----and it might as well be official. I’ve been talking about this for some time, and yesterday Retired Doc nailed it with this post about his impressions of the General Internal Medicine section of MKSAP 14.
Citing the subsections on contraception and uterine bleeding he asks “Does the American College of Physicians (ACP) believe and encourage that internists should be adequately expert and trained to go through the vagaries of abnormal uterine bleeding complete with ordering ultrasound and doing a endometrial biopsy? Some of the questions seem to imply just that.” He notes that these items along with others promoted by ACP such as derm procedures and group sessions for smoking cessation counseling are not among the reasons he became an internist. Ditto to that.
He goes on: “A section on corneal abrasions implies internists need fluorescein strips and Wood's lights in their office as the expectation is that not only will such patients be evaluated by the internist but treated and the internists will have the patients come back for follow up observation to see if a referral to an opthalmologist is needed.”
I’ve done just about every edition of MKSAP since completion of residency. I agree with Retired Doc. Each successive edition seems increasingly geared to teaching internists to be like family practitioners. Don’t get me wrong about ACP. They have some wonderful educational resources. But I’m increasingly inclined to believe that they no longer promote Internal Medicine as a unique specialty, and Retired Doc’s post only serves to confirm that.
Background: Internal Medicine has an identity crisis and the ACP is doing nothing about it.
3 comments:
For all the talk in the previous post you linked about how internists deal with adult patients, it sounds from the complaint about having to deal with birth control that the doctor you're linking really wants to deal with male patients, or if s/he has to see a female, it sounds like s/he doesn't want to deal with her as a whole person.
Many people have a uterus, ovaries, a vagina. These are part of the complexity of women's health. If you can't handle that complexity, then don't claim to do adult medicine, claim to do men's health. Don't make women waste their time trying to see you for health care.
The same biases I'm reading in the complaint come into play when doctors mis-recognize women's heart conditions because they think the normative human body is always male.
As an FP who has worked alongside internists, I feel your pain . I have had contact with with several internists lately who are VERY discouraged with the state and role of general internal medicine today compared with 10 or so yrs ago..asked to see more pts, spend less time with each, do more things outside traditional internal medicine- Ortho, Gyn, etc..and I feel sorry for them in a sense. At least I was trained and feel more comfortable with some of these other areas but the internists that I know, have not. As fewer students choose primary care and the boomer population reaches their 60s and 70s, I'm afraid things will only get worse.
Putting nostalgia aside, perhaps it just does not make sense in 2007 to have multiple primary care "specialties". The office-based primary care physician should know things like basic Gyn care, basic dermatology, and corneal abrasions. The hospital-based primary care physician (i.e. hospitalist) will have a different knowledge base and skill set. There have been many articles and editorials alluding to the hospitalist as the internist of the 21'st century. Why doesn't it make sense for the current office-based internists and FP's to join forces for the common good of excellence in outpatient primary care.?
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