The place of general internal medicine in the hospital

General internal medicine tends to decrease in many Belgian hospitals. On t he opposite, United States are now clearly engaged in a reform of their hea lth system, with a drastic augmentation of the number of general internists . This reflection recognizes the specificities of general internal medicine : the first contact, the longitudinal follow-up, the comprehensive approach and the coordination with other medical participants. The need for subspec ialists would be reduced and the need for primary comprehensive care physic ians would be increased. The development of a performent sector of general internal medicine is able to respond to the demand of the patients and also of the general family practitioners. This model has positive impacts for t he whole hospital community. We are all weary of discussions of state medicine, of the high cost of medi cal care, of the adequacy of medical care for the indigent, of the shortage of hospital beds for those who can pay, of the shortage of nurses, and so on. But these are, in part our problems; if their solution is to be to our liking, we must be active in them. The spector of state medicine is continu ally raised before us. Greater participation, by the federal, state and loc al governments in matters of health seems inevitable although most of us th ink it is important to retain in some manner or other the principle of priv ate enterprise. Change of some sort will come; it is evident that unless we ourselves reorganize the practice of medicine, it will be reorganized for us.