An explanation by Dr. Kordonowy
Speaking to patients as well as personal friends, I have become aware that many patients do not understand what an Internal Medicine physician is or does. We are the broadest specialty that diagnoses and manages adult health problems. Surgery is another example of a broad specialty from which various surgical subspecialties arise. We are not interns-an intern is a first year resident. We are also not General Practitioners (GP).
The term Internal Medicine comes from the German name Innere Medizin (prounounced in-‘err-a med-i-tzeen’), popularized in Germany 100 years ago to describe physicians who combined the science of the laboratory with the care of patients. Many early 20th Century American doctors studied medicine in Germany and brought this new field-which married scientific discovery to the healing art-to the US. They adopted the name Internal Medicine. Like some words adopted from other languages, it doesn’t fit any American meaning. This is likely why they’re so much confusion around an Internist. We are one of three specialties in the area known as Primary Care- the other two being Pediatrics and Family Medicine. Primary care physicians can be viewed as personal health care advisers for patients. We function as physicians who guide patients through the complex system of modern health care services. Modern health care services include: preventive services including vaccinations, referring to other specialists, assisting in getting admitted to the hospital, coordinating prescriptions, as well as coordinating home health care and/or durable medical equipment.
On any given day I wear multiple medical “hats”. My first appointment might involve a health physical where I am making sure a patient has had all the proper vaccinations and is getting cancer screening and not developing the most common of adult silent illnesses such as obesity, hypertension or diabetes. In that first room the patient’s complaint of new scaling skin lesions may require that I be a Dermatologist and diagnose and perhaps treat the problem. In the next room a patient may be complaining of cough and sputum changes, which falls in the field of Pulmonary Medicine. My third appointment may involve complaints related to the heart system and thus on goes my Cardiology ”hat”. Many times in a single visit, I may wear 2, 3, or even four different physician “hats”. The above described typical day illustrates why my field is called General Internal Medicine. I see, evaluate and manage many general/common adult health problems.
One description of Internal Medicine that I find resonates the best with patients is when I suggest they view me as the “Pediatrician for Adults”. Sometimes Internists referred themselves as “Doctors for Adults”. Family medicine physicians take care of patients from infancy to the end-of-life and often have surgical training as part of their comprehensive training. Family medicine physicians are even broader in their patient responsibility and skill set. Traditionally, Internists have a much more intensive hospital training background than Family Medicine physicians. Also Internists focus a full 3 years of their residency taking care of complex adult medical illnesses.
Many subspecialties that people are familiar with come from within the field of Internal Medicine. Examples include: Pulmonary and Critical Care, Endocrinology, Nephrology, Rheumatology, Gastroenterology, Cardiology, Hematology/Oncology, and Infectious Disease. All of the mentioned specialties in the prior list were first trained as General Internists. After taking their Internal Medicine Board exams, they subsequently went on and trained between 2-4 years of additional fellowship training in their particular subspecialty. When I trained in Internal Medicine, I spent at least one month training side-by-side with a specialist in all the above-mentioned fields. This is typical training for Internal Medicine physicians.
As a patient, if you are thinking you might need a subspecialist such as a cardiologist, I wish for you to understand that your general Internist has extensive prior training as well as medical knowledge in that field. The cardiology subspecialist went on to become more intensely exposed to cardiac conditions and specifically they learned interventional techniques as related to cardiovascular disease diagnosis and management. As an internist, I view the need for the subspecialists as necessary when specific diagnostic procedures or treatment plans that are new or unusual are needed to manage a medical problem. For the common subspecialty conditions an Internist is fully capable of managing the problem. Patients often have more than one medical condition that falls within the very subspecialties. Again it is best to be managed by a general Internal Medicine physician who is capable of using medications from the various specialties inhelping patients not take harmful combinations are duplicate medications. This is where the “quarterback “ function of your Internist is highlighted.
Doctors as a whole refer to the Internist as the “Doctor’s Doctor.” Internists tend to be the “detectives of health” and are known for their diagnostic skills. If a person has a unusual or difficult medical problem that perhaps no one has yet labeled, they are best served by seeing an Internist. As you’re internist, I am the “go to” quarterback physician. Unless you have suffered an obvious trauma, I recommend you call upon me and my colleagues to evaluate any ailment you may develop. By starting with an internist you can be effectively diagnosed and removed through the complex health care system efficiently. I recommend the average patient not tried to self refer to a specialist based on a particular physical complaint. Since the human body is very complex we may have various symptoms and complaints related to various diseases. If you send yourself to a neurologist when in fact you need a neurosurgeon, you have wasted important time as well as money and physician resources. If your cough happens to be related to a cardiac condition but you assumed it is a lung problem, your referral to a Pulmonary Specialist might result in delayed treatment or proper diagnosis.
Many patients do not understand the wide skill set that Internal Medicine physicians have. Depending upon an Internal Medicine physician’s training and procedural experience, we are often are able to manage a large majority of things that are also seen by specialists. As an example, I am very comfortable providing cryotherapy to premalignant and early malignant skin cancers. I provide injections to large joints such as the knee and shoulder and all of us in our group supervise and interpret EKG’s and cardiac stress tests. When it comes to musculoskeletal disorders, our patients are often surprised that we can coordinate diagnostic imaging such as MRI if necessary and appropriate. In the majority of cases musculoskeletal complaints are best remedied with conservative management such as stretching and/or physical therapy. Our electronic medical record system provides very useful handouts that provide information and illustrations for patients to begin taking care of their problem at home. If our conservative recommendations fail or a person’s pain is so acute that they need more hands-on assistance, we can readily refer them to independent physical or occupational therapists. This approach is a more effective utilization of our health care system and helps reduce the burden on our specialists in the areas of orthopedics and neurosurgery. The price of an Internal Medicine office assessment offers terrific value. An internist can diagnosis and manage a multitude of medical conditions that technically fall into the field of numerous subspecialties but quite frankly don’t require a subspecialist level of expertise to manage in the majority of cases. I encouraged our readers to visit our website and specifically look at the services we provide to get better idea of what an internal medicine physician is capable of.