Internal medicine

Doctors of internal medicine ("internists") are medical specialists who focus on adult medicine and have had special study and training focusing on the prevention and treatment of adult diseases. At least three of their seven or more years of medical school and postgraduate training are dedicated to learning how to prevent, diagnose, and treat diseases that affect adults. Internists are sometimes referred to as the "doctor's doctor," because they are often called upon to act as consultants to other physicians to help solve puzzling diagnostic problems. While the name "internal medicine" may lead one to believe that internists only treat "internal" problems, this is not the case. Doctors of internal medicine treat the whole person, not just internal organs.

Definition of an internist

Doctors of internal medicine may be referred to by several terms, including "internists," "general internists" and "doctors of internal medicine." They are not to be confused with "interns," who are doctors in their first year of residency training. Although internists may act as primary care physicians, they are not "family physicians," "family practitioners," or "general practitioners," whose training is not solely concentrated on adults and may include surgery, obstetrics and pediatrics. General internists practice medicine from a primary care perspective but they can treat and manage over 90% of all ailments.

Internal medicine subspecialists may also practice general internal medicine, but usually focus their practice on their particular subspecialty (like cardiology or pulmonology).

In the USA, Adult Primary care is usually provided by either Family practice or general internal medicine physicians. The Primary care of adolescenents is provided by Family practice, internists and pediatricians. The primary care of children and infants is provided by Family Practice or Pediatricians. Thus, there is overlap.

In the UK, the specialty is referred to as general medicine (although the combination general (internal) medicine can be found increasingly), and its practitioners are physicians or hospital physicians as distinct from surgeons.

Caring for the whole patient

Internists are specially trained to solve puzzling diagnostic problems and can handle severe chronic illnesses and situations where several different illnesses may strike at the same time. They also bring to patients an understanding of wellness (disease prevention and the promotion of health), women's health, substance abuse, mental health, as well as effective treatment of common problems of the eyes, ears, skin, nervous system and reproductive organs.

Where does the term "internal medicine" come from?

The term "Internal Medicine" comes from the German term Innere Medizin, a discipline popularized in Germany in the late 1800s to describe physicians who combined the science of the laboratory with the care of patients. Many early 20th century American doctors studied medicine in Germany and brought this medical field to the United States. Thus, the name "internal medicine" was adopted.

Subspecialties of internal medicine

Internists can choose to focus their practice on general internal medicine, or may take additional training to "subspecialize" in one of 13 areas of internal medicine, generally organized by organ system. Cardiologists, for example, are doctors of internal medicine who subspecialize in diseases of the heart. The training an internist receives to subspecialize in a particular medical area is both broad and deep. Subspecialty training (often called a "fellowship") usually requires an additional one to three years beyond the standard three year general internal medicine residency. (Residencies come after a student has graduated from medical school.)

In the United States, there are two organizations responsible for certification of subspecialists within the field, the American Board of Internal Medicine, and the American Osteopathic Board of Internal Medicine.

The following are the subspecialties recognized by the American Board of Internal Medicine ^*.

Cardiology, dealing with disorders of the heart and blood vessels
Endocrinology, dealing with disorders of the endocrine system and its specific secretions called hormones
Gastroenterology, concerned with the field of digestive diseases
Hematology, concerned with blood, the blood-forming organs and its disorders
Infectious disease, concerned with disease caused by a biological agent such as by a virus, bacterium or parasite
Medical oncology, dealing with the study and treatment of cancer
Nephrology,dealing with the study of the function and diseases of the kidney
Pulmonology, dealing with diseases of the lungs and the respiratory tract
Rheumatology, devoted to the diagnosis and treatment of problems involving the muscles and/or joints.

The ABIM also recognizes additional qualifications in the following areas

The American College of Osteopathic Internists recognizes the following subspecialties.^*

Principles of diagnosis

The main tools of the doctor are the medical history and the physical examination, but this holds particularly true for internal medicine. Subtle descriptions of disease (e.g. cyclic shallow and deep breathing, as in Cheyne-Stokes's respiration, or persistently deep breathing as in Kussmaul's) or physical signs (e.g. clubbing in many internal diseases) are important tools in guiding the diagnostic process. In the medical history, the "Review of Systems" serves to pick up symptoms of disease that a patient might not normally have mentioned, and the physical examination typically follows a structured fashion.

At this stage, a doctor is generally able to generate a differential diagnosis, or a list of possible diagnoses that can explain the constellation of signs and symptoms. Occam's razor dictates that, when possible, all symptoms should be presumed to be manifestations of the same disease process, but often multiple problems are identified.

In order to "narrow down" the differential diagnosis, blood tests and medical imaging are used. They can also serve screening purposes, e.g. to identify anemia in patients with unrelated complaints. Commonly performed screening tests, especially in older patients, are an X-ray of the chest, a full blood count, basic electrolytes, renal function and blood urea nitrogen.

At this stage, the physician will often have already arrived at a diagnosis, or maximally a list of a few items. Specific tests for the presumed disease are often required, such as a biopsy for cancer, microbiological culture etc.

Treatment

Medicine is mainly focused on the art of diagnosis and treatment with medication, but many subspecialties administer non-surgical treatment:

References

Content based on authoritative information from the Web sites of the American College of Physicians, ABIM, and ACOI. See links above.

External links

Internal Medicine Jobs
American College of Physicians - the world's largest medical specialty society for doctors of internal medicine
Doctors for Adults.com - The American College of Physicians' patient education Web site, with more info about internal medicine and internists
On-line Internal Medicine Journal Club (via JournalReview.org)
The American Board of Internal Medicine - The largest certifying board for internists and related subspecialists in the USA
The American College of Osteopathic Internists
International Journal of Medical Sciences
The Society for General Internal Medicine - A society to improve patient care, research and education in Primary Care and General Internal Medicine

Medical specialties