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{{redirect|Internist|the medical intern|Internship (medicine)}}
'''Internal medicine''',
In the United States and Commonwealth nations, there is often confusion between internal medicine and [[family medicine]], with people mistakenly considering them equivalent.
== Etymology and historical development ==
▲The etymology of the term ''internal medicine'' in English is rooted in the [[German language|German]] term ''{{Lang|de|Innere Medizin}}'' from the 19th century.<ref name="Echenberg"/> Internal medicine was initially characterized by determination of the underlying "internal" or pathological causes of [[symptom]]s and [[syndrome]]s by use of laboratory investigations in addition to bedside clinical assessment of patients. In contrast, [https://drvidyavenumaxhealth.com/best-general-physician-hospital-nalgonda/ physicians] in previous generations, such as the 17th-century physician [[Thomas Sydenham]], who is known as the father of English medicine or "the English [[Hippocrates]]", had developed [[nosology]] (the study of diseases) via the clinical approach of diagnosis and management, by careful bedside study of the natural history of diseases and their treatment.<ref name="Meynell">{{cite journal |last = Meynell |first = G.G. |title = John Locke and the preface to Thomas Sydenham's Observationes medicae |journal = Medical History |year = 2006 |volume = 50 |issue = 1 |pages = 93–110 |doi = 10.1017/s0025727300009467 |pmid = 16502873 |pmc = 1369015 }}</ref> Sydenham eschewed dissection of corpses and scrutiny of the internal workings of the body, for considering the internal mechanisms and causes of symptoms.<ref name="Brought to Life">{{cite web |title = Brought to Life: Exploring the History of Medicine: Thomas Sydenham (1624-89) |url = http://www.sciencemuseum.org.uk/broughttolife/people/thomassydenham |website = Science Museum, London |access-date = 17 May 2017 |archive-date = 14 August 2017 |archive-url = https://web.archive.org/web/20170814213637/http://www.sciencemuseum.org.uk/broughttolife/people/thomassydenham |url-status = dead }}</ref> It was thus subsequent to the 17th century that there was a rise in [[anatomical pathology]] and laboratory studies, with [[Giovanni Battista Morgagni]], an Italian anatomist of the 18th century, being considered the father of anatomical pathology.<ref name="Morgagnu">{{cite journal |last = Morgagnu |first = G.B. |title = Founders of Modern Medicine: Giovanni Battista Morgagni. (1682–1771) |journal = Medical Library and Historical Journal |year = 1903 |volume = 1 |issue = 4 |pages = 270–277 |pmid= 18340813 |pmc = 1698114 }}</ref> Laboratory investigations became increasingly significant, with contribution of doctors including German physician and bacteriologist [[Robert Koch]] in the 19th century.<ref name="Robert Koch">{{cite web |title = Robert Koch |url = https://www.britannica.com/biography/Robert-Koch#ref700442
|website = Encyclopaedia Britannica |access-date = 26 June 2017 }}</ref> The 19th century saw the rise of internal medicine that combined the clinical approach with use of investigations.<ref>{{cite journal |last = Berger |first = Darlene |title = A brief history of medical diagnosis and the birth of the clinical laboratory: Part 1—Ancient times through the 19th century |journal = MLO Med Lab Obs. |year = 1999 |volume = 31 |issue = 7 |pages = 28–30, 32, 34–40 |pmid = 10539661 |url = http://www.academia.dk/Blog/wp-content/uploads/KlinLab-Hist/LabHistory1.pdf |access-date = 2018-06-26 }}</ref> Many early-20th-century American physicians studied medicine in Germany and brought this medical field to the [[United States]]. Thus, the name "internal medicine" was adopted in imitation of the existing German term.<ref name="Echenberg">{{cite journal |last = Echenberg |first = D. |title = A history of internal medicine: medical specialization: as old as antiquity |journal = Rev Med Suisse |year = 2007 |volume = 3 |issue = 135 |pages = 2737–9 |pmid = 18214228 }}</ref>▼
