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{{redirect|Internist|the medical intern|Internship (medicine)}}
'''Internal medicine''', also known as '''general internal medicine''' in [[Commonwealth nations]], is a [[medical specialty]] for [[medical doctors]] focused on the prevention, diagnosis, and treatment of internal diseases in adults. Medical practitioners of internal medicine are referred to as '''internists''', or '''physicians''' in Commonwealth nations.<ref>{{Cite web |date=2019-12-10 |title=What Is Internal Medicine? |url=https://www.castleconnolly.com/topics/internal-medicine/what-is-internal-medicine |access-date=2023-06-13 |website=Castle Connolly |language=en}}</ref> Internists possess specialized skills in managing patients with undifferentiated or [[Multisystem disease|multi-system disease]] processes. They provide care to both hospitalized (inpatient) and [[Ambulatory care|ambulatory]] (outpatient) patients and often contribute significantly to teaching and research. Internists are qualified physicians who have undergone [[postgraduate]] training in internal medicine, and should not be confused with "[[Internship (medicine)|interns]]
In the United States and Commonwealth nations, there is often confusion between internal medicine and [[family medicine]], with people mistakenly considering them equivalent.
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== Etymology and historical development ==
[[File:Robert Koch.jpg|thumb|206x206px|[[Robert Koch]], 19th century German physician and microbiologist<ref name="Robert Koch" />]]The term ''internal medicine'' in English has its [[etymology]] in the 19th-century German term ''{{Lang|de|Innere Medizin}}''. Originally,<ref name="Echenberg"/> internal medicine focused on determining the underlying "internal" or [[pathological]] causes of [[symptoms]] and [[syndrome]]s through a combination of medical tests and bedside [[clinical examination]] of patients. This approach differed from earlier generations of physicians, such as the 17th-century English physician [[Thomas Sydenham]], known as the father of English medicine or "the English [[Hippocrates]]." Sydenham developed the field of [[nosology]] (the study of diseases) through a clinical approach that involved diagnosing and managing diseases based on careful bedside observation of the [[natural history of disease]] 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 emphasized understanding the internal mechanisms and causes of symptoms rather than dissecting [[cadaver]]s and scrutinizing the internal workings of the body.<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>
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
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== Role of internal medicine specialists ==
Internal medicine specialists, also referred to as general internal medicine specialists or general medicine physicians in 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 |archive-date=10 March 2017 |archive-url=https://web.archive.org/web/20170310032809/http://www.imsanz.org.au/documents/item/418 |url-status=dead }}</ref> are specialized physicians trained to manage complex or multisystem disease conditions that single-organ specialists may not be equipped to handle.<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 are often called upon to address undifferentiated presentations that do not fit neatly within the scope 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 shortness of breath, fatigue, weight loss, chest pain, confusion, or alterations in conscious state.<ref name="imsanz.org.au" /> They may manage serious [[acute illness]]es that affect multiple organ systems concurrently within a single patient, as well as the management of multiple [[chronic diseases]] in a single patient.<ref name="General and Acute Care Medicine" />
While many internal medicine physicians choose to subspecialize in specific [[organ system]]s, general internal medicine specialists do not necessarily possess any lesser expertise than single-organ specialists. Rather, they are specifically trained to care for patients with multiple simultaneous problems or complex comorbidities.<ref name="Specialist or generalist care? A st" />
Due to the complexity involved in explaining the treatment of diseases that are not localized to a single organ, there has been some confusion surrounding the meaning of internal medicine and the role of an "internist
==Education and training==
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*[[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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==== 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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=== 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 patient's right to make informed decisions. However, in situations where a patient has requested not to be informed or to have the information provided to a second party or in an emergency situation in which the patient does not have decision-making capacity, withholding information may be appropriate.<ref>{{Cite web |title=Withholding Information from Patients |url=https://www.ama-assn.org/delivering-care/ethics/withholding-information-patients |access-date=2022-11-10 |website=American Medical Association |language=en}}</ref>
== See also ==
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*[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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