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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]]”",<ref>{{cite journal |last=Arneson |first=J |author2=McDonald, WJ |date=July 1998 |title=Can we educate the public about internal medicine? Initial results |journal=The American Journal of Medicine |volume=105 |issue=1 |pages=1–5 |doi=10.1016/S0002-9343(98)00220-4 |pmid=9688013}}</ref> a term commonly used for a medical doctor who has obtained a [[medical degree]] but does not yet have a license to practice medicine unsupervised.<ref name="acponline.org">{{cite web |title=What is an Internist - Doctors for Adults |url=http://www.acponline.org/patients_families/about_internal_medicine/ |access-date=4 Apr 2012 |work=American College of Physicians}}</ref><ref>{{cite web |date=June 28, 2011 |title=Glossary of Terms |url=http://acgme.org/acgmeweb/Portals/0/PFAssets/ProgramRequirements/ab_ACGMEglossary.pdf |url-status=dead |archive-url=https://web.archive.org/web/20121115010409/http://acgme.org/acgmeweb/Portals/0/PFAssets/ProgramRequirements/ab_ACGMEglossary.pdf |archive-date=15 November 2012 |access-date=2 December 2012 |publisher=ACGME}}</ref>
 
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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== 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.".<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=978-00717902770-07-179027-7|pages=229–250|edition=3rd}}</ref> Although internists may serve as [[primary care physician]]s, they are not synonymous with "[[family physicians]],", "family practitioners,", "[[general practitioners]],", or "GPs.". The training of internists is solely focused on adults and does not typically include [[surgery]], [[obstetrics]], or [[pediatrics]]. According to the [[American College of Physicians]], internists are defined 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 may be some overlap in the patient population served by both internal medicine and family medicine physicians, internists primarily focus on adult care with an emphasis on diagnosis, whereas family medicine incorporates a holistic approach to care for the entire family unit. Internists also receive substantial training in various recognized subspecialties within the field and are experienced in both inpatient and outpatient settings. On the other hand, family medicine physicians receive education covering a wide range of conditions and typically train in an outpatient setting with less exposure to hospital settings.<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> The historical roots of internal medicine can be traced back to the incorporation of scientific principles into medical practice in the 1800s, while family medicine emerged as part of the primary care movement in the 1960s.<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><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>
 
==Education and training==
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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 “differential"differential diagnosis”diagnosis" for the patient and is typically ordered from most likely to least likely, with special attention given to those conditions that have dire consequences for the patient if they were missed.<ref>{{Cite journal |last1=Weingart |first1=C. |last2=Schneider |first2=H.-J. |last3=Sieber |first3=C. C. |date=September 2017 |title=[Syncope, falls and vertigo] |url=https://pubmed.ncbi.nlm.nih.gov/28717918 |journal=Der Internist |volume=58 |issue=9 |pages=916–924 |doi=10.1007/s00108-017-0292-2 |issn=1432-1289 |pmid=28717918}}</ref><ref>{{Cite journal |last1=Kwok |first1=Chun Shing |last2=Bennett |first2=Sadie |last3=Azam |first3=Ziyad |last4=Welsh |first4=Victoria |last5=Potluri |first5=Rahul |last6=Loke |first6=Yoon K. |last7=Mallen |first7=Christian D. |date=2021-09-01 |title=Misdiagnosis of Acute Myocardial Infarction: A Systematic Review of the Literature |url=https://pubmed.ncbi.nlm.nih.gov/33606411 |journal=Critical Pathways in Cardiology |volume=20 |issue=3 |pages=155–162 |doi=10.1097/HPC.0000000000000256 |issn=1535-2811 |pmid=33606411|s2cid=231961318 }}</ref> Epidemiology and endemic conditions are also considered in creating and evaluating the list of diagnoses.<ref>{{Cite journal |last1=Fusco |first1=Francesco Maria |last2=Pisapia |first2=Raffaella |last3=Nardiello |first3=Salvatore |last4=Cicala |first4=Stefano Domenico |last5=Gaeta |first5=Giovanni Battista |last6=Brancaccio |first6=Giuseppina |date=2019-07-22 |title=Fever of unknown origin (FUO): which are the factors influencing the final diagnosis? A 2005-2015 systematic review |journal=BMC Infectious Diseases |volume=19 |issue=1 |pages=653 |doi=10.1186/s12879-019-4285-8 |issn=1471-2334 |pmc=6647059 |pmid=31331269 |doi-access=free }}</ref>
 
