Internal medicine
[1] Internists possess specialized skills in managing patients with undifferentiated or multi-system disease processes.
They provide care to both hospitalized (inpatient) and ambulatory (outpatient) patients and often contribute significantly to teaching and research.
Internists primarily work in hospitals, as their patients are frequently seriously ill or require extensive medical tests.
[14] They are often called upon to address undifferentiated presentations that do not fit neatly within the scope of a single-organ specialty,[15] such as shortness of breath, fatigue, weight loss, chest pain, confusion, or alterations in conscious state.
[15] 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".
The training of internists is solely focused on adults and does not typically include surgery, obstetrics, or pediatrics.
Internists also receive substantial training in various recognized subspecialties within the field and are experienced in both inpatient and outpatient settings.
[21] Following completion of entry-level training, newly graduated medical practitioners are often required to undertake a period of supervised practice before their licensure, or registration, is granted, typically one or two years.
[25][26] In the UK, the General Medical Council oversees licensing and certification of internal medicine physicians.
The role of general medicine, after a period of decline, was reemphasised by the Royal College of Physicians of London report from the Future Hospital Commission (2013).
[36][37] The internal medicine specialist is recognized in every country in the European Union and typically requires five years of multi-disciplinary post-graduate education.
[34] 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.
[28] The fields of specialty practice are approved by the Council of Australian Governments (COAG) and managed by the MBA.
[29] Internists may practice in Canada as generalists in Internal Medicine or serve in one of seventeen subspecialty areas.
[45] Internists may work in many settings including outpatient clinics, inpatient wards, critical care units, and emergency departments.
The currently recognized subspecialties include the following:[43] Medicine is mainly focused on the art of diagnosis and treatment with medication.
[55] The list is dynamic and changes as the physician obtains additional information that makes a condition more ("rule-in") or less ("rule-out") likely based on the disease profile.
[56][57] The list is used to determine what information will be acquired next, including which diagnostic test or imaging modality to order.
[63] Communication to the patient is also important to ensure there is informed consent and shared decision-making throughout the diagnostic process.
[72][73][74] Aside from diagnosing and treating acute conditions, the Internist may also assess disease risk and recommend preventive screening and intervention.
[75][76] Internists also routinely provide pre-operative medical evaluations including individualized assessment and communication of operative risk.
Medical ethics guidelines in the Western world typically follow four principles including beneficence, non-maleficence, patient autonomy, and justice.
[84][85] Providing treatment including prescribing medications based on remote information gathering without a proper established relationship is not accepted as good practice with few exceptions.
[82] The ethics of telemedicine including questions on its impact to diagnosis, physician-patient relationship, and continuity of care have been raised.
[82][87] However, with appropriate use and specific guidelines, risks may be minimized and the benefits including increased access to care may be realized.
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.
