• GENERAL MEDICINE (see Internal Medicine)
• INTERNAL MEDICINE
• INFECTIOUS DISEASES

Maj Cox and colleagues should be congratulated for capturing the general medical activity at a deployed Role 3 field hospital during Operation Herrick from 2011 to 2013.1 During my time there as the single deployed physician from March 2010 to May 2010, the admission rate for general medical admissions was double that reported with 221 cases in 7 weeks (∼5 per day), of whom 157 (71%) were judged to have infectious diseases, 18 (8%) were medically evacuated to the UK and none died. I did not find International Classification of Diseases (ICD) 10 to be a useful classification for these cases and so categorised them according to which medical subspecialty might best be able to manage them in a UK setting. Hence there were 97 (44%) gastroenterology cases, 44 (20%) infectious diseases and tropical medicine cases, 17 (8%) respiratory cases, 16 (7%) dermatology cases, 15 (7%) neurology cases, 14 (6%) miscellaneous cases (eg, heat illness, allergies, overdoses, etc), 11 (5%) cardiology cases, 3 (1%) haematology cases, 3 (1%) psychiatry cases and 1 (<1%) endocrinology case. Perhaps these figures should have some influence on the recruitment of subspecialists into our military general medicine cadre?

The variation in workload from UK patients at this field hospital from 2006 to 2014 can also be seen from the official MOD operational casualty and fatality tables2 (which provide numerator figures) and official troop deployment figures3 (which provide denominator figures). These show a total of 7443 admissions, of whom 5255 (71%) were disease or non-battle injury (DNBI) cases and 2188 (29%) were wounded in action (WIA). Even during the busiest war-fighting years of 2009–2010, there were more DNBI than WIA admissions. From the 57 000 troops deployed in 2007–2013, it can be shown that 4860 (9%) were admitted with DNBI compared with 2086 (4%) with WIA. Regrettably, no breakdown of DNBI cases into separate disease and non-battle injury categories is provided by Defence Statistics. However, this could probably be done retrospectively and would be worthwhile in view of what the National Audit Office has said about the MOD needing to do more data analysis on this topic.3 Until more detailed figures are available officially, the work of clinicians collecting such data at Role 3 and Role 4 medical facilities1 ,4 will remain vital and should be fully supported.