Monday, May 02, 2022

Are internal medicine’s core values effectively applied in today’s hospitalist practice?

Hospital medicine has changed. The change has been brought by business and regulatory pressures rather than the core values of internal medicine. Internal medicine’s core values are timeless.

Phillip Tumulty was famous as one of internal medicine’s great teachers. He was a lead faculty member in the department of internal medicine at Johns Hopkins for over 20 years. He published an article in JAMAInternal Medicine in 1977 in which he laid out some of the core values of internal medicine. Tumulty, an exemplar of internal medicine if their ever was one, had these things to say (paraphrasing from some of the points he made):

An internist is meticulous in the application of expertise in history and physical examination.

An internist develops a “referral practice” which leads to distinction among peers. (In other words, an internist is a specialist).

An internist “must not nod, nor grow bored, but sustain his enthusiasm through constantly searching for the unexpected in the seemingly obvious. Its occasional discovery in a patient’s problem hitherto passed over as routine brings self renewal.“ In other words the internist’s professional satisfaction feeds on being able to spot zebras in the morass of “bread and butter“ problems.

The internist should not be regarded “merely as some useful indispensable medical work horse, ably attending to the daily clinical chores.“

Tumulty summarizes his points this way: “some may say this is all very well but only as an idealistic concept of a kind of clinician and care that is no longer practical. I agree; it is indeed a concept of excellence. However, in the care of the sick, should one plan for less?“

Are the pressures and expectations placed on hospitalists today aligned with these core principles and values of internal medicine as articulated by Tumulty?

No comments: