I’m trudging through the third edition of Sapira’s Art and Science of Bedside Diagnosis. Full of medical pearls, musings and humor, it’s much more than a reference on physical diagnosis. It’s a book to read at the beach or by the fire. On page 7 I found this definition of Internal Medicine:
"(1) (Obsolete) That nonsurgical medical specialty concerned with clinical diagnosis and scientific therapy. Previously a secondary-care consultant specialty, it underwent crisis by lysis in the late 1960s; (2) (contemporary) a biopolitical consortium of balkanized tertiary nonsurgical subspecialties, which, oxymoronically, claim it to be a primary care specialty."
2 comments:
Clearly Internal Medicine has all the characteristics of a specialty. When the phrase primary care was first adopted, it had a different meaning then it does today.
Because managed care hijacked the phrase and gave it a perverted meaning, we should no longer call ourselves a primary care specialty. Rather, we should recognize that internists provide comprehensive care. We are comprehensive because we care for multiple disease in patients who have both medical and social problems. One must act comprehensively to provide the highest quality care to our patients.
Internal Medicine seems most well suited as a preliminary stage of professional development that allows one to focus on defined areas with additional experience or training. Given the lack of respect among third party payors, the internal medicine academic programs should respond by shortening the internal medicine training to 18-24 months and then allow subspecialty training to take over. If one chooses primary care, then added training could be acquired in the appropriate setting.
My predicition is that the number of people who are choosing to practice primary care is dramatically falling, so the programs should make changes now or only the less qualified medical students will end up choosing internal medicine.
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