Thursday, June 15, 2006

DB weighs in on the definition of Internal Medicine

And well he should. After all he is president of the Society of General Internal Medicine. I share his vision for internal medicine. The curmudgeonly, somewhat tongue in cheek definition I lifted from the pages of Art and Science of Bedside Diagnosis, thought provoking as it is, may push some buttons.

I grew up with the older, somewhat more traditional view of Internal Medicine. My father was a GP who had great respect for internists. He would have become one himself had his training not been interrupted by the Second World War. He would refer his most difficult cases to internists. These were patients in need of special diagnostic sleuthing. In those days internists were often known as diagnosticians. Internists were clearly specialists.

Years later in medical school at Vanderbilt my notion of the internist as specialist-consultant was reinforced as I encountered internal medicine role models who were master clinicians and great teachers. The exemplar of the internist there was Thomas Brittingham. His example helped influence me to choose Internal Medicine.

Early in private practice I first became aware of Internal Medicine’s identity problem. Asked by an acquaintance what kind of doctor I was I replied that I was an internist. She, thinking I meant intern, asked “are you learning anything?” That day I became a “specialist in Internal Medicine.” I never again told anybody I was an internist.

Over the years many factors---the rise of Family Practice as a specialty, the pressures of managed care and the advent of “med-peds”---have further muddied the definition of Internal Medcine. Like DB and Dr. Sapira I believe primary care specialty is a poor characterization of the field.

So what is Internal Medicine? DB says internists provide comprehensive care. That statement is true but it doesn’t define the specialty. Is it a comprehensive care specialty slightly less comprehensive than Family Practice? Another definition I once read characterizes it as the specialty of non-surgical, non-obstetrical diseases of adults. These definitions are lacking. The American Board of Internal Medicine and the American College of Physicians have done a poor job of defining the specialty. Those of us who were trained in the “grand tradition” know what Internal Medicine really is. I only hope DB and other thought leaders in the field can come up with the magic words to define it.

1 comment:

Anonymous said...

I actually just became President in April.