Internal medicine or general medicine (in Commonwealth nations) is the medical specialty dealing with the prevention, diagnosis, and treatment of adult diseases. Physicians specializing in internal medicine are called internists, or physicians (without a modifier) in Commonwealth nations. Internists are especially skilled in the management of patients who have undifferentiated or multi-system disease processes. Internists care for hospitalized and ambulatory patients and may play a major role in teaching and research.
Since internal medicine patients are often seriously ill or require complex investigations, internists do much of their work in hospitals. Internists often have subspecialty interests in diseases affecting particular organs or organ systems.
- 1 History
- 2 Terminology
- 3 Education and training of internists
- 4 Certification of specialists
- 5 Subspecialties of internal medicine
- 6 Medical diagnosis and treatment
- 7 See also
- 8 References
- 9 Further reading
- 10 External links
Historically, internal medicine physicians have practiced both in clinics and in hospitals, often in the same day. Pressures on time have led to many internal medicine physicians to choose one practice setting, and only practice in the hospital, as a "hospitalist," or only in an outpatient clinic.
The term internal medicine originates from the German term Innere Medizin, popularized in Germany in the late 19th century to describe physicians who combined the science of the laboratory with the care of patients. Many early-20th century American physicians studied medicine in Germany and brought this medical field to the United States. Thus, the name "internal medicine" was adopted in imitation of the existing German term.
Much confusion surrounds the meaning of internal medicine and the role of an "internist." Internists are qualified physicians with postgraduate training in internal medicine and should not be confused with "interns", who are doctors in their first year of residency training (officially the term intern is no longer in use). 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. The American College of Physicians defines internists as "physicians who specialize in the prevention, detection and treatment of illnesses in adults".
Education and training of internists
The training and career pathways for internists vary considerably across the world.
Many programs require previous undergraduate education prior to medical school admission. This "pre-medical" education is typically four or five years in length. Graduate medical education programs, which vary in length by country. Medical education programs are tertiary-level courses, undertaken at a medical school attached to a university. In the United States, medical school consists of four years. Hence, gaining a basic medical education may typically take eight years, depending on jurisdiction and university.
Following completion of entry-level training, newly graduated medical practitioners are often required to undertake a period of supervised practice before the licensure, or registration, is granted, typically one or two years. This period may be referred to as "internship", "conditional registration", or "foundation programme". Then, doctors may finally follow specialty training in internal medicine if they wish, typically being selected to training programs through competition. In North America, this period of postgraduate training is referred to as residency training, followed by an optional fellowship if the internist decides to train in a subspecialty. In Commonwealth countries, during that training period in internal medicine, trainees are often called senior house officers, and advance to registrar grade when they undergo a compulsory subspecialty training whilst commonly continuing service provision in the main speciality. In the United States, residency training for internal medicine lasts three years.
Certification of specialists
In the United States, three organizations are responsible for certification of trained internists (i.e., doctors who have completed an accredited residency training program) in terms of their knowledge, skills, and attitudes that are essential for excellent patient care: the American Board of Internal Medicine, the American Osteopathic Board of Internal Medicine and the Board of Certification in Internal Medicine.
Subspecialties of internal medicine
||The examples and perspective in this section may not represent a worldwide view of the subject. (December 2010)|
In the United States, two organizations are responsible for certification of subspecialists within the field: the American Board of Internal Medicine and the American Osteopathic Board of Internal Medicine. Physicians (not only internists) that successfully pass board exams get "board certified" status, and, as of 2011, earn on average an 88.8% higher salary in the USA.
American Board of Internal Medicine
- Adolescent medicine
- Cardiology, dealing with disorders of the heart and blood vessels
- Clinical cardiac electrophysiology
- Critical care medicine
- Endocrinology, dealing with disorders of the endocrine system and its specific secretions called hormones
- Gastroenterology, concerned with the field of digestive diseases
- Geriatric medicine
- Hematology, concerned with blood, the blood-forming organs and its disorders.
- Hospital medicine
- Infectious disease, concerned with disease caused by a biological agent such as by a virus, bacterium or parasite
- Interventional cardiology
- Medical oncology, dealing with the chemotherapeutic (chemical) 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 therapy of rheumatic diseases.
- Sleep medicine
- Sports medicine
- Transplant hepatology
Internists may also specialize in "allergy" and "immunology." The American Board of Allergy, Asthma, and Immunology is a conjoint board between internal medicine and pediatrics.
American College of Osteopathic Internists
- Critical care medicine
- Geriatric medicine
- Infectious diseases
- Nuclear medicine
Medical diagnosis and treatment
Medicine is mainly focused on the art of diagnosis and treatment with medication, but many subspecialties administer surgical treatment:
- Cardiology: angioplasty, cardioversion, cardiac ablation, intra-aortic balloon pump
- Critical care medicine: mechanical ventilation
- Gastroenterology: endoscopy and ERCP
- Nephrology: dialysis
- Pulmonology: Bronchoscopy
- Larson, Eric B. (2001 May 15). "General Internal Medicine at the Crossroads of Prosperity and Despair: Caring for Patients with Chronic Diseases in an Aging Society". Annals of Internal Medicine 134 (10): 997–1000. doi:10.7326/0003-4819-134-10-200105150-00013. PMID 11352700.
- "What is an Internist - Doctors for Adults". American College of Physicians. Retrieved 04-11-2012.
- Freeman, Brian S. (2012). The ultimate guide to choosing a medical specialty (3rd ed.). New York: McGraw-Hill Medical. p. 229-250. ISBN 978-0071790277.
- Arneson, J; McDonald, WJ (1998 Jul). "Can we educate the public about internal medicine? Initial results". The American journal of medicine 105 (1): 1–5. doi:10.1016/S0002-9343(98)00220-4. PMID 9688013.
- "Glossary of Terms". ACGME. June 28, 2011. Retrieved 2 December 2012.
- "ACP: Who We Are". American College of Physicians. Retrieved 2011-03-30.
- Freeman 2012, pp. 236
- Schierhorn, Carolyn (Dec. 6, 2012). "Like to puzzle over diagnoses? Internal medicine may be for you". The DO.
- Dr. Marina Gafanovich MD New York Internal Medicine
- Medscape Physician Salary Report 2012
- "abim.org". Retrieved 2009-05-26.
- "Subspecialty Section Membership". American College of Osteopathic Internists.
- Goldman, Lee (15 April 2001). "Key challenges confronting internal medicine in the early twenty-first century". The American Journal of Medicine 110 (6): 463–470. doi:10.1016/S0002-9343(01)00649-0. PMID 11331058.
- Meltzer, David; Manning, WG; Morrison, J; Shah, MN; Jin, L; Guth, T; Levinson, W (2002 Dec 3). "Effects of Physician Experience on Costs and Outcomes on an Academic General Medicine Service: Results of a Trial of Hospitalists". Annals of Internal Medicine 137 (11): 866–74. doi:10.7326/0003-4819-137-11-200212030-00007. PMID 12458986.
- Salerno, Stephen M; Landry, Francis J; Kaboli, Peter J (2001 Feb 1). "Patient perceptions of the capabilities of internists: a multi-center survey". The American Journal of Medicine 110 (2): 111–117. doi:10.1016/S0002-9343(00)00666-5. PMID 11165552.
- Sox, Harold C (2001 Jun 15). "Supply, demand, and the workforce of internal medicine". The American Journal of Medicine 110 (9): 745–749. doi:10.1016/S0002-9343(01)00756-2. PMID 11403763.
- Wetterneck, Tosha B.; Linzer, M; McMurray, JE; Douglas, J; Schwartz, MD; Bigby, J; Gerrity, MS; Pathman, DE; Karlson, D; Rhodes, E; Society of General Internal Medicine Career Satisfaction Study, Group (2002 Mar 25). "Worklife and Satisfaction of General Internists". Archives of Internal Medicine 162 (6): 649–56. doi:10.1001/archinte.162.6.649. PMID 11911718.
- International Society of Internal Medicine
- Internal Medicine Society of Australia and New Zealand
- The American Board of Internal Medicine
- Canadian Society of Internal Medicine
- The American College of Osteopathic Internists
- American College of Physicians