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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|deu|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, 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=":5">{{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=":5" /><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 Medicale 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=":5" /><ref>{{Cite journal |last=Abyad |first=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 =====
The following are the subspecialties recognized by the [[American Board of Internal Medicine]].<ref name="
*[[Adolescent medicine]]
*[[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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===== American College of Osteopathic Internists =====
The [[American College of Osteopathic Internists]] recognizes the following subspecialties:<ref name="
*[[Allergy]]/[[immunology]]
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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="
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="
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="
==== Australia ====
Accreditation for medical education and training programs in Australia is provided by the [[Australian Medical Council]] (AMC) and the [[Medical Council of New Zealand|Medical Council of New Zealeand]] (MCNZ).<ref>{{Cite web |title=Australian Medical Council {{!}} The
* [[Cardiology]]
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==== Canada ====
After completing medical school, internists in Canada require an additional four years of training. Internists desiring to subspecialize are required to complete two additional years of training that may begin after the third year of internist training.<ref name="
* [[Critical care medicine]]
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* Clinical allergy and immunology
* [[Dermatology]]
* [[Nephrology]]
==Medical diagnosis and treatment==
Medicine is mainly focused on the art of diagnosis and treatment with [[medication]]. The diagnostic process involves gathering data, generating one or more diagnostic hypotheses, and iteratively testing these potential diagnoses against dynamic disease profiles to determine the best course of action for the patient.<ref name="
=== Gathering data ===
Data may be gathered directly from the patient in medical history-taking and [[physical examination]].<ref name="
[[File:Seattle physician with patient 1999.jpg|thumb|253x253px|History and physical examination are a vital part of the diagnostic process.<ref name="
Internists often can perform and interpret diagnostic tests like [[Electrocardiography|EKGs]] and [[ultrasound]] imaging (Point-of-care Ultrasound – PoCUS).<ref>{{Cite journal |
Internists who pursue sub-specialties have additional diagnostic tools, including those listed below.
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* [[Nephrology]]: [[Kidney dialysis|dialysis]]
* [[Pulmonology]]: [[bronchoscopy]]
Other tests are ordered, and patients are also referred to specialists for further evaluation. The effectiveness and efficiency of the specialist referral process is an area of potential improvement.<ref>{{Cite journal |
=== 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="
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>
=== Communication ===
Communication is a vital part of the diagnostic process. The Internist uses both synchronous and asynchronous communication with other members of the medical care team, including other internists, radiologists, specialists, and laboratory technicians.<ref>{{Cite journal |
Communication to the patient is also important to ensure there is informed consent and shared decision-making throughout the diagnostic process.<ref>{{Cite journal |
=== Treatment ===
Treatment modalities generally include both pharmacological and non-pharmacological, depending on the primary diagnosis.<ref>{{Cite journal |
=== Prevention and other services ===
Aside from diagnosing and treating acute conditions, the Internist may also assess disease risk and recommend preventive screening and intervention. Some of the tools available to the Internist include genetic evaluation.<ref>{{Cite journal |last=Laukaitis |first=Christina M. |date=January 2012 |title=Genetics for the general internist
Internists also routinely provide pre-operative medical evaluations including individualized assessment and communication of operative risk.<ref>{{Cite journal |
Training the next generation of internists is an important part of the profession. As mentioned above, post-graduate medical education is provided by licensed physicians as part of accredited education programs that are usually affiliated with teaching hospitals.<ref>{{Cite journal |
== Ethics ==
Inherent in any medical profession are legal and ethical considerations. Specific laws vary by jurisdiction and may or may not be congruent with ethical considerations.<ref name="
=== Patient-physician relationship ===
The relationship is built upon the physician obligations of competency, respect for the patient, and appropriate referrals while the patient requirements include decision-making and provides or withdraws consent for any treatment plan. Good communication is key to a strong relationship but has ethical considerations as well, including proper use of electronic communication and clear documentation.<ref>{{Cite journal |
=== Treatment and telemedicine ===
Providing treatment including prescribing medications based on remote information gathering without a proper established relationship is not accepted as good practice with few exceptions.<ref>{{Cite journal |date=2002-06-01 |title=Model Guidelines for the Appropriate Use of the Internet in Medical Practice
The ethics of [[Telehealth|telemedicine]] including questions on its impact to diagnosis, physician-patient relationship, and continuity of care have been raised;,<ref name="
=== Financial issues and conflicts of interest ===
Ethical considerations in financial include accurate billing practices and clearly defined financial relationships. Physicians have both a professional duty and obligation under the justice principle to ensure that patients are provided the same care regardless of status or ability to pay. However, informal copayment forgiveness may have legal ramifications and the providing professional courtesy may have negatively impact care.<ref name="
Physicians must disclose all possible [[Conflict of interest in the healthcare industry|conflicts of interest]] including financial relationships, investments, research and referral relationships, and any other instances that may subjugate or give the appearance of subjugating patient care to self-interest.<ref name="
=== Other topics ===
Other foundational ethical considerations include privacy, confidentiality, accurate and complete medical records, [[electronic health record]]s, disclosure, and informed decision-making and consent.<ref name="
[[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 |
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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