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An internist specializes in providing adults with comprehensive prevention, diagnosis and treatment services for a wide range of diseases and conditions, including infections, minor injuries, and acute and chronic diseases. Internists are highly skilled as diagnosticians. They also provide adults with regular, routine primary healthcare services.
What is an internist?
An internist is a personal physician who provides long-term, comprehensive care in the office and in the hospital, managing both common and complex illnesses of adolescents, adults, and the elderly. Internists are trained in the diagnosis and treatment of cancer, infections, and diseases affecting the heart, blood, kidneys, joints, and the digestive, respiratory, and vascular systems. They are also trained in the essentials of primary care internal medicine, which incorporates an understanding of disease prevention, wellness, substance abuse, mental health, and effective treatment of common problems of the eyes, ears, skin, nervous system, and reproductive organs.
What does an internist do?
Internists are physician specialists uniquely trained to apply scientific knowledge to the care of adults across the spectrum from health to complex illness.
As an internist, a physician may choose to become a general internist or an internal medicine subspecialist. A general internist handles the broad, comprehensive spectrum of illnesses that affect adults. General internists are recognized as experts in diagnosis, in treatment of chronic illness, and in health promotion and disease prevention—they are not limited to one type of medical problem or organ system.
Many general internists provide care for their patients in an ambulatory (office or outpatient) setting, often serving as their primary care physician over the duration of their adult lives, which provides the opportunity to establish long and rewarding personal relationships with their patients. Some general internists choose to focus their practice exclusively in inpatient settings, functioning as what are termed as “hospitalists.”
Still other general internists will function in a primary care role and continue to care for their patients when they are admitted to the hospital. Additionally, many general internists practice in other clinical settings, such as rehabilitation centers, hospices, and extended care facilities.
An internist also has the option of choosing to become a subspecialist in internal medicine by receiving additional in-depth training and board certification in the diagnosis and management of diseases of a specific type (e.g., infectious diseases) or diseases affecting a single organ system (e.g., the cardiovascular system). Subspecialists often see patients on a limited basis in consultation with a general internist or another medical specialist, though they too may develop long, rewarding relationships with patients who have ongoing or chronic illnesses.
For most general internal medicine specialists and subspecialists, caring for patients is their primary daily activity. Nonetheless, there are many other activities available in the field of internal medicine that may suit the needs of physicians who have additional interests. One such choice is teaching medical students, residents, and/or subspecialty fellows and other health professionals. Teaching responsibilities can be an important component of a career that is based in a teaching hospital or medical school setting. Internists make up the largest proportion of medical school faculty of any clinical field.
Another career choice may be in medical research, ranging from bench research (i.e., basic science) to applied translational or clinical research. Again, these research responsibilities can be a primary component of an internist’s professional activities or can complement other activities in patient care and/or teaching.
Many internists pursue careers in administration (activities related to managing the business side of healthcare). Work in this area provides opportunities for developing managerial and leadership skills.
No matter the setting, there is a need for administrative expertise.
Finally, health policy, health care delivery and public health are areas of interest for internists. Internists who wish to impact populations of people rather than provide direct patient care may pursue a career working in such settings as public health departments, public health schools, or a variety of governmental or other nonprofit organizations.
The precise medical training of an internist allows them to diagnose and treat patients with specific illnesses. A general internist can treat a number of various diseases, but internists with a subspecialty are highly trained to focus their efforts on complications stemming from one affliction. Internists are also trained to provide preventative care, from cancer screenings to mammograms, an internist is qualified to help patients plan their schedules and establish a regular routine.
Internists are also great at communicating with each other, giving patients the full support they need. Referrals, hospital transfers and other interoffice communications are made seamless through the help of internists.
Depending on an internist’s subspecialty, a patient could very well begin seeing one internist when the patient is 18, and stay with that internist for decades. This will allow the patient to develop a trusting, reliable relationship with their doctor, a connection that is invaluable.
Advanced Heart Failure And Transplant Cardiology
Advanced heart failure and transplant cardiology encompasses the unique knowledge and skills required to care for patients with advanced heart failure, and those who have undergone or are awaiting transplantation.
Cardiovascular disease, or cardiology, is the subspecialty of internal medicine concerned with diseases of the heart, lungs, and blood vessels. Cardiology involves the prevention, diagnosis, and management of disorders of the cardiovascular system, including ischemic heart disease, cardiac dysrhythmias, cardiomyopathies, valvular heart disease, pericarditis and myocarditis, endocarditis, congenital heart disease in adults, hypertension, and disorders of the veins, arteries, and pulmonary circulation. Management of risk factors for disease and early diagnosis and intervention for established disease are important elements of the specialty. The specialty is relatively high-tech in its approach to diagnosis and treatment and is also on the cutting edge of preventive health and noninvasive treatment modalities. Cardiologists deal primarily with adults, many of whom are elderly. The practice involves a wide scope of patient care activities, ranging from basic physical exams to sophisticated interventions in life and death emergencies.
Clinical Cardiac Electrophysiology
A field of special interest within the subspecialty of cardiovascular disease which involves intricate technical procedures to evaluate heart rhythms and determine appropriate treatment for them.
Critical Care Medicine
A physician who diagnoses, treats and supports patients with multiple organ dysfunction. This specialist may have administrative responsibilities for intensive care units and may also facilitate and coordinate patient care among the primary physician, the critical care staff, and other specialists. Critical Care medicine is a subspecialty of internal medicine or anesthesiology.
Endocrinology, Diabetes, And Metabolism
An internist who concentrates on disorders of the internal (endocrine) glands such as the thyroid and adrenal glands. The principle problems endocrinologists encounter include goiter, thyroid nodules, thyroid dysfunction, diabetes mellitus, hyper- and hypocalcemia, adrenal cortex dysfunction, endocrine hypertension, gonadal disorders, disorders of sodium and water balance, manifestations of pituitary disorders, disorders of bone metabolism, and hyperlipidemia. While not strictly an endocrine disorder, obesity is considered part of the spectrum of endocrinology because it often enters into the differential diagnosis of endocrine disease and is a major element in the management of type 2 diabetes. Prevention focuses on the complications of obesity, diabetes, hyperlipidemias, thyroid disease, and the iatrogenic effects of glucocorticoids. Endocrinologists are called on to treat problems concerning subnormal growth, early or late puberty, excess hair growth, high blood glucose or calcium levels, osteoporosis, pituitary tumors, and reproduction. They provide consultation for postoperative and chronic disease patients who require special nutritional support , and often participate in basic or clinical research.
A gastroenterologist is an internist who specializes in diagnosis and treatment of diseases of the digestive organs including the esophagus, stomach, bowels, liver, pancreas, and gallbladder. This specialist treats conditions such as abdominal pain, ulcers, diarrhea, cancer, and jaundice and performs complex diagnostic and therapeutic procedures using endoscopes to visualize internal organs. Gastroenterology also includes the discipline of hepatology--the diagnosis and treatment of liver and biliary tract diseases. Additional areas of focus include nutrition and nutritional deficiencies as well as prevention and screening, particularly for colorectal cancer. Gastroenterology requires increasingly complex decision-making; mastery of a growing number of endoscopic techniques, both diagnