Internal medicine, also known as general medicine in

Commonwealth nations The Commonwealth of Nations, often referred to as the British Commonwealth or simply the Commonwealth, is an International organization, international association of member states of the Commonwealth of Nations, 56 member states, the vast majo ...

, is a

medical specialty A medical specialty is a branch of medical practice that is focused on a defined group of patients, diseases, skills, or philosophy. Examples include those branches of medicine that deal exclusively with children (pediatrics), cancer (oncology), ...

for medical doctors focused on the prevention, diagnosis, and treatment of diseases in adults. Its namesake stems from "treatment of diseases of the internal organs". Medical practitioners of internal medicine are referred to as internists, or physicians in Commonwealth nations. Internists possess specialized skills in managing patients with undifferentiated or multi-system disease processes. They provide care to both hospitalized (

inpatient A patient is any recipient of health care services that are performed by healthcare professionals. The patient is most often ill or injured and in need of treatment by a physician, nurse, optometrist, dentist, veterinarian, or other heal ...

) and

ambulatory The ambulatory ( 'walking place') is the covered passage around a cloister or the processional way around the east end of a cathedral or large church and behind the high altar. The first ambulatory was in France in the 11th century but by the 13t ...

(outpatient) patients and often contribute significantly to teaching and research. Internists are qualified physicians who have undergone

postgraduate Postgraduate education, graduate education, or graduate school consists of academic or professional degrees, certificates, diplomas, or other qualifications usually pursued by post-secondary students who have earned an undergraduate (bachelor' ...

training in internal medicine, and should not be confused with " interns", a term commonly used for a medical doctor who has obtained a

medical degree A medical degree is a professional degree admitted to those who have passed coursework in the fields of medicine and/or surgery from an accredited medical school. Obtaining a degree in medicine allows for the recipient to continue on into special ...

but does not yet have a license to practice medicine unsupervised. In the United States and Commonwealth nations, there is often confusion between internal medicine and

family medicine Family medicine is a medical specialty that provides continuing and comprehensive health care for the individual and family across all ages, genders, diseases, and parts of the body. The specialist, who is usually a primary care physician, is ...

, with people mistakenly considering them equivalent. Internists primarily work in hospitals, as their patients are frequently seriously ill or require extensive

medical test A medical test is a medical procedure performed to detect, diagnose, or monitor diseases, disease processes, susceptibility, or to determine a course of treatment. Medical tests such as, physical and visual exams, diagnostic imaging, genetic ...

s. Internists often have

subspecialty A subspecialty or subspeciality (see spelling differences) is a narrow field of professional knowledge/skills within a specialty of trade, and is most commonly used to describe the increasingly more diverse medical specialties. A subspecialist is ...

interests in diseases affecting particular organs or organ systems. The certification process and available subspecialties may vary across different countries. Additionally, internal medicine is recognized as a specialty within

clinical pharmacy 230px, A hospital pharmacist is checking a liquid solution. Clinical pharmacy is the branch of pharmacy in which clinical pharmacists provide direct patient care that optimizes the use of medication and promotes health, wellness, and disease p ...

and

veterinary medicine Veterinary medicine is the branch of medicine that deals with the prevention, management, medical diagnosis, diagnosis, and treatment of disease, disorder, and injury in non-human animals. The scope of veterinary medicine is wide, covering all a ...

Etymology and historical development

The term ''internal medicine'' in English has its

etymology Etymology ( ) is the study of the origin and evolution of words—including their constituent units of sound and meaning—across time. In the 21st century a subfield within linguistics, etymology has become a more rigorously scientific study. ...

in the 19th-century German term '. Originally, internal medicine focused on determining the underlying "internal" or pathological causes of

symptoms Signs and symptoms are diagnostic indications of an illness, injury, or condition. Signs are objective and externally observable; symptoms are a person's reported subjective experiences. A sign for example may be a higher or lower temperature ...

and

syndrome A syndrome is a set of medical signs and symptoms which are correlated with each other and often associated with a particular disease or disorder. The word derives from the Greek language, Greek σύνδρομον, meaning "concurrence". When a sy ...

s through a combination of medical tests and bedside clinical examination of patients. It emphasized treatment of the diseases affecting the internal organs of the body. This approach differed from earlier generations of physicians, such as the 17th-century English physician

Thomas Sydenham Thomas Sydenham (; 10 September 1624 – 29 December 1689) was an England, English physician. He was the author of ''Observationes Medicae'' (1676) which became a standard textbook of medicine for two centuries so that he became known as 'The ...

, known as the father of English medicine or "the English

Hippocrates Hippocrates of Kos (; ; ), also known as Hippocrates II, was a Greek physician and philosopher of the Classical Greece, classical period who is considered one of the most outstanding figures in the history of medicine. He is traditionally referr ...

." Sydenham developed the field of

nosology Nosology () is the branch of medical science that deals with the classification of diseases. Fully classifying a medical condition requires knowing its cause (and that there is only one cause), the effects it has on the body, the symptoms th ...