In the 17th century, there was a shift towards [[anatomical pathology]] and laboratory studies, and [[Giovanni Battista Morgagni]], an Italian anatomist of the 18th century, is considered the father of anatomical pathology.<ref name="Morgagnu">{{cite journal |last = Morgagnu |first = G.B. |title = Founders of Modern Medicine: Giovanni Battista Morgagni. (1682–1771) |journal = Medical Library and Historical Journal |year = 1903 |volume = 1 |issue = 4 |pages = 270–277 |pmid= 18340813 |pmc = 1698114 }}</ref> [[Laboratory investigation]]s gained increasing significance, with contributions from physicians like German physician and bacteriologist [[Robert Koch]] in the 19th century.<ref name="Robert Koch">{{cite web |title = Robert Koch |url = https://www.britannica.com/biography/Robert-Koch#ref700442
Historically, some of the oldest traces of internal medicine can be traced from [[ancient India]] and [[ancient China]].<ref>{{cite book |title = Physical Activity and Health: A Report of the Surgeon General |page = 12 |author = United States. Department of Health and Human Services }}</ref> The earliest texts about internal medicine are the [[Ayurvedic]] anthologies of [[Charaka]].<ref>{{cite book |title = The Eye in History |page = 93 |author = Frank Joseph Goes |publisher = JP Medical Ltd. }}</ref>▼
▲|website = Encyclopaedia Britannica |access-date = 26 June 2017 }}</ref>
▲
== Role of internal medicine physicians ==▼
Internal medicine specialists, also known as general internal medicine specialists or general medicine physicians in [[Commonwealth of Nations|Commonwealth]] countries,<ref name="imsanz.org.au">{{cite web |last1=Poole |first1=Philippa |title=Restoring the Balance - The Importance of General Medicine in the New Zealand Health System |url=https://www.imsanz.org.au/documents/item/418 |website=Internal Medicine Society of Australia and New Zealand |access-date=27 June 2018}}</ref> are specialist physicians trained to manage particularly complex or multisystem disease conditions that single-organ-disease specialists may not be trained to deal with.<ref name="General and Acute Care Medicine">{{cite web |title=General and Acute Care Medicine |url=https://www.racp.edu.au/trainees/advanced-training/advanced-training-programs/general-and-acute-care-medicine |website=The Royal Australasian College of Physicians |access-date=27 June 2018}}</ref> They may be asked to tackle undifferentiated presentations that cannot be easily fitted within the expertise of a single-organ specialty,<ref name="Specialist or generalist care? A st">{{cite journal |last1=Lowe |first1=J. |last2=Candlish |first2=P. |last3=Henry |first3=D. |last4=Wlodarcyk |first4=J. |last5=Fletcher |first5=P. |title=Specialist or generalist care? A study of the impact of a selective admitting policy for patients with cardiac failure |journal=Int J Qual Health Care |date=2000 |volume=12 |issue=4 |pages=339–45|doi=10.1093/intqhc/12.4.339 |pmid=10985273 |doi-access=free }}</ref> such as [[dyspnea]], fatigue, weight loss, chest pain, confusion or change in conscious state.<ref name="imsanz.org.au"/> They may manage serious acute illnesses that affect multiple organ systems at the same time in a single patient, and they may manage [[Multimorbidity|multiple chronic diseases]] that a single patient may have.<ref name="General and Acute Care Medicine"/>▼
Many internal medicine physicians decide to subspecialize in specific organ systems. General internal medicine specialists do not provide necessarily less expertise than single-organ specialists, rather, they are trained for a specific role of caring for patients with multiple simultaneous problems or complex comorbidities.<ref name="Specialist or generalist care? A st"/>▼
▲Internal medicine specialists, also
▲
Perhaps because it is complex to explain treatment of diseases that are not localized to a single-organ, there has been confusion about the meaning of internal medicine and the role of an "internist".<ref>{{cite book|last1=Freeman|first1=Brian S.|title=The ultimate guide to choosing a medical specialty|publisher=McGraw-Hill Medical|date=2012|location=New York|isbn=978-0071790277|pages=229–250|edition=3rd}}</ref> Although internists may act as [[primary care physician]]s, they are not "[[Family medicine|family physician]]s", "family practitioners", or "[[general practitioner]]s", or "[[General practitioner|GP]]s", whose training is not solely concentrated on adults and may include [[surgery]], [[obstetrics]], and [[pediatrics]]. The [[American College of Physicians]] defines internists as "physicians who specialize in the prevention, detection and treatment of illnesses in adults".<ref>{{cite web | title=ACP: Who We Are | work=American College of Physicians | url=http://www.acponline.org/about_acp/who_we_are/ | access-date=2011-03-30 }}</ref> While there is overlap in the population served by both internal medicine and family medicine physicians, internists typically focus on adult care with an emphasis on diagnosis while family medicine incorporates holistic care for the entire family unit.<ref name="www.acponline.org">{{Cite web |title=Internal Medicine vs. Family Medicine {{!}} ACP |url=https://www.acponline.org/about-acp/about-internal-medicine/career-paths/medical-student-career-path/internal-medicine-vs-family-medicine |access-date=2022-11-14 |website=www.acponline.org}}</ref> Internists also receive significant training in many of the recognized sub-specialties of the profession (see below) and are trained in both inpatient and outpatient settings. Family medicine physicians receive education on a broad range of conditions and typically train in an outpatient setting with minimal experience in a hospital setting. The historical roots of internal medicine lie in the movement to incorporate scientific into medical practice in the 1800s.<ref name="www.acponline.org" /><ref>{{Cite journal |last=Echenberg |first=Donald |date=2007-11-28 |title=[A history of internal medicine: medical specialization: as old as antiquity] |url=https://pubmed.ncbi.nlm.nih.gov/18214228 |journal=Revue Médicale Suisse |volume=3 |issue=135 |pages=2737–2739 |issn=1660-9379 |pmid=18214228}}</ref> Family medicine grew from the primary care movement in the 1960s.<ref name="www.acponline.org" /><ref>{{Cite journal |last1=Abyad |first1=Abdulrazak |last2=Al-Baho |first2=Abeer Khaled |last3=Unluoglu |first3=Ilhami |last4=Tarawneh |first4=Mohammed |last5=Al Hilfy |first5=Thamer Kadum Yousif |date=November 2007 |title=Development of family medicine in the middle East |url=https://pubmed.ncbi.nlm.nih.gov/17987417 |journal=Family Medicine |volume=39 |issue=10 |pages=736–741 |issn=0742-3225 |pmid=17987417}}</ref>▼
▲
==Professional education and training==▼
{{Main|Medical education}}
The training and career pathways for internists vary considerably across
Many programs require previous undergraduate education prior to medical school admission. This "[[
Following completion of entry-level training, newly graduated medical practitioners are often required to undertake a period of supervised practice before
In
==Certification==
In the
=== Subspecialties ===
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==== United States of America ====
In the
===== American Board of Internal Medicine =====
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*[[Cardiology|Adult congenital heart disease]]
*[[Cardiology|Advanced heart failure and transplant cardiology]]
*[[Allergy]]
*[[Cardiology|Cardiovascular disease]], dealing with disorders of the [[heart]] and [[blood vessels]]*
*[[Clinical cardiac electrophysiology]]
*[[Critical care medicine]], is dealing with life-threatening conditions requiring intensive monitoring and treatment.
*[[Endocrinology|Endocrinology, diabetes & metabolism]], dealing with disorders of the [[endocrine system]] and its specific secretions called [[hormones]]
*[[Gastroenterology]], concerned with the field of [[digestive diseases]]
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*[[Palliative care|Palliative care medicine]]
*[[Pulmonary Medicine|Pulmonary Diseases]]
*[[Pulmonology]]
*[[Rheumatology]]
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==== United Kingdom ====
In the United Kingdom, the three medical [[Medical royal college|Royal College]]s (the [[Royal College of Physicians]] of London, the [[Royal College of Physicians of Edinburgh]] and the [[Royal College of Physicians and Surgeons of Glasgow]]) are responsible for setting curricula and training programmes through the Joint Royal Colleges Postgraduate Training Board (JRCPTB), although the process is monitored and accredited by the independent [[General Medical Council]] (which also maintains the specialist register).<ref name="General Medical Council-2022" />
Doctors who have completed medical school spend two years in [[Foundation doctor|foundation training]] completing a basic postgraduate curriculum. After two years of [[Core Medical Training]] (CT1/CT2), or three years of Internal Medicine Training (IMT1/IMT2/IMT3) as of 2019, since and attaining the [[Membership of the Royal College of Physicians]], physicians commit to one of the medical specialties:<ref>{{cite web|title=Approved specialty and subspecialty training curricula by Royal College|url=http://www.gmc-uk.org/education/approved_curricula_systems.asp|publisher=General Medical Council|access-date=3 February 2014}}</ref>
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==== European Union ====
The European Board of Internal Medicine (EBIM) was formed as a collaborative effort between the [[European Union of Medical Specialists]] (UEMS) - Internal Medicine Section and the European Federation of Internal Medicine (EFIM) to provide guidance on standardizing training and practice of internal medicine throughout Europe.<ref>{{Cite web |title=European Board of Internal Medicine – EBIM Educational Platform of Internal Medicine |url=https://www.ebim-online.org/ |access-date=2022-11-10 |language=en}}</ref><ref name="efim.org">{{Cite web |title=What is Internal Medicine? {{!}} European Federation of Internal Medicine |url=https://efim.org/what-internal-medicine |access-date=2022-11-10 |website=efim.org}}</ref><ref>{{Cite web |title=Main UEMS - Home |url=https://www.uems.eu/ |access-date=2022-11-10 |website=www.uems.eu}}</ref> The EBIM published training requirements in 2016 for postgraduate education in internal medicine, and efforts to create a European Certificate of Internal Medicine (ECIM) to facilitate the free movement of medical professionals with the EU are currently underway.<ref>{{Cite web |title=Main UEMS - European Standards in Medical Training - ETRs |url=https://www.uems.eu/areas-of-expertise/postgraduate-training/european-standards-in-medical-training |access-date=2022-11-10 |website=www.uems.eu}}</ref><ref>{{Cite web |title=European Certification in Internal Medicine – European Board of Internal Medicine |date=28 August 2020 |url=https://www.ebim-online.org/european-certification-in-internal-medicine/ |access-date=2022-11-10 |language=en}}</ref>
The internal medicine specialist is recognized in every country in the [[European Union]] and typically requires five years of multi-disciplinary post-graduate education.<ref name="efim.org" /> The specialty of internal medicine is seen as providing care in a wide variety of conditions involving every organ system and is distinguished from family medicine in that the latter provides a broader model of care the includes both surgery and obstetrics in both adults and children.<ref name="efim.org" />
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* Clinical allergy and immunology
* [[Dermatology]]
* [[Nephrology]]
==Medical diagnosis and treatment==
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=== Gathering data ===
Data may be gathered directly from the patient in medical history-taking and [[physical examination]].<ref name="Detsky-2022" /><ref>{{Cite journal |last1=Bernstein |first1=Jonathan A. |last2=Fox |first2=Roger W. |last3=Martin |first3=Vincent T. |last4=Lockey |first4=Richard F. |date=May 2013 |title=Headache and facial pain: differential diagnosis and treatment
[[File:Seattle physician with patient 1999.jpg|thumb|253x253px|History and physical examination are a vital part of the diagnostic process.<ref name="Detsky-2022" />]]
Internists often can perform and interpret diagnostic tests like [[Electrocardiography|EKGs]] and [[ultrasound]] imaging (Point-of-care Ultrasound – PoCUS).<ref>{{Cite journal |last1=Olgers |first1=T. J. |last2=Azizi |first2=N. |last3=Blans |first3=M. J. |last4=Bosch |first4=F. H. |last5=Gans |first5=R. O. B. |last6=Ter Maaten |first6=J. C. |date=June 2019 |title=Point-of-care Ultrasound (PoCUS) for the internist in Acute Medicine: a uniform curriculum |url=https://pubmed.ncbi.nlm.nih.gov/31264587 |journal=The Netherlands Journal of Medicine |volume=77 |issue=5 |pages=168–176 |issn=1872-9061 |pmid=31264587}}</ref><ref>{{Cite journal |last1=Möckel |first1=M. |last2=Störk |first2=T. |date=September 2017 |title=[Acute chest pain] |url=https://pubmed.ncbi.nlm.nih.gov/28765984 |journal=Der Internist |volume=58 |issue=9 |pages=900–907 |doi=10.1007/s00108-017-0299-8 |issn=1432-1289 |pmid=28765984|s2cid=21364030 }}</ref>
Internists who pursue sub-specialties have additional diagnostic tools, including those listed below.
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=== Generating diagnostic hypotheses ===
Determining which pieces of information are most important to the next phase of the diagnostic process is of vital importance.<ref name="Detsky-2022" /><ref>{{Cite journal |last1=Hegedus |first1=Eric J. |last2=Goode |first2=Adam P. |last3=Cook |first3=Chad E. |last4=Michener |first4=Lori |last5=Myer |first5=Cortney A. |last6=Myer |first6=Daniel M. |last7=Wright |first7=Alexis A. |date=November 2012 |title=Which physical examination tests provide clinicians with the most value when examining the shoulder? Update of a systematic review with meta-analysis of individual tests |journal=British Journal of Sports Medicine |volume=46 |issue=14 |pages=964–978 |doi=10.1136/bjsports-2012-091066 |issn=1473-0480 |pmid=22773322|s2cid=2373599 |doi-access=free }}</ref> It is during this stage that clinical bias like anchoring or premature closure may be introduced.<ref>{{Cite journal |last1=Saposnik |first1=Gustavo |last2=Redelmeier |first2=Donald |last3=Ruff |first3=Christian C. |last4=Tobler |first4=Philippe N. |date=2016-11-03 |title=Cognitive biases associated with medical decisions: a systematic review |journal=BMC Medical Informatics and Decision Making |volume=16 |issue=1 |pages=138 |doi=10.1186/s12911-016-0377-1 |issn=1472-6947 |pmc=5093937 |pmid=27809908 |doi-access=free }}</ref> Once key findings are determined, they are compared to profiles of possible diseases. These profiles include findings that are typically associated with the disease and are based on the likelihood that someone with the disease has a particular symptom. A list of potential diagnoses is termed the
The list is dynamic and changes as the physician obtains additional information that makes a condition more (
An important part of this process is knowledge of the various ways that a disease can present in a patient. This knowledge is gathered and shared to add to the database of disease profiles used by physicians. This is especially important in rare diseases.<ref>{{Cite journal |last=Al-Mogairen |first=Sultan M. |date=August 2011 |title=Lupus protein-losing enteropathy (LUPLE): a systematic review |url=https://pubmed.ncbi.nlm.nih.gov/21344315 |journal=Rheumatology International |volume=31 |issue=8 |pages=995–1001 |doi=10.1007/s00296-011-1827-9 |issn=1437-160X |pmid=21344315|s2cid=21008365 }}</ref>
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=== Treatment ===
Treatment modalities generally include both pharmacological and non-pharmacological, depending on the primary diagnosis.<ref>{{Cite journal |last1=Gay |first1=C. |last2=Chabaud |first2=A. |last3=Guilley |first3=E. |last4=Coudeyre |first4=E. |date=June 2016 |title=Educating patients about the benefits of physical activity and exercise for their hip and knee osteoarthritis. Systematic literature review |journal=Annals of Physical and Rehabilitation Medicine |volume=59 |issue=3 |pages=174–183 |doi=10.1016/j.rehab.2016.02.005 |issn=1877-0665 |pmid=27053003|doi-access=free }}</ref><ref>{{Cite journal |last1=Fu |first1=Jinming |last2=Liu |first2=Yupeng |last3=Zhang |first3=Lei |last4=Zhou |first4=Lu |last5=Li |first5=Dapeng |last6=Quan |first6=Hude |last7=Zhu |first7=Lin |last8=Hu |first8=Fulan |last9=Li |first9=Xia |last10=Meng |first10=Shuhan |last11=Yan |first11=Ran |last12=Zhao |first12=Suhua |last13=Onwuka |first13=Justina Ucheojor |last14=Yang |first14=Baofeng |last15=Sun |first15=Dianjun |date=2020-10-20 |title=Nonpharmacologic Interventions for Reducing Blood Pressure in Adults With Prehypertension to Established Hypertension |journal=Journal of the American Heart Association |volume=9 |issue=19 |pages=e016804 |doi=10.1161/JAHA.120.016804 |issn=2047-9980 |pmc=7792371 |pmid=32975166}}</ref>
=== Prevention and other services ===
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[[Electronic health record]]s have been shown to improve patient care but have risks including data breaches and inappropriate and/or unauthorized disclosure of protected health information.<ref>{{Cite journal |last1=Sulmasy |first1=Lois Snyder |last2=López |first2=Ana María |last3=Horwitch |first3=Carrie A. |last4=American College of Physicians Ethics, Professionalism and Human Rights Committee |date=August 2017 |title=Ethical Implications of the Electronic Health Record: In the Service of the Patient |journal=Journal of General Internal Medicine |volume=32 |issue=8 |pages=935–939 |doi=10.1007/s11606-017-4030-1 |issn=1525-1497 |pmc=5515784 |pmid=28321550}}</ref>
Withholding information from a patient is typically seen as unethical and in violation of a
== See also ==
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==External links==
{{wikibooks}}
*[http://www.aaaai.org/ The American Academy of Allergy, Asthma & Immunology (AAAAI)]; [https://www.abai.org/ American Board of Allergy & Immunology (ABAI)]
*[https://web.archive.org/web/20090429212417/http://www.acponline.org/isim/ International Society of Internal Medicine]
*[http://www.imsanz.org.au/about/index.cfm Internal Medicine Society of Australia and New Zealand] {{Webarchive|url=https://web.archive.org/web/20160831081201/http://www.imsanz.org.au/about/index.cfm |date=2016-08-31 }}
*[http://www.abim.org The American Board of Internal Medicine]
*[https://web.archive.org/web/20060715143141/http://csim.medical.org/ Canadian Society of Internal Medicine]
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