Thursday, February 22, 2007

Is Internal Medicine Obsolete?

My post about the lack of support from the American College of Physicians for Internal Medicine as a specialty drew some interesting comments. An anonymous family practitioner said “I have had contact 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.” That’s well put and pretty much mirrors Retired Doc’s concerns.

Another commenter missed the point with this: “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.” It has nothing to do with men’s versus women’s health. Retired Doc also lamented internists being asked to do dermatology procedures and evaluate corneal abrasions. The commenter goes on: “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.” I’m sure Retired Doc would refer a patient with testicular pain to a urologist just as fast as he would refer a patient with abnormal uterine bleeding to a gynecologist. But here’s the real point the commenter missed: We’re NOT claiming to do “adult medicine”, at least not primary care adult medicine! That’s the whole point Retired Doc and I are making. Adult primary care medicine is a simplistic notion that the ACP is shoving down internists’ throats, and that’s the problem.

DB , who is President of the Society of General Internal Medicine, has ranted about this many times, most recently here, stating “I personally reject the primary care label to describe general internal medicine”. Internists are specialists, OK? Internists are not just “doctors for adults” as the ACP defines them. Not even “general” internists.

As I said before the ACP does some good things. If they believe the specialty of Internal Medicine is obsolete I can respect that point of view and am willing to debate it. I just wish they’d be honest about it. Why don’t they come out and say they focus on adult primary care and quit pretending to represent Internal Medicine? They might as well call for the dissolution of Internal Medicine as a specialty and merge with the American Academy of Family Practice.

Since the ACP swallowed up the American Society of Internal Medicine in 1998 there remains only one organization, SGIM, which still represents and promotes the specialty of Internal Medicine.


emmy said...

OK, well you have told us what Internal Medicine doctors are not. Would you now tell us what they are? Because I'm kind of confused. You see, I go to an Internal Medicine doctor as my primary care physician, and if that's not her role then I can't see what else her practice would be described as. So if you would let us know, so we could make a better decision it would be a good thing. Thanks.

Joseph Oh, MD said...

I would have to say that I agree with you that internal medicine doctors are specialists; i.e. they specialize in treating the general health conditions of adults. The same goes for pediatricians (of which I am one); we are trained specifically to treat children. It would be both irresponsible and foolish to expect us to treat coronary vascular disease, nor would I trust an internal medicine doctor to treat newborn jaundice. The more pertinent question in my mind is, is Family Practice Medicine obsolete? With the complexity of dermatology, pediatrics, general surgery, and OB/Gyn, can a Family Practice Doctor truly be competent in all those areas?