(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 The natural history of disease is the course a disease takes in individual people from its pathological onset ("inception") until its resolution (either through complete recovery or eventual death). The inception of a disease is not a firmly defi ...

and their treatment. Sydenham emphasized understanding the internal mechanisms and causes of symptoms rather than dissecting

cadaver A cadaver, often known as a corpse, is a Death, dead human body. Cadavers are used by medical students, physicians and other scientists to study anatomy, identify disease sites, determine causes of death, and provide tissue (biology), tissue to ...

s and scrutinizing the internal workings of the body. In the 17th century, there was a shift towards

anatomical pathology Anatomical pathology (''Commonwealth'') or anatomic pathology (''U.S.'') is a medical specialty that is concerned with the diagnosis of disease based on the macroscopic, microscopic, biochemical, immunologic and molecular examination ...

and laboratory studies, and

Giovanni Battista Morgagni Giovanni Battista Morgagni (25 February 1682 – 6 December 1771) was an Italian anatomy, anatomist, generally regarded as the father of modern anatomical pathology, who taught thousands of medical students from many countries during his 56 year ...

, an Italian anatomist of the 18th century, is considered the father of anatomical pathology.

Laboratory investigation A medical laboratory or clinical laboratory is a laboratory where tests are conducted out on clinical specimens to obtain information about the health of a patient to aid in diagnosis, treatment, and prevention of disease. Clinical medical labor ...

s gained increasing significance, with contributions from physicians like German physician and bacteriologist

Robert Koch Heinrich Hermann Robert Koch ( ; ; 11 December 1843 – 27 May 1910) was a German physician and microbiologist. As the discoverer of the specific causative agents of deadly infectious diseases including tuberculosis, cholera and anthrax, he i ...

in the 19th century. During this time, internal medicine emerged as a field that integrated the clinical approach with the use of investigations. Many American physicians of the early 20th century studied medicine in Germany and introduced this medical field to the United States, adopting the name "internal medicine" in imitation of the existing German term. Internal medicine has historical roots in

ancient India Anatomically modern humans first arrived on the Indian subcontinent between 73,000 and 55,000 years ago. The earliest known human remains in South Asia date to 30,000 years ago. Sedentism, Sedentariness began in South Asia around 7000 BCE; ...

and

ancient China The history of China spans several millennia across a wide geographical area. Each region now considered part of the Chinese world has experienced periods of unity, fracture, prosperity, and strife. Chinese civilization first emerged in the Y ...

. The earliest texts about internal medicine can be found in the

Ayurvedic Ayurveda (; ) is an alternative medicine system with historical roots in the Indian subcontinent. It is heavily practised throughout India and Nepal, where as much as 80% of the population report using ayurveda. The theory and practice of ayur ...

anthologies of

Charaka Charaka was one of the principal contributors to Ayurveda, a system of medicine and lifestyle developed in ancient India. He is known as a physician who edited the medical treatise entitled ''Charaka Samhita'', one of the foundational texts of ...

Role of internal medicine specialists

Internal medicine specialists, also referred to as general internal medicine specialists or general medicine physicians in Commonwealth countries, are specialized physicians trained to manage complex or multisystem disease conditions that single-organ specialists may not be equipped to handle. They are often called upon to address undifferentiated presentations that do not fit neatly within the scope of a single-organ specialty, such as shortness of breath, fatigue, weight loss, chest pain, confusion, or alterations in conscious state. They may manage serious acute illnesses that affect multiple organ systems concurrently within a single patient, as well as the management of multiple

chronic diseases A chronic condition (also known as chronic disease or chronic illness) is a health condition or disease that is persistent or otherwise long-lasting in its effects or a disease that comes with time. The term ''chronic'' is often applied when the ...

in a single patient. While many internal medicine physicians choose to subspecialize in specific

organ system An organ system is a biological system consisting of a group of organ (biology), organs that work together to perform one or more bodily functions. Each organ has a specialized role in an organism body, and is made up of distinct Tissue (biolog ...

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. 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". Although internists may serve as

primary care physician A primary care physician (PCP) is a physician who provides both the first contact for a person with an undiagnosed health concern as well as continuing care of varied medical conditions, not limited by cause, organ system, or diagnosis. The term ...

s, they are not synonymous with " family physicians", "family practitioners", "

general practitioners A general practitioner (GP) is a doctor who is a Consultant (medicine), consultant in general practice. GPs have distinct expertise and experience in providing whole person medical care, whilst managing the complexity, uncertainty and risk ass ...

", or "GPs". The training of internists is solely focused on adults and does not typically include

surgery Surgery is a medical specialty that uses manual and instrumental techniques to diagnose or treat pathological conditions (e.g., trauma, disease, injury, malignancy), to alter bodily functions (e.g., malabsorption created by bariatric surgery s ...

obstetrics Obstetrics is the field of study concentrated on pregnancy, childbirth and the postpartum period. As a medical specialty, obstetrics is combined with gynecology under the discipline known as obstetrics and gynecology (OB/GYN), which is a su ...

, or

pediatrics Pediatrics (American English) also spelled paediatrics (British English), is the branch of medicine that involves the medical care of infants, children, Adolescence, adolescents, and young adults. In the United Kingdom, pediatrics covers many o ...

. According to the

American College of Physicians The American College of Physicians (ACP) is a Philadelphia-based national organization of internal medicine physicians, who specialize in the diagnosis, treatment, and care of adults. With 161,000 members, ACP is the largest medical-specialty or ...

, internists are defined as "physicians who specialize in the prevention, detection, and treatment of illnesses in adults." 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. 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.

Education and training

The training and career pathways for internists vary considerably across different countries. Many programs require previous undergraduate education prior to medical school admission. This "

pre-medical Pre-medical (often referred to as pre-med) is an educational track that undergraduate students mostly in the United States pursue prior to becoming medical students. It involves activities that prepare a student for medical school, such as pre-med ...

" education is typically four or five years in length. Graduate medical education programs vary in length by country. Medical education programs are

tertiary Tertiary (from Latin, meaning 'third' or 'of the third degree/order..') may refer to: * Tertiary period, an obsolete geologic period spanning from 66 to 2.6 million years ago * Tertiary (chemistry), a term describing bonding patterns in organic ch ...

-level courses, undertaken at a

medical school A medical school is a tertiary educational institution, professional school, or forms a part of such an institution, that teaches medicine, and awards a professional degree for physicians. Such medical degrees include the Bachelor of Medicine, ...

attached to a

university A university () is an educational institution, institution of tertiary education and research which awards academic degrees in several Discipline (academia), academic disciplines. ''University'' is derived from the Latin phrase , which roughly ...

. In the US, medical school consists of four years. Hence, gaining a basic medical education may typically take eight years, depending on jurisdiction and university. Following completion of entry-level training, newly graduated medical practitioners are often required to undertake a period of supervised practice before their

licensure Occupational licensing, also called licensure, is a form of government regulation requiring a license to pursue a particular profession or vocation for compensation. It is related to occupational closure. Some claim higher public support for ...

, or ''registration'', is granted, typically one or two years. This period may be referred to as "

internship An internship is a period of work experience offered by an organization for a limited period of time. Once confined to medical graduates, internship is used to practice for a wide range of placements in businesses, non-profit organizations and g ...

", "conditional registration", or "

foundation programme The Foundation Programme is a two-year structured programme of workplace-based learning for junior doctors that forms a bridge between medical school and specialty training. The programme aims to provide a safe, well-supervised environment for d ...

". Then, doctors may follow specialty training in internal medicine if they wish, typically being selected to training programs through competition. In North America, this period of postgraduate training is referred to as

residency training Residency or postgraduate training is a stage of graduate medical education. It refers to a qualified physician (one who holds the degree of MD, DO, MBBS/MBChB), veterinarian ( DVM/VMD, BVSc/BVMS), dentist ( DDS or DMD), podiatrist ( DPM), o ...

, followed by an optional

fellowship A fellow is a title and form of address for distinguished, learned, or skilled individuals in academia, medicine, research, and industry. The exact meaning of the term differs in each field. In learned or professional societies, the term refers ...

if the internist decides to train in a subspecialty. In most countries, residency training for internal medicine lasts three years and centers on secondary and tertiary levels of

health care Health care, or healthcare, is the improvement or maintenance of health via the preventive healthcare, prevention, diagnosis, therapy, treatment, wikt:amelioration, amelioration or cure of disease, illness, injury, and other disability, physic ...

, as opposed to

primary health care Primary health care (PHC) is a whole-of-society approach to effectively organise and strengthen national health systems to bring services for health and wellbeing closer to communities. Primary health care enables health systems to support a pe ...

. In Commonwealth countries, trainees are often called

senior house officer A senior house officer (SHO) is a non-consultant hospital doctor in Ireland and many Commonwealth countries. SHOs usually have a minimum of 1 year post medical school training. SHOs are supervised in their work by consultants and registrars. In tr ...

s for four years after the completion of their medical degree (foundation and core years). After this period, they are able to advance to registrar grade when they undergo a compulsory subspecialty training (including acute internal medicine or a dual subspecialty including internal medicine). This latter stage of training is achieved through competition rather than just by yearly progress as the first years of postgraduate training.

Certification

In the US, three organizations are responsible for the certification of trained internists (i.e., doctors who have completed an accredited residency training program) in terms of their knowledge, skills, and attitudes that are essential for patient care: the

American Board of Internal Medicine The American Board of Internal Medicine (ABIM) is a 501(c)(3) nonprofit, self-appointed physician-evaluation organization that certifies physicians practicing internal medicine and its subspecialties. The American Board of Internal Medicine is no ...

, the American Osteopathic Board of Internal Medicine and the Board of Certification in Internal Medicine. In the UK, the

General Medical Council The General Medical Council (GMC) is a public body that maintains the official register of physician, medical practitioners within the United Kingdom. Its chief responsibility is to "protect, promote and maintain the health and safety of the pu ...

oversees licensing and certification of internal medicine physicians. The

Royal Australasian College of Physicians The Royal Australasian College of Physicians (RACP) is a not-for-profit professional organisation responsible for training and educating physicians and paediatricians across Australia and New Zealand. The RACP is responsible for training both ...

confers fellowship to internists (and sub-specialists) in Australia. The

Medical Council of Canada The Medical Council of Canada (MCC; ) is an organization charged with the partial assessment and evaluation of medical graduates and physicians through standardized examination. It grants the qualification called Licentiate of the Medical Council ...

oversees licensing of internists in Canada.

Subspecialties

United States of America

In the US, two organizations are responsible for certification of subspecialists within the field: the

and the American Osteopathic Board of Internal Medicine. Physicians (not only internists) who successfully pass board exams receive "board certified" status.

= American Board of Internal Medicine

= The following are the subspecialties recognized by the

. *

Adolescent medicine Adolescent medicine, also known as adolescent and young adult medicine, is a medical subspecialty that focuses on care of patients who are in the adolescent period of development. This period begins at puberty and lasts until growth has stopped, ...

* Adult congenital heart disease * Advanced heart failure and transplant cardiology *

Allergy Allergies, also known as allergic diseases, are various conditions caused by hypersensitivity of the immune system to typically harmless substances in the environment. These diseases include Allergic rhinitis, hay fever, Food allergy, food al ...

and

immunology Immunology is a branch of biology and medicine that covers the study of Immune system, immune systems in all Organism, organisms. Immunology charts, measures, and contextualizes the Physiology, physiological functioning of the immune system in ...

, concerned with the diagnosis, treatment and management of

allergies Allergies, also known as allergic diseases, are various conditions caused by hypersensitivity of the immune system to typically harmless substances in the environment. These diseases include Allergic rhinitis, hay fever, Food allergy, food al ...

asthma Asthma is a common long-term inflammatory disease of the airways of the lungs. It is characterized by variable and recurring symptoms, reversible airflow obstruction, and easily triggered bronchospasms. Symptoms include episodes of wh ...

and disorders of the

immune In biology, immunity is the state of being insusceptible or resistant to a noxious agent or process, especially a pathogen or infectious disease. Immunity may occur naturally or be produced by prior exposure or immunization. Innate and adaptive ...

system. *

Cardiovascular disease Cardiovascular disease (CVD) is any disease involving the heart or blood vessels. CVDs constitute a class of diseases that includes: coronary artery diseases (e.g. angina, heart attack), heart failure, hypertensive heart disease, rheumati ...

, dealing with disorders of the

heart The heart is a muscular Organ (biology), organ found in humans and other animals. This organ pumps blood through the blood vessels. The heart and blood vessels together make the circulatory system. The pumped blood carries oxygen and nutrie ...

and

blood vessels Blood vessels are the tubular structures of a circulatory system that transport blood throughout many animals’ bodies. Blood vessels transport blood cells, nutrients, and oxygen to most of the tissues of a body. They also take waste an ...

* * Clinical cardiac electrophysiology *

Critical care medicine Intensive care medicine, usually called critical care medicine, is a medical specialty that deals with seriously or critically ill patients who have, are at risk of, or are recovering from conditions that may be life-threatening. It includes ...

, is dealing with life-threatening conditions requiring intensive monitoring and treatment. * Endocrinology, diabetes & metabolism, dealing with disorders of the

endocrine system The endocrine system is a messenger system in an organism comprising feedback loops of hormones that are released by internal glands directly into the circulatory system and that target and regulate distant Organ (biology), organs. In vertebrat ...

and its specific secretions called

hormones A hormone (from the Greek participle , "setting in motion") is a class of signaling molecules in multicellular organisms that are sent to distant organs or tissues by complex biological processes to regulate physiology and behavior. Hormones a ...

Gastroenterology Gastroenterology (from the Greek gastḗr- "belly", -énteron "intestine", and -logía "study of") is the branch of medicine focused on the digestive system and its disorders. The digestive system consists of the gastrointestinal tract, sometime ...

, concerned with the field of

digestive diseases Gastrointestinal diseases (abbrev. GI diseases or GI illnesses) refer to diseases involving the gastrointestinal tract, namely the esophagus, stomach, small intestine, large intestine and rectum; and the accessory organs of digestion, the liver, ...

Geriatric medicine Geriatrics, or geriatric medicine, is a medical specialty focused on addressing the unique health needs of older adults. The term ''geriatrics'' originates from the Greek γέρων ''geron'' meaning "old man", and ιατρός ''iatros'' meani ...

Hematology Hematology (American and British English spelling differences#ae and oe, spelled haematology in British English) is the branch of medicine concerned with the study of the cause, prognosis, treatment, and prevention of diseases related to bloo ...

, concerned with

blood Blood is a body fluid in the circulatory system of humans and other vertebrates that delivers necessary substances such as nutrients and oxygen to the cells, and transports metabolic waste products away from those same cells. Blood is com ...

, the blood-forming organs and its disorders. * Hospice & palliative medicine *

Infectious disease An infection is the invasion of tissue (biology), tissues by pathogens, their multiplication, and the reaction of host (biology), host tissues to the infectious agent and the toxins they produce. An infectious disease, also known as a transmis ...

, concerned with disease caused by a

biological agent Biological agents, also known as biological weapons or bioweapons, are pathogens used as weapons. In addition to these living or replicating pathogens, toxins and Toxin#Biotoxins, biotoxins are also included among the bio-agents. More than 1,2 ...

such as by a

virus A virus is a submicroscopic infectious agent that replicates only inside the living Cell (biology), cells of an organism. Viruses infect all life forms, from animals and plants to microorganisms, including bacteria and archaea. Viruses are ...

bacterium Bacteria (; : bacterium) are ubiquitous, mostly free-living organisms often consisting of one biological cell. They constitute a large domain of prokaryotic microorganisms. Typically a few micrometres in length, bacteria were among the ...

parasite Parasitism is a Symbiosis, close relationship between species, where one organism, the parasite, lives (at least some of the time) on or inside another organism, the Host (biology), host, causing it some harm, and is Adaptation, adapted str ...

Interventional cardiology Interventional cardiology is a branch of cardiology that deals specifically with the catheter based treatment of structural heart diseases. Andreas Gruentzig is considered the father of interventional cardiology after the development of angioplast ...

* Medical oncology, dealing with the

chemotherapeutic Chemotherapy (often abbreviated chemo, sometimes CTX and CTx) is the type of cancer treatment that uses one or more anti-cancer drugs (chemotherapeutic agents or alkylating agents) in a standard regimen. Chemotherapy may be given with a curat ...

(chemical) and/or immunotherapeutic (immunological) treatment of

cancer Cancer is a group of diseases involving Cell growth#Disorders, abnormal cell growth with the potential to Invasion (cancer), invade or Metastasis, spread to other parts of the body. These contrast with benign tumors, which do not spread. Po ...

Nephrology Nephrology is a specialty for both adult internal medicine and pediatric medicine that concerns the study of the kidneys, specifically normal kidney function (renal physiology) and kidney disease (renal pathophysiology), the preservation of kid ...

, dealing with the study of the function and diseases of the

kidney In humans, the kidneys are two reddish-brown bean-shaped blood-filtering organ (anatomy), organs that are a multilobar, multipapillary form of mammalian kidneys, usually without signs of external lobulation. They are located on the left and rig ...

Neurocritical care Neurocritical care (or neurointensive care) is a medical field that treats life-threatening diseases of the nervous system and identifies, prevents, and treats secondary brain injury. History There have been many attempts to manage head inj ...

Pulmonary disease Respiratory diseases, or lung diseases, are pathological conditions affecting the organs and tissues that make gas exchange difficult in air-breathing animals. They include conditions of the respiratory tract including the trachea, bronchi, bron ...

, dealing with diseases of the

lungs The lungs are the primary organs of the respiratory system in many animals, including humans. In mammals and most other tetrapods, two lungs are located near the backbone on either side of the heart. Their function in the respiratory syste ...

and the

respiratory tract The respiratory tract is the subdivision of the respiratory system involved with the process of conducting air to the alveoli for the purposes of gas exchange in mammals. The respiratory tract is lined with respiratory epithelium as respirato ...

Rheumatology Rheumatology () is a branch of medicine devoted to the diagnosis and management of disorders whose common feature is inflammation in the bones, muscles, joints, and internal organs. Rheumatology covers more than 100 different complex diseases, c ...

, devoted to the

diagnosis Diagnosis (: diagnoses) is the identification of the nature and cause of a certain phenomenon. Diagnosis is used in a lot of different academic discipline, disciplines, with variations in the use of logic, analytics, and experience, to determine " ...

and therapy of

rheumatic Rheumatology () is a branch of medicine devoted to the diagnosis and management of disorders whose common feature is inflammation in the bones, muscles, joints, and internal organs. Rheumatology covers more than 100 different complex diseases, c ...

diseases *

Sleep medicine Sleep medicine is a medical specialty or subspecialty devoted to the diagnosis and therapy of sleep disturbances and disorders. From the middle of the 20th century, research has provided increasing knowledge of, and answered many questions a ...

Sports medicine Sports medicine is a branch of medicine that deals with physical fitness and the treatment and prevention of injuries related to sports and exercise. Although most sports teams have employed team physicians for many years, it is only since the ...

*Transplant

hepatology Hepatology is the branch of medicine that incorporates the study of liver, gallbladder, biliary tree, and pancreas as well as management of their disorders. Although traditionally considered a sub-specialty of gastroenterology, rapid expansion ...

= American College of Osteopathic Internists

= The American College of Osteopathic Internists recognizes the following subspecialties: *

Cardiology Cardiology () is the study of the heart. Cardiology is a branch of medicine that deals with disorders of the heart and the cardiovascular system. The field includes medical diagnosis and treatment of congenital heart defects, coronary artery di ...

*Cardiac electrophysiology *

Endocrinology Endocrinology (from ''endocrine system, endocrine'' + ''wikt:-logy#Suffix, -ology'') is a branch of biology and medicine dealing with the endocrine system, its diseases, and its specific secretions known as hormones. It is also concerned with the ...

Geriatrics Geriatrics, or geriatric medicine, is a medical specialty focused on addressing the unique health needs of older adults. The term ''geriatrics'' originates from the Greek γέρων ''geron'' meaning "old man", and ιατρός ''iatros'' mean ...

oncology Oncology is a branch of medicine that deals with the study, treatment, diagnosis, and prevention of cancer. A medical professional who practices oncology is an ''oncologist''. The name's Etymology, etymological origin is the Greek word ὄγ ...

s *

Oncology Oncology is a branch of medicine that deals with the study, treatment, diagnosis, and prevention of cancer. A medical professional who practices oncology is an ''oncologist''. The name's Etymology, etymological origin is the Greek word ὄγ ...

* Palliative care medicine *

Pulmonary Diseases Respiratory diseases, or lung diseases, are pathological conditions affecting the organs and tissues that make gas exchange difficult in air-breathing animals. They include conditions of the respiratory tract including the trachea, bronchi, bron ...

Pulmonology Pulmonology (, , from Latin ''pulmō, -ōnis'' "lung" and the Greek suffix "study of"), pneumology (, built on Greek πνεύμων "lung") or pneumonology () is a medical specialty that deals with diseases involving the respiratory tract. ...

United Kingdom

In the United Kingdom, the three medical Royal Colleges (the

Royal College of Physicians The Royal College of Physicians of London, commonly referred to simply as the Royal College of Physicians (RCP), is a British professional membership body dedicated to improving the practice of medicine, chiefly through the accreditation of ph ...

of London, the

Royal College of Physicians of Edinburgh The Royal College of Physicians of Edinburgh (RCPE) is a medical royal college in Scotland. It is one of three organisations that set the specialty training standards for physicians in the United Kingdom. It was established by royal charter i ...

and the

Royal College of Physicians and Surgeons of Glasgow The Royal College of Physicians and Surgeons of Glasgow is a global community of over 15,000 Members working together to develop skills, knowledge and leadership to drive the highest standards in healthcare. For 425 years, the Royal College of ...

) 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

(which also maintains the specialist register). Doctors who have completed medical school spend two years in 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 Membership of the Royal Colleges of Physicians of the United Kingdom (MRCP(UK)) is a postgraduate medical diploma in the United Kingdom (UK). The examinations are run by the Federation of the Medical Royal Colleges – the Royal College of Phys ...

, physicians commit to one of the medical specialties: * Acute internal medicine (with possible subspecialty in stroke medicine) *

* Audio vestibular medicine * Aviation and space medicine *

(with possible subspecialty in stroke medicine) *

Clinical genetics Medical genetics is the branch of medicine that involves the diagnosis and management of hereditary disorders. Medical genetics differs from human genetics in that human genetics is a field of scientific research that may or may not apply to m ...

Clinical neurophysiology Clinical neurophysiology is a medical specialty that studies the central and peripheral nervous systems through the recording of bioelectrical activity, whether spontaneous or stimulated. It encompasses both research regarding the pathophysiology ...

* Clinical oncology *

Clinical pharmacology and therapeutics Clinical may refer to: Healthcare * Of or about a clinic, a healthcare facility * Of or about the practice of medicine Other uses * Clinical (film), ''Clinical'' (film), a 2017 American horror thriller See also

* * * Clinical chemistry, the an ...

(with possible subspecialty in stroke medicine) *

Dermatology Dermatology is the branch of medicine dealing with the Human skin, skin.''Random House Webster's Unabridged Dictionary.'' Random House, Inc. 2001. Page 537. . It is a speciality with both medical and surgical aspects. A List of dermatologists, ...

* Endocrinology and diabetes mellitus *

(with possible subspecialty in

) * General (internal) medicine (with possible subspecialty in metabolic medicine or stroke medicine) *

Genito-urinary medicine Reproductive medicine is a branch of medicine concerning the male and female reproductive systems. It encompasses a variety of reproductive conditions, their prevention and assessment, as well as their subsequent treatment and prognosis. Reprodu ...

(with possible subspecialty in stroke medicine) *

Haematology Hematology ( spelled haematology in British English) is the branch of medicine concerned with the study of the cause, prognosis, treatment, and prevention of diseases related to blood. It involves treating diseases that affect the production ...

Immunology Immunology is a branch of biology and medicine that covers the study of Immune system, immune systems in all Organism, organisms. Immunology charts, measures, and contextualizes the Physiology, physiological functioning of the immune system in ...

s * Intensive care medicine * Medical microbiology * Medical oncology (clinical or radiation oncology falls under the

Royal College of Radiologists The Royal College of Radiologists (RCR) is the professional body responsible for the specialties of clinical oncology and clinical radiology throughout the United Kingdom. Its role is to advance the science and practice of radiology and oncol ...

, although entry is through CMT and MRCP is required) * Medical ophthalmology * Medical virology *

Neurology Neurology (from , "string, nerve" and the suffix wikt:-logia, -logia, "study of") is the branch of specialty (medicine) , medicine dealing with the diagnosis and treatment of all categories of conditions and disease involving the nervous syst ...

(with possible subspecialty in stroke medicine) *

Nuclear medicine Nuclear medicine (nuclear radiology, nucleology), is a medical specialty involving the application of radioactivity, radioactive substances in the diagnosis and treatment of disease. Nuclear imaging is, in a sense, ''radiology done inside out'', ...

* Occupational medicine * Paediatric cardiology (the only pediatric subspecialty not under the

Royal College of Paediatrics and Child Health The Royal College of Paediatrics and Child Health, often referred to as the RCPCH, is the professional body for paediatricians (doctors specialising in child health) in the United Kingdom. It is responsible for the postgraduate training of pa ...

) * Palliative medicine *

Rehabilitation medicine Physical medicine and rehabilitation (PM&R), also known as physiatry, and outside the United States as physical and rehabilitation medicine (PRM), is a branch of medicine that aims to enhance and restore functional ability and quality of life ...

(with possible subspecialty in stroke medicine) * Renal medicine *

Respiratory medicine ''Respiratory Medicine'' is a monthly peer-reviewed medical journal published by Elsevier covering research in pulmonology. According to the ''Journal Citation Reports'', ''Respiratory Medicine'' has a 2020 impact factor The impact factor (I ...

* Sport and exercise medicine *

Tropical medicine Tropical medicine is an interdisciplinary branch of medicine that deals with health issues that occur uniquely, are more widespread, or are more difficult to control in tropical and subtropical regions. Physicians in this field diagnose and tr ...

Many training programmes provide dual accreditation with general (internal) medicine and are involved in the general care to hospitalised patients. These are acute medicine, cardiology, Clinical Pharmacology and Therapeutics, endocrinology and diabetes mellitus, gastroenterology, infectious diseases, renal medicine, respiratory medicine and often, rheumatology. 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).

European Union

The European Board of Internal Medicine (EBIM) was formed as a collaborative effort between the

European Union of Medical Specialists The European Union of Medical Specialists (UEMS: Union Européenne des Médecins Spécialistes) is a professional organization of doctors representing medical specialists in the European Union, which was founded in 1958. It is the oldest medical ...

(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. 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. The internal medicine specialist is recognized in every country in the

European Union The European Union (EU) is a supranational union, supranational political union, political and economic union of Member state of the European Union, member states that are Geography of the European Union, located primarily in Europe. The u ...

and typically requires five years of multi-disciplinary post-graduate education. 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.

Australia

Accreditation for medical education and training programs in Australia is provided by the

Australian Medical Council The Australian Medical Council (AMC) is an independent national standards and assessment body for medical education and training. It was established in 1985. Purpose The purpose of the AMC is: :"To ensure that standards of education, training ...

(AMC) and the Medical Council of New Zealeand (MCNZ). The Medical Board of Australia (MBA) is the registering body for Australian doctors and provides information to the

Australian Health Practitioner Regulation Agency The Australian Health Practitioner Regulation Agency (Ahpra) is a cross-jurisdictional statutory authority responsible for the regulation of 16 common Health professional, health professions in Australia. While legislated responsibility for regul ...

(AHPRA). Medical graduates apply for provisional registration in order to complete intern training. Those completing an accredited internship program are then eligible to apply for general registration. Once the candidate completes the required basic and advanced post-graduate training and a written and clinical examination, the

confers designation Fellow of the Royal Australasian College of Physicians (FRACP). Basic training consists of three years of full-time equivalent (FTE) training (including intern year) and advanced training consists of 3–4 years, depending on specialty. The fields of specialty practice are approved by the Council of Australian Governments (COAG) and managed by the MBA. The following is a list of currently recognized specialist physicians. *

Clinical pharmacology Clinical pharmacology is "that discipline that teaches, does research, frames policy, gives information and advice about the actions and proper uses of medicines in humans and implements that knowledge in clinical practice". Clinical pharmacology ...

and

* General medicine *

* Haemotology * Immunology and allergy *

Infectious diseases infection is the invasion of tissues by pathogens, their multiplication, and the reaction of host tissues to the infectious agent and the toxins they produce. An infectious disease, also known as a transmissible disease or communicable dise ...

* Medical oncology *

Respiratory The respiratory system (also respiratory apparatus, ventilatory system) is a biological system consisting of specific organs and structures used for gas exchange in animals and plants. The anatomy and physiology that make this happen varies gr ...

and

sleep medicine Sleep medicine is a medical specialty or subspecialty devoted to the diagnosis and therapy of sleep disturbances and disorders. From the middle of the 20th century, research has provided increasing knowledge of, and answered many questions a ...

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. The

Royal College of Physicians and Surgeons of Canada The Royal College of Physicians and Surgeons of Canada () is a regulatory college which acts as a national, nonprofit organization established in 1929 by a special Act of Parliament to oversee the medical education of specialists in Canada. The ...

(RCPSC) is a national non-profit agency that oversees and accredits medical education in Canada. A full medical license in Internal Medicine in Canada requires a medical degree, a license from the

, completion of the required post-graduate education, and certification from the RCPSC. Any additional requirements from separate medical regulatory authorities in each province or territory is also required. Internists may practice in Canada as generalists in Internal Medicine or serve in one of seventeen subspecialty areas. Internists may work in many settings including outpatient clinics, inpatient wards, critical care units, and emergency departments. The currently recognized subspecialties include the following: *

* Endocrinology and metabolism *

* General internal medicine *

* Medical oncology * Clinical allergy and immunology *

Medical diagnosis and treatment

Medicine is mainly focused on the art of diagnosis and treatment with

medication Medication (also called medicament, medicine, pharmaceutical drug, medicinal product, medicinal drug or simply drug) is a drug used to medical diagnosis, diagnose, cure, treat, or preventive medicine, prevent disease. Drug therapy (pharmaco ...

. 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.

Gathering data

Data may be gathered directly from the patient in medical history-taking and

physical examination In a physical examination, medical examination, clinical examination, or medical checkup, a medical practitioner examines a patient for any possible medical signs or symptoms of a Disease, medical condition. It generally consists of a series of ...

. Previous medical records including laboratory findings, imaging, and clinical notes from other physicians is also an important source of information; however, it is vital to talk to and examine the patient to find out what the patient is currently experiencing to make an accurate diagnosis. Seattle physician with patient 1999

Internists often can perform and interpret diagnostic tests like EKGs and

ultrasound Ultrasound is sound with frequency, frequencies greater than 20 Hertz, kilohertz. This frequency is the approximate upper audible hearing range, limit of human hearing in healthy young adults. The physical principles of acoustic waves apply ...

imaging (Point-of-care Ultrasound – PoCUS). Internists who pursue sub-specialties have additional diagnostic tools, including those listed below. *

angioplasty Angioplasty, also known as balloon angioplasty and percutaneous transluminal angioplasty, is a minimally invasive procedure, minimally invasive endovascular surgery, endovascular Medical procedure, procedure used to widen narrowed or obstructe ...

cardioversion Cardioversion is a medical procedure by which an abnormally fast heart rate (tachycardia) or other cardiac arrhythmia is converted to a normal rhythm using electricity or drugs. Synchronized electrical cardioversion uses a therapeutic dose of ...

, cardiac ablation,

intra-aortic balloon pump The intra-aortic balloon pump (IABP) is a mechanical device that increases myocardial oxygen perfusion and indirectly increases cardiac output through afterload reduction. It consists of a cylindrical polyurethane balloon that sits in the aorta, ...

mechanical ventilation Mechanical ventilation or assisted ventilation is the Medicine, medical term for using a ventilator, ventilator machine to fully or partially provide artificial ventilation. Mechanical ventilation helps move air into and out of the lungs, wit ...

endoscopy An endoscopy is a procedure used in medicine to look inside the body. The endoscopy procedure uses an endoscope to examine the interior of a hollow organ or cavity of the body. Unlike many other medical imaging techniques, endoscopes are insert ...

and ERCP *

: dialysis *

bronchoscopy Bronchoscopy is an endoscopic technique of visualizing the inside of the airways for diagnostic and therapeutic purposes. An instrument (bronchoscope) is inserted into the airways, usually through the nose or mouth, or occasionally through a tr ...

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.

Generating diagnostic hypotheses

Determining which pieces of information are most important to the next phase of the diagnostic process is of vital importance. It is during this stage that clinical bias like anchoring or premature closure may be introduced. 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 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. Epidemiology and endemic conditions are also considered in creating and evaluating the list of diagnoses. 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. 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 specificity and sensitivity of a particular test. 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.

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. Tools to evaluate teamwork exist and have been employed in multiple settings. Communication to the patient is also important to ensure there is informed consent and shared decision-making throughout the diagnostic process.

Treatment

Treatment modalities generally include both pharmacological and non-pharmacological, depending on the primary diagnosis. Additional treatment options include referral to specialist care including physical therapy and rehabilitation. Treatment recommendations differ in the acute inpatient and outpatient settings. Continuity of care and long-term follow-up is crucial in successful patient outcomes.

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. Internists also routinely provide pre-operative medical evaluations including individualized assessment and communication of operative risk. 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. Studies show that there are no differences in patient outcomes in teaching versus non-teaching facilities. Medical research is an important part of most post-graduate education programs, and many licensed physicians continue to be involved in research activities after completing post-graduate training.

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. Thus, a strong ethical foundation is paramount to any medical profession. Medical ethics guidelines in the Western world typically follow four principles including beneficence,

non-maleficence ' () is a Latin phrase that means "first, do no harm". The phrase is sometimes recorded as '. Non-maleficence, which is derived from the maxim, is one of the principal precepts of bioethics that all students in healthcare are taught in school a ...

, patient autonomy, and

justice In its broadest sense, justice is the idea that individuals should be treated fairly. According to the ''Stanford Encyclopedia of Philosophy'', the most plausible candidate for a core definition comes from the ''Institutes (Justinian), Inst ...

. These principles underlie the patient-physician relationship and the obligation to put the welfare and interests of the patient above their own.

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.

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. These exceptions include cross-coverage within a practice and certain public health urgent or emergent issues. The ethics of telemedicine including questions on its impact to diagnosis, physician-patient relationship, and continuity of care have been raised. However, with appropriate use and specific guidelines, risks may be minimized and the benefits including increased access to care may be realized.

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. Physicians must disclose all possible

conflicts of interest A conflict of interest (COI) is a situation in which a person or organization is involved in multiple interests, financial or otherwise, and serving one interest could involve working against another. Typically, this relates to situations in whi ...

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.

References

External links

The American Academy of Allergy, Asthma & Immunology (AAAAI)American Board of Allergy & Immunology (ABAI)International Society of Internal MedicineInternal Medicine Society of Australia and New Zealand

The American Board of Internal MedicineCanadian Society of Internal MedicineThe American College of Osteopathic InternistsAmerican College of Physicians
{{DEFAULTSORT:Internal Medicine Hospital staff

Etymology and historical development

Role of internal medicine specialists

Education and training

Certification

Subspecialties

United States of America

= American Board of Internal Medicine

= American College of Osteopathic Internists

United Kingdom

European Union

Australia

Canada

Medical diagnosis and treatment

Gathering data

Generating diagnostic hypotheses

Communication

Treatment

Prevention and other services

Ethics

Patient-physician relationship

Treatment and telemedicine

Financial issues and conflicts of interest

Other topics

See also

References

Further reading

External links