The list is dynamic and changes as the physician obtains additional information that makes a condition more (“rule"rule-in”in") or less (“rule"rule-out”out") likely based on the disease profile.<ref>{{Cite journal |last1=Knuuti |first1=Juhani |last2=Ballo |first2=Haitham |last3=Juarez-Orozco |first3=Luis Eduardo |last4=Saraste |first4=Antti |last5=Kolh |first5=Philippe |last6=Rutjes |first6=Anne Wilhelmina Saskia |last7=Jüni |first7=Peter |last8=Windecker |first8=Stephan |last9=Bax |first9=Jeroen J. |last10=Wijns |first10=William |date=2018-09-14 |title=The performance of non-invasive tests to rule-in and rule-out significant coronary artery stenosis in patients with stable angina: a meta-analysis focused on post-test disease probability |url=https://pubmed.ncbi.nlm.nih.gov/29850808 |journal=European Heart Journal |volume=39 |issue=35 |pages=3322–3330 |doi=10.1093/eurheartj/ehy267 |issn=1522-9645 |pmid=29850808|hdl=11380/1286682 |hdl-access=free }}</ref> <ref>{{Cite journal |last1=Westwood |first1=Marie |last2=Ramaekers |first2=Bram |last3=Grimm |first3=Sabine |last4=Worthy |first4=Gill |last5=Fayter |first5=Debra |last6=Armstrong |first6=Nigel |last7=Buksnys |first7=Titas |last8=Ross |first8=Janine |last9=Joore |first9=Manuela |last10=Kleijnen |first10=Jos |date=May 2021 |title=High-sensitivity troponin assays for early rule-out of acute myocardial infarction in people with acute chest pain: a systematic review and economic evaluation |journal=Health Technology Assessment |volume=25 |issue=33 |pages=1–276 |doi=10.3310/hta25330 |issn=2046-4924 |pmc=8200931 |pmid=34061019}}</ref>  The list is used to determine what information will be acquired next, including which diagnostic test or imaging modality to order.  The selection of tests is also based on the physician's knowledge of the [[Sensitivity and specificity|specificity and sensitivity]] of a particular test.<ref>{{Cite journal |last1=Hegedus |first1=E. J. |last2=Goode |first2=A. |last3=Campbell |first3=S. |last4=Morin |first4=A. |last5=Tamaddoni |first5=M. |last6=Moorman |first6=C. T. |last7=Cook |first7=C. |date=February 2008 |title=Physical examination tests of the shoulder: a systematic review with meta-analysis of individual tests |journal=British Journal of Sports Medicine |volume=42 |issue=2 |pages=80–92; discussion 92 |doi=10.1136/bjsm.2007.038406 |issn=1473-0480 |pmid=17720798|s2cid=9717602 |doi-access=free }}</ref><ref>{{Cite journal |last1=Wacker |first1=Christina |last2=Prkno |first2=Anna |last3=Brunkhorst |first3=Frank M. |last4=Schlattmann |first4=Peter |date=May 2013 |title=Procalcitonin as a diagnostic marker for sepsis: a systematic review and meta-analysis |url=https://pubmed.ncbi.nlm.nih.gov/23375419 |journal=The Lancet. Infectious Diseases |volume=13 |issue=5 |pages=426–435 |doi=10.1016/S1473-3099(12)70323-7 |issn=1474-4457 |pmid=23375419}}</ref><ref>{{Cite journal |last1=Garcia-Casal |first1=Maria Nieves |last2=Pasricha |first2=Sant-Rayn |last3=Martinez |first3=Ricardo X. |last4=Lopez-Perez |first4=Lucero |last5=Peña-Rosas |first5=Juan Pablo |date=2021-05-24 |title=Serum or plasma ferritin concentration as an index of iron deficiency and overload |journal=The Cochrane Database of Systematic Reviews |volume=2021 |issue=5 |pages=CD011817 |doi=10.1002/14651858.CD011817.pub2 |issn=1469-493X |pmc=8142307 |pmid=34028001}}</ref>
 
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> <ref>{{Cite journal |last1=Malesker |first1=Mark A. |last2=Callahan-Lyon |first2=Priscilla |last3=Ireland |first3=Belinda |last4=Irwin |first4=Richard S. |last5=CHEST Expert Cough Panel |date=November 2017 |title=Pharmacologic and Nonpharmacologic Treatment for Acute Cough Associated With the Common Cold: CHEST Expert Panel Report |journal=Chest |volume=152 |issue=5 |pages=1021–1037 |doi=10.1016/j.chest.2017.08.009 |issn=1931-3543 |pmc=6026258 |pmid=28837801}}</ref><ref name="Viniegra Domínguez-2015">{{Cite journal |last1=Viniegra Domínguez |first1=M. Adela |last2=Parellada Esquius |first2=Neus |last3=Miranda de Moraes Ribeiro |first3=Rafaela |last4=Parellada Pérez |first4=Laura Mar |last5=Planas Olives |first5=Carme |last6=Momblan Trejo |first6=Cristina |date=June 2015 |title=[An integral approach to insomnia in primary care: Non-pharmacological and phytotherapy measures compared to standard treatment] |journal=Atencion Primaria |volume=47 |issue=6 |pages=351–358 |doi=10.1016/j.aprim.2014.07.009 |issn=1578-1275 |pmc=6983700 |pmid=25443769}}</ref><ref>{{Cite journal |last1=Leite |first1=Renata Giacomini Oliveira Ferreira |last2=Banzato |first2=Luísa Rocco |last3=Galendi |first3=Julia Simões Corrêa |last4=Mendes |first4=Adriana Lucia |last5=Bolfi |first5=Fernanda |last6=Veroniki |first6=Areti Angeliki |last7=Thabane |first7=Lehana |last8=Nunes-Nogueira |first8=Vania Dos Santos |date=2020-01-12 |title=Effectiveness of non-pharmacological strategies in the management of type 2 diabetes in primary care: a protocol for a systematic review and network meta-analysis |journal=BMJ Open |volume=10 |issue=1 |pages=e034481 |doi=10.1136/bmjopen-2019-034481 |issn=2044-6055 |pmc=7045081 |pmid=31932394}}</ref> Additional treatment options include referral to specialist care including physical therapy and rehabilitation.<ref>{{Cite journal |date=September 1999 |title=Guidelines for referral and management of systemic lupus erythematosus in adults. American College of Rheumatology Ad Hoc Committee on Systemic Lupus Erythematosus Guidelines |url=https://pubmed.ncbi.nlm.nih.gov/10513791 |journal=Arthritis and Rheumatism |volume=42 |issue=9 |pages=1785–1796 |doi=10.1002/1529-0131(199909)42:9<1785::AID-ANR1>3.0.CO;2-# |issn=0004-3591 |pmid=10513791}}</ref>  Treatment recommendations differ in the acute inpatient and outpatient settings.<ref name="Viniegra Domínguez-2015" /><ref>{{Cite journal |last1=A |first1=Pérez |last2=A |first2=Ramos |last3=G |first3=Carreras |date=Jan–Feb 2020 |title=Insulin Therapy in Hospitalized Patients |url=https://pubmed.ncbi.nlm.nih.gov/31833876/ |journal=American Journal of Therapeutics |language=en |volume=27 |issue=1 |pages=e71–e78 |doi=10.1097/MJT.0000000000001078 |issn=1536-3686 |pmid=31833876|s2cid=209340414 }}</ref> Continuity of care and long-term follow-up is crucial in successful patient outcomes.<ref>{{Cite journal |last1=Jackson |first1=Claire |last2=Ball |first2=Lauren |date=October 2018 |title=Continuity of care: Vital, but how do we measure and promote it? |journal=Australian Journal of General Practice |volume=47 |issue=10 |pages=662–664 |doi=10.31128/AJGP-05-18-4568 |issn=2208-7958 |pmid=31195766|s2cid=169207062 |doi-access=free |hdl=10072/391610 |hdl-access=free }}</ref><ref>{{Cite journal |last1=Kripalani |first1=Sunil |last2=LeFevre |first2=Frank |last3=Phillips |first3=Christopher O. |last4=Williams |first4=Mark V. |last5=Basaviah |first5=Preetha |last6=Baker |first6=David W. |date=2007-02-28 |title=Deficits in communication and information transfer between hospital-based and primary care physicians: implications for patient safety and continuity of care |url=https://pubmed.ncbi.nlm.nih.gov/17327525 |journal=JAMA |volume=297 |issue=8 |pages=831–841 |doi=10.1001/jama.297.8.831 |issn=1538-3598 |pmid=17327525}}</ref><ref>{{Cite journal |last1=Goodwin |first1=James S. |last2=Li |first2=Shuang |last3=Hommel |first3=Erin |last4=Nattinger |first4=Ann B. |last5=Kuo |first5=Yong-Fang |last6=Raji |first6=Mukaila |date=2021-08-02 |title=Association of Inpatient Continuity of Care With Complications and Length of Stay Among Hospitalized Medicare Enrollees |journal=JAMA Network Open |volume=4 |issue=8 |pages=e2120622 |doi=10.1001/jamanetworkopen.2021.20622 |issn=2574-3805 |pmc=9026593 |pmid=34383060}}</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> <ref>{{Cite journal |last=Berger |first=Jeffrey T. |date=2005 |title=Ignorance is bliss? Ethical considerations in therapeutic nondisclosure |url=https://pubmed.ncbi.nlm.nih.gov/15779872 |journal=Cancer Investigation |volume=23 |issue=1 |pages=94–98 |doi=10.1081/CNV-46392 |issn=0735-7907 |pmid=15779872|s2cid=22167459 }}</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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