Internal medicine

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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.

Internal medicine is also a specialty within clinical pharmacy and veterinary medicine.

History[edit]

Historically, some of the oldest traces of internal medicine can be traced from Ancient India and Ancient China.[1] Earliest texts about internal medicine are the Ayurvedic anthologies of Charaka.[2]

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, who may choose to practice only in the hospital, as a "hospitalist", or only in an outpatient clinic, as a primary care physician.[3]

Terminology[edit]

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.[4]

Much confusion surrounds the meaning of internal medicine and the role of an "internist."[5] Internists are qualified physicians with postgraduate training in internal medicine and should not be confused with "interns",[6] who are doctors in their first year of residency training (officially the term intern is no longer in use).[4][7] 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".[8]

Education and training of internists[edit]

Main article: Medical education

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.[9][10]

Certification of specialists[edit]

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[edit]

United States[edit]

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.[11][12]

American Board of Internal Medicine[edit]

The following are the subspecialties recognized by the American Board of Internal Medicine.[13]

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[edit]

The American College of Osteopathic Internists recognizes the following subspecialties:[14]

United Kingdom[edit]

In the United Kingdom, the three medical Royal Colleges (the Royal College of Physicians of London, the Royal College of Physicians of Edinburgh and the Royal College of Physicians and Surgeons of Glasgow) are responsible for setting curricula and training programmes through the Joint Royal Colleges Postgraduate Training Board (JRCPTB), although the process is monitored and accredited by the General Medical Council (which also maintains the specialist register).

Doctors who have completed medical school spend two years in foundation training completing a basic postgraduate curriculum. After two years of Core Medical Training (CT1/CT2) and attaining the Membership of the Royal College of Physicians, physicians commit to one of the medical specialties:[15]

Many training programmes provide dual accreditation with general (internal) medicine and are involved in the general care to hospitalized patients. These are acute medicine, cardiology, clinical pharmacology and therapeutics, endocrinology and diabetes mellitus, gastroenterology, infectious diseases, renal medicine, respiratory medicine and (often) rheumatology. The role of general medicine, after a period of decline, was reemphasized by the Royal College of Physicians of London report from the Future Hospital Commission (2013).[16]

Medical diagnosis and treatment[edit]

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

See also[edit]

References[edit]

  1. ^ United States. Department of Health and Human Services. Physical Activity and Health: A Report of the Surgeon General. p. 12. 
  2. ^ Frank Joseph Goes. The Eye in History. JP Medical Ltd. p. 93. 
  3. ^ Larson, Eric B. (May 15, 2001). "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. 
  4. ^ a b "What is an Internist - Doctors for Adults". American College of Physicians. Retrieved 04-11-2012.  Check date values in: |accessdate= (help)
  5. ^ Freeman, Brian S. (2012). The ultimate guide to choosing a medical specialty (3rd ed.). New York: McGraw-Hill Medical. pp. 229–250. ISBN 978-0071790277. 
  6. ^ Arneson, J; McDonald, WJ (July 1998). "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. 
  7. ^ "Glossary of Terms". ACGME. June 28, 2011. Retrieved 2 December 2012. 
  8. ^ "ACP: Who We Are". American College of Physicians. Retrieved 2011-03-30. 
  9. ^ Freeman 2012, pp. 236
  10. ^ Schierhorn, Carolyn (Dec 6, 2012). "Like to puzzle over diagnoses? Internal medicine may be for you". The DO. 
  11. ^ Dr. Marina Gafanovich MD New York Internal Medicine
  12. ^ Medscape Physician Salary Report 2012
  13. ^ "abim.org". Retrieved 2009-05-26. 
  14. ^ "Subspecialty Section Membership". American College of Osteopathic Internists. 
  15. ^ "Approved specialty and subspecialty training curricula by Royal College". General Medical Council. Retrieved 3 February 2014. 
  16. ^ "Future hospital: Caring for medical patients". Royal College of Physicians. Retrieved 3 February 2014. 

Further reading[edit]

  • 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 (Dec 3, 2002). "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 (Feb 1, 2001). "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 (Jun 15, 2001). "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 (Mar 25, 2002). "Worklife and Satisfaction of General Internists". Archives of Internal Medicine 162 (6): 649–56. doi:10.1001/archinte.162.6.649. PMID 11911718. 

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