I’ve done some thinking the last few days about readers’ reactions to my posts on Internal Medicine as a specialty. The common understanding of Internal Medicine differs a great deal from my own. Judging from comments I’ve read my view needs better explanation. First I would recommend DB’s postulates, which were posted late in the discussion and should go a long way toward answering many of the questions.
I was taken to task on the one hand for listing all the things Internal Medicine is not without addressing what it is, and on the other hand for claiming that Internal Medicine is everything Family Practice is, only better. One would think I was talking out of both sides of my mouth.
Emmy commented “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.“ A broad range of adult problems comprises Internal Medicine. Internists do in fact practice primary care when it is defined as that care which is given by the first doctor the patient sees for a problem. But I agree with DB that the term has been hijacked by so many people with agendas that it has become meaningless. It’s not useful in defining Internal Medicine as a specialty. While Internal Medicine and Family Practice are overlapping circles in a Venn diagram there is a difference in focus and there are distinctions.
Internal Medicine and Family Practice are overlapping, though not identical, specialties. There are problems (and I’m not just referring to Ob/Gyn and Peds) in the realm of expertise of Family Practice for which internists are not particularly well trained and vice versa. As I once explained, Internal Medicine stresses the care of patients with multiple complex problems. As DB said in his postulates internists have more training in the care of severely ill patients. Internists are (or should be!) uniquely, more than other specialists, interested in the basic scientific underpinnings---the how and why---of both normal function and disease. (Note that the word “internal” is apt here).
This concept of multiple complex medical problems as a defining attribute of the Internal Medicine patient is evidently difficult for some, but Emmy of all people should understand. Just look at her profile. (Emmy, by all means, stick with your internist!).
Some medical students read my blog and commented over at the Student Doctor Network Forum. Their comments suggest that they too misunderstand what general IM is supposed to be:
I suppose if the public expects you to act like a family physician, it only makes sense to train as one.
…the people who don't go on to fellowships will have a hard time.
There is nothing that IM covers that there is not a specialty for (Intensive Care, Pulmonology, Cardiology... etc etc etc) so how can you call them a specialty.
Why? They can be hospitalists...
Wow. No wonder it’s difficult to get students to choose general Internal Medicine.