217-2219. doi:10.1001/archinte.1984.04400020139021

When The Johns Hopkins Hospital opened in 1889, its medical clinic was the hub of academic and patient-care [ill]ctivities.1 As its chief, Sir William Osler attended the clinic daily and was surrounded by faculty, residents, and students. The ensuing 90 years have seen a decline in the importance of the medical clinic. Medical subspecialization, advances in diagnostic and therapeutic methods, and the potential for income generation have transformed the inpa[ill]ient service into the central arena for medical education.

However, recent concern about preparing students and house officers for ambulatory practice, as well as emphasis [ill] cost containment and the inordinate expense of inpatient services, has redirected attention to the general medicine clinic (GMC). The American Board of Internal Medicine supports and encourages training in ambulatory care.2 Today, a longitudinal clinic experience is a part of most [ill]raining programs (D.L.E. and D.H.L., unpublished data, June 1983). In spite of this renewed