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Internal medicine, also known as adult medicine, is the specialty of medicine which deals with the nonsurgical prevention, care and management of diseases affecting adults. Medical doctors who practice internal medicine are referred to as internists, adult doctors, general internists, or adult physicians. Sometimes, they are also called a “doctor’s doctor.” This is because other specialists, such as surgeons and obstetricians, sometimes consult with internists for aid in cases of diagnostic dilemma.
Internists often tend to be primary care physicians, which means that they are the first doctors whom patients go to when they have medical complaints. This is why they are sometimes confused with general practitioners and family medicine practitioners, although they are different. General practitioners are doctors who have finished medical school but who have not finished training in any medical specialty. On the contrary, family medicine practitioners are medical doctors who trained in family medicine, which has a more general take on adult medicine but also tackles basic pediatric, surgical and obstetric cases.
Also, internists are sometimes mistaken for medical interns. However, medical interns are doctors undergoing their first year of residency training, or in some countries, are students in their last year of medical school.
It takes about 7 to 8 years to be an internist, depending on the country. One must have finished 4 to 5 years of medical school, after which one takes 3 more years of residency training in internal medicine. In the United States, for example, one undergoes 4 years of medical school, then a year of internship in internal medicine, followed by 2 more years of residency training. Also, in the United States, individuals other than those with a degree in medicine (MD) may practice internal medicine. These include doctors of osteopathy (DO) and biomedical doctors (those with a degree in biomedical science).
Internists in the United States may belong to any of 2 bodies, the American Board of Internal Medicine (ABIM) and the American Osteopathic Board of Internal Medicine. These organizations are also in charge of certifying internists who go into particular subspecialties of internal medicine. Although internists may choose to practice general internal medicine, they may also opt to concentrate their medical practice on a particular field of internal medicine, or subspecialty. This entails about 2 to 3 more years of training, referred to as fellowship.
In general, subspecialties are based on organ systems. These include cardiology, concerned with the heart and the blood vessels; neurology, concerned with the brain and the rest of the nervous system; nephrology, concerned with the kidneys and the rest of the urinary system; infectious disease, concerned with disease caused by infectious agents in the form of bacteria, viruses, and parasites; gastroenterology, concerned with the digestive tract; oncology, concerned with cancer; endocrinology, concerned with the organs of the endocrine system and the substances they secrete, called hormones; pulmonology, concerned with the lungs and the rest of the respiratory system; hematology, concerned with the blood and the organs which produce the components of blood; rheumatology, concerned with the musculoskeletal system; dermatology, concerned with the skin; allergology and immunology, concerned with the immune system; and so on and so forth. Other subspecialties include geriatrics, which deals with the care of elderly individuals, and sports medicine, which specializes in the care of athletes. Still other subspecialties are critical care medicine, adolescent medicine, nuclear medicine, clinical cardiac electrophysiology, and transplant hepatology.
The primary tools used by internists to diagnose and treat their patients are the clinical history and physical examination. Although this applies to all doctors in general, a good clinical history and physical examination are especially important to the internist. Aside from the history of the patient’s chief complaint and illness at the time of consult, the clinical history includes the general data, review of systems, past and family medical histories, and personal and social history. The physical examination is a systematic and organized method of inspecting the different organ systems.
Often, the clinical history and physical examination suffice for the internist to make a list of differential diagnoses, from which the internist derives his final diagnosis. Internists are also guided by the principle of parsimony, which states that, as much as possible, one diagnosis should be used to explain all the symptoms and signs of the patient.
Internists also make use of various diagnostics, such as blood tests, imaging, culture, biopsy and the like, to aid in the screening, diagnosing, and treating of diseases.
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