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Internists (in US elsewhere, especially in Commonwealth nations, such specialists are often called Physicians.) are specialists in Internal Medicine is the medical specialty concerned with the diagnosis, management and nonsurgical treatment of unusual or serious diseases. Because their patients are often seriously ill or require complex investigations, internists do much of their work in hospitals. Formerly, many internists were not subspecialized and would see any complex nonsurgical problem; this style of practice has become much less common.

In modern urban practice, most internists are subspecialists: that is, they generally limit their medical practice to problems of one organ system or to one particular area of medical knowledge. For example, gastroenterologists and nephrologists specialize respectively in diseases of the gut and the kidneys.

Internists have a lengthy clinical and scientific training in their areas of medical interest and have special expertise in the use of prescription drugs or other medical therapies (as opposed to surgery). While the name "Internal Medicine" may suggest that internists only treat problems of internal organs, this is not the case. Internists are trained to treat patients as whole people, not as mere organ systems.

Definition of an internist Edit

Internists are trained to diagnose severe, chronic illnesses and situations where several different illnesses may strike at the same time. They also help patients understand preventive medicines, men's and women's health, substance abuse, mental health, as well as effective treatment of common problems of the eyes, ears, skin, nervous system and reproductive organs. Most older adults in the United States see internists as their primary medical practitioners.

Education and training of internistsEdit

Main article: Medical education

The training and career pathways for internists vary considerably across the world.

First, they must receive the "entry-level" education required of any medical practitioner in the relevant jurisdiction. The entry-level for medical education programs are tertiary-level courses, undertaken at a medical school attached to a university.

Programs that require previous undergraduate education are usually four or five years in length. 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 the licensure, or registration, is granted, typically one or two years. This period may be referred to as, "internship" or "conditional registration." Then, internists require specialist training in internal medicine or one of its' subspecialities. In North America, this postgraduate training is often referred to as residency training; in Commonwealth countries, such trainees are often called registrars.

Training in medical specialties typically takes from three- to 10 years, and sometimes more, depending on specialty and jurisdiction. A medical practitioner who completes specialist training in internal medicine (or in one of its subspecialties) is an internist, or a medical specialist in the older, narrower sense. In some jurisdictions, training in internal medicine is begun immediately following completion of entry-level training, or even before. In other jurisdictions, a medical specialist must undertake generalist (un-streamed) training for one or more years before commencing specialization. Hence, depending on jurisdiction, an internist typically takes 12 or more years after commencing basic medical training — five to eight years at university to obtain a basic medical qualification and up to another six years to become a medical specialist. Internal Medicine subspecialists may also practice general internal medicine, but a particular subspecialty, i.e., cardiology or pulmonology licensure is granted after completing a fellowship (Additional training of 2-3 years).

Subspecialties of internal medicineEdit

In the United States, there are two organizations responsible for certification of subspecialists within the field, the American Board of Internal Medicine, and the American Osteopathic Board of Internal Medicine.

The following are the subspecialties recognized by the American Board of Internal Medicine.[1]

Internists may also specialize in "allergy" and "immunology." The American Board of Allergy, Asthma, and Immunology is a conjoint board between internal medicine and pediatrics.

The American College of Osteopathic Internists recognizes the following subspecialties.[2]



In addition to the above, in Canada, General Internal Medicine itself is considered a subspecialty. This usually involves 1-2 years of additional fellowship training above and beyond the 3-year core internal medicine training shared by all other subspecialists. This differs significantly from the system in the U.S. Canadian General Internal Medicine specialists frequently have procedural (ie: bronchoscopy, echocardiography, colonoscopy etc...) or research training (ie: epidemiology, public administration, medical teaching, etc...) incoporated into their 5-year postgraduate course.

Medical diagnosis and treatmentEdit

Medicine is mainly focused on the art of diagnosis and treatment with medication, but many subspecialties administer surgical treatment:

See also Edit

References & BibliographyEdit

Key textsEdit

BooksEdit

PapersEdit

  • Aboff, B. M. (1996). What are internists looking for? Journal of general internal medicine, 11(8).
  • Adamson, T. E., Rodnick, J. E., & Guillion, D. S. (1989). Family physicians and general internists: do they treat hypertensive patients differently? The Journal of family practice, 29(1), 93-99.
  • Alamoudi, O. S., & Al-Mohammadi, R. (2007). Internists in training; what do they know about inhalers? Eastern Mediterranean health journal = La revue de sante de la Mediterranee orientale = al-Majallah al-sihhiyah li-sharq al-mutawassit, 13(1), 160-167.
  • Alloggiamento, T., Cummings, S. R., & Redberg, R. F. (1999). Do cardiologists and general internists differ in testing and treating patients with aortic stenosis or mitral regurgitation? A preliminary study with editorial perspective. American heart journal, 137(4 Pt 1), 596-600.
  • Allyn, R. (1976). A library for internists. II. Recommended by the American College of Physicians. Annals of internal medicine, 84(3), 346-373.
  • Allyn, R. (1979). A library for internists III: recommended by the American College of Physicians. Annals of internal medicine, 90(3), 446-448.
  • Allyn, R. (1982). A library for internists IV. Recommended by the American College of Physicians. Annals of internal medicine, 96(3), 385-401.
  • Allyn, R., & Stearns, N. S. (1973). A library for Internists. Recommended by the American College of Physicians. Annals of internal medicine, 79(2), 293-322.
  • Alper, E. I. (1979). Work load of internists. Annals of internal medicine, 91(4).
  • Alpert, J. S. (2008). Why internists need to be able to manage patients with myocardial infarction. The American journal of medicine, 121(5).
  • Altman, I., Kroeger, H. H., Clark, D. A., Johnson, A. C., & Sheps, C. G. (1965). THE OFFICE PRACTICE OF INTERNISTS. II. PATIENT LOAD. JAMA : the journal of the American Medical Association, 193, 667-672.
  • Apsner, R., Muhm, M., Unver, B., HÃrl, W. H., & Sunder-Plassmann, G. (2001). Expanding our interventional skills: placement of totally implantable injection ports by internists/intensivists. Acta medica Austriaca, 28(1), 23-26.
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  • Aronov, D. M., Akhmedzhanov, N. M., Sokolova, O., Tkhostov, A., & Pervichko, E. I. (2006). [Attitude of district internists to the problem of secondary prevention of ischemic heart disease (results of a special questionnaire survey)]. Kardiologiia, 46(8), 18-25.
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  • Bailey, R. M. (1969). A comparison of internists in solo and fee-for-service group practice in the San Francisco Bay area. The New York journal of dentistry, 39(10), 447-453.
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  • Behrend, E. N., Kemppainen, R. J., Clark, T. P., Salman, M. D., & Peterson, M. E. (2002). Diagnosis of hyperadrenocorticism in dogs: a survey of internists and dermatologists. Journal of the American Veterinary Medical Association, 220(11), 1643-1649.
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  • Bochud, M., Cornuz, J., Vader, J. P., Kamm, W., & Burnand, B. (2002). Are internists in an non-prescriptive setting favourable to guidelines? A survey in a Department of Internal Medicine in Switzerland. Swiss medical weekly : official journal of the Swiss Society of Infectious Diseases, the Swiss Society of Internal Medicine, the Swiss Society of Pneumology, 132(15-16), 201-206.
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  • Bohinc, B., & Snyder, J. E. (2008). The effects of race, ethnicity, and underlying medical diseases on osteoporosis are still unguided territory for internists. Annals of internal medicine, 149(7), 514-515; author reply 515-516.
  • Boling, P. A., Keenan, J. M., Schwartzberg, J., Retchin, S. M., Olson, L., & Schneiderman, M. (1992). Reported home health agency referrals by internists and family physicians. Journal of the American Geriatrics Society, 40(12), 1241-1249.
  • Bonarjee, V. V., & Dickstein, K. (2001). Management of patients with heart failure: are internists as good as cardiologists? European heart journal, 22(7), 530-531.
  • Borowsky, S. J., Rubenstein, L. V., Skootsky, S. A., & Shapiro, M. F. (1997). Referrals by general internists and internal medicine trainees in an academic medicine practice. The American journal of managed care, 3(11), 1679-1687.
  • Bowman, M. A. (1990). Family physicians and internists: differences in practice styles and proposed reasons. The Journal of the American Board of Family Practice / American Board of Family Practice, 3(1), 43-49.
  • Boyce-Smith, G., Zier, B., & Deller, J. J., Jr. (1977). Deficiencies in the training of internists. Results of a survey. The Western journal of medicine, 127(5), 450-452.
  • Boyle, J. F. (1989). Achieving equity for internists: new challenges ahead. The Internist, 30(8), 34-35.
  • Brantley, J. T., Wise, T. N., & Ahmed, S. W. (1985). Consultation-liaison fellowships: Effect on internists' attitudes toward psychiatric consultation. Psychosomatics: Journal of Consultation Liaison Psychiatry, 26(1), 18-27.
  • Brennan, T. A. (2005). Recertification for internists--one "grandfather's" experience. The New England journal of medicine, 353(19), 1989-1992.
  • Brenner, B. E., & Kauffman, J. (1993). Reluctance of internists and medical nurses to perform mouth-to-mouth resuscitation. Archives of internal medicine, 153(15), 1763-1769.
  • Brenner, G., Heuer, H., Kerek-Bodden, H., Koch, H., & Lang, A. (2001). [5% of patients are responsible for 20% of health care costs in ambulatory internist practices. Documentation of diagnoses reveals the morbidity impact of high-risk patients on clinical practice of internists (as of 10.10.2000)]. Der Internist, 42(2), M35-41.
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  • Brett, A. S., Carney, P. I., & McKeown, R. E. (2005). Brief Report: Attitudes Toward Hormone Therapy After the Women's Health Initiative: A Comparison of Internists and Gynecologists. Journal of General Internal Medicine, 20(5), 416-418.
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  • Calenda, P., Jain, P., & Smith, L. G. (1996). Utilization of echocardiography by internists and cardiologists: a comparative study. The American journal of medicine, 101(6), 584-591.
  • Campbell, E. W., Jr. (1995). Training general internists and "STARS". Annals of internal medicine, 122(1).
  • Cano, S. B., Generali, J. A., Letendre, D. E., Hastings, M. T., Preskorn, S. H., & Godwin, H. N. (1984). Evaluation of amitriptyline use for depression when prescribed by internists and psychiatrists. Hospital formulary, 19(12), 1131-1132, 1136, 1140-1131 passim.
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