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What is Internal Medicine?

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Internal medicine is a medical speciality involving the application of scientific knowledge and clinical expertise to diagnose and treat adults across a range of illnesses. Physicians who specialise in internal medicine are known as internists.

General Internists

According to the ACP, general internists are uniquely qualified to practice primary care and follow patients through their adult lives. A few general internists may be “hospitalists” who work in a hospital setting. Other general internists provide both outpatient and inpatient care for patients. General internists may also practice in rehabilitation centers and long-term care facilities.

The internal medicine training involves general medical conditions as well as each of the internal medicine subspecialties (such as endocrinology, rheumatology, and infectious diseases) and neurology. Internists are experienced in psychiatry, dermatology, ophthalmology, gynecology, otorhinolaryngology, non-surgical orthopedics, palliative medicine, sleep medicine, geriatrics, and rehabilitation medicine to comprehensively care for adults both outpatient and inpatient settings. In addition to continuity clinic experience, trainees also see outpatients during their subspecialty clinical rotations. They are trained for at least one year caring for hospitalized patients, with at least three months under intensive/critical care settings. Internists acquire hospital-based training lasting more than one year with additional exposure to inpatient subspecialties such as cardiology, hematology-oncology, or gastroenterology.

General Family Practioners

Doctors specializing in general practice are just like family physicians and are qualified to treat patients of any gender or age. Unlike internists, general family practitioners do not solely concentrate on adults and may practice pediatrics, obstetrics, and surgery. According to the ACP, “family medicine is built around a social unit (the family) as opposed to either a specific patient population (i.e. adults, children, or women), organ system (i.e., otolaryngology or urology), or nature of an intervention (i.e., surgery).” Therefore, family physicians are able to address the entire range of medical issues faced by the members of a family. Family physician trainees provide acute, chronic, and wellness services for continuity patients, with a minimum number of encounters being with children and older adults.

Family physician training involves:

  • Adult critical care (1 month)
  • Care for children in the hospital or emergency settings (nearly 2 months)
  • Geriatric care (1 month)
  • Gynecology (1 month)
  • Inpatient hospital experience (6 months minimum)
  • Musculoskeletal medicine (2 months)
  • Newborn encounters
  • Obstetrics (2 months)
  • Surgery (1 month)

Family medicine training also includes behavioral health, common skin diseases, population health, and health system management, wellness, and disease prevention.

Specialized Training

Internists are medical doctors who specialize in prevention, diagnosis, and treatment of diseases that affect adults. General internists are considered as experts in resolving any problem—simple or complex—facing the patient in terms of diagnosis, treatment of chronic illness, or health promotion and disease prevention. Internists go through an additional one to three years of a fellowship program after the basic three-year residency to acquire expertise in a subspecialty.

Internal Medicine Subspecialties

In addition to general internists, the following subspecialists are recognized, including:

  • Allergy and Immunology (immune system)
  • Cardiovascular Disease (heart and vascular system)
  • Advanced Heart Failure and Transplant Cardiology
  • Interventional Cardiology
  • Clinical Cardiac Electrophysiology
  • Endocrinology, Diabetes, and Metabolism (diabetes and other glandular and metabolic disorders)
  • Gastroenterology (gastrointestinal system, liver, and gall bladder)
  • Transplant Hepatology
  • Hematology (blood)
  • Infectious Disease (bacterial, viral, fungal, and parasitic infections)
  • Nephrology (kidneys)
  • Oncology (cancer)
  • Pulmonary Disease (lungs and respiratory system)
  • Rheumatology (joints and musculoskeletal system)

Internal Medicine/Body Connection

Internal medicine is used to treat conditions affecting internal organs, such as heart disease, hypertension, diabetes, obesity, and chronic lung disease. Depending on their subspecialty, internists may be called upon to work with doctors in other medical specialties or to consult on a patient referred by another specialist. For example, a heart specialist focuses on heart-related issues, while an endocrinologist treats hormonal issues related to glands. Often, internal medicine entails diagnosis and management of complex, chronic, and multi-system disorders.

Treating a Broad Range of Internal Medicine Conditions

A wide range of diseases and conditions can be diagnosed and treated within internal medicine, according to the American Medical Association. Internists diagnose, treat and manage diseases such as cancer, infections, and conditions affecting the heart, blood, kidneys, joints, and the digestive, respiratory, and vascular systems. Diseases and conditions that can be addressed by internists include:

  • Abnormal liver biochemical and function tests
  • Abnormal uterine bleeding
  • Acid peptic disease associated with upper gastrointestinal bleeding
  • Acquired thrombotic thrombocytopenic purpura (TTP)
  • Acquired von Willebrand syndrome
  • Acute aortic dissection
  • Acute aortic regurgitation
  • Acute bacterial meningitis
  • Acute bronchitis
  • Acute calculous cholecystitis
  • Acute cholangitis
  • Acute colonic diverticulitis
  • Acute decompensated heart failure
  • Acute diverticulitis
  • Acute exacerbations of asthma
  • Acute ischemic stroke and transient ischemic attack
  • Acute liver failure
  • Acute lower extremity ischemia
  • Acute mesenteric arterial occlusion
  • Acute migraine
  • Acute myocardial infarction
  • Acute pancreatitis
  • Acute pericarditis
  • Acute pharyngitis
  • Acute pulmonary embolism
  • Acute respiratory distress syndrome
  • Acute sinusitis and rhinosinusitis
  • Acute variceal hemorrhage
  • Acute viral gastroenteritis
  • Adrenal insufficiency
  • Airway foreign bodies
  • Allergic rhinitis
  • Anal fissure
  • Angioedema
  • Aseptic meningitis
  • Aspiration pneumonia
  • Atrial fibrillation
  • Bacterial brain abscess
  • Balanitis and balanoposthitis in children and adolescents
  • Bell’s palsy
  • Bleeding peptic ulcers
  • Cancer pain
  • Cardiogenic shock complicating acute myocardial infarction
  • Cellulitis and skin abscesses
  • Chronic complications and age-related comorbidities in people with hemophilia
  • Chronic limb-threatening ischemia
  • Clostridial myonecrosis
  • Clostridioides (formerly Clostridium) difficile infection
  • Cognitive impairment and dementia
  • Colonic ischemia
  • Constrictive pericarditis
  • Convulsive status epilepticus in adults
  • Corneal abrasions and corneal foreign bodies
  • Cushing’s syndrome
  • Diabetic ketoacidosis and hyperosmolar hyperglycemic state in adults
  • Disseminated intravascular coagulation
  • Dysphagia in adults
  • Electrocardiographic abnormalities suggesting myocardial ischemia and infarction
  • Emergency contraception
  • Epilepsy and EEG
  • Esophageal disease
  • Exacerbations of chronic obstructive pulmonary disease
  • Exercise-associated hyponatremia
  • External otitis
  • Failed fibrinolysis (thrombolysis) or threatened reocclusion in acute ST elevation myocardial infarction
  • Fasting ketosis and alcoholic ketoacidosis
  • Gastrointestinal infections
  • Giant cell arteritis
  • Gout flares
  • HELLP syndrome (hemolysis, elevated liver enzymes, and low platelets)
  • Hepatic encephalopathy
  • Hereditary TTP
  • Hyperkalemia
  • Hypotonic hyponatremia
  • Infections of cerebrospinal fluid shunts and other devices
  • Ingested foreign bodies and food impactions in adults
  • Intestinal ischemia
  • Intracranial epidural abscess
  • Invasive group A streptococcal infection and toxic shock syndrome
  • Lactic acidosis
  • Lower gastrointestinal bleeding
  • Lyme disease
  • Malignancy-related superior vena cava syndrome
  • Massive hemoptysis
  • Mechanical colorectal obstruction
  • Mechanical small bowel obstruction
  • Mesenteric venous thrombosis
  • Metabolic acidosis
  • Metabolic acidosis in chronic kidney disease
  • Metabolic alkalosis
  • Mineral and bone metabolism
  • Mitral valve prolapse and flail mitral leaflet
  • Moderate to severe hypertensive retinopathy and hypertensive encephalopathy
  • Myopericardial disease
  • Narrow QRS complex tachycardias
  • Necrotizing soft tissue infections
  • Neoplastic epidural spinal cord compression
  • Neuromuscular disease
  • Neuropathies
  • New-onset atrial fibrillation
  • Non-sustained ventricular tachycardia
  • Nonocclusive mesenteric ischemia
  • Open-angle glaucoma
  • Osmotic demyelination syndrome (ODS) and overly rapid correction of hyponatremia
  • Osteonecrosis (avascular necrosis of bone)
  • Ovarian and fallopian tube torsion
  • Pelvic inflammatory disease
  • Perianal and perirectal abscess
  • Peripheral nerve and muscle disease
  • Pneumothorax
  • Pregnancy complications
  • Prerenal disease and acute tubular necrosis in acute kidney injury
  • Pulmonary infections
  • Retinal detachment
  • Rhabdomyolysis
  • Right-sided native valve infective endocarditis
  • Second and third degree atrioventricular blocks
  • Secondary spontaneous pneumothorax
  • Segmental colitis associated with diverticulosis
  • Severe Crohn disease
  • Severe hypovolemia or hypovolemic shock
  • Severe ulcerative colitis
  • Sickle cell disease
  • Simple and mixed acid-base disorders
  • Sinus bradycardia
  • Spinal epidural abscess
  • Spontaneous bacterial peritonitis
  • Staphylococcal toxic shock syndrome
  • Stevens-Johnson syndrome and toxic epidermal necrolysis
  • Streptococcal pharyngitis
  • Subacute kidney injury
  • Sudden cardiac arrest
  • Supraventricular arrhythmias after myocardial infarction
  • Suspected acute coronary syndrome (myocardial infarction, unstable angina)
  • Suspected nephrolithiasis
  • Suspected nonvertebral osteomyelitis
  • Sustained monomorphic ventricular tachycardia in patients with structural heart disease
  • Symptomatic aortic stenosis
  • Syncope
  • Thoracic aortic aneurysm
  • Thyroid storm
  • Tubo-ovarian abscess
  • Tumor lysis syndrome
  • Unexplained thrombocytopenia
  • Unstable angina and non-ST elevation myocardial infarction
  • Upper gastrointestinal bleeding
  • Urinary tract obstruction and hydronephrosis
  • Ventricular arrhythmias
  • Ventricular arrhythmias during acute myocardial infarction
  • Vertigo
  • Viral encephalitis
  • Viral infections (except HIV)
  • Wide QRS complex tachycardias

Other reasons to see an internist include:

  • Broad symptoms for precise diagnosis and prompt treatment
  • Conditions affecting any of the body’s systems
  • Improved overall health for guidance, counseling, and preventive interventions
  • Long-lasting comprehensive care and palliative care
  • Mental health disorders such as depression and anxiety caused by abnormal activities in the brain, a lingering disease, or hormonal imbalances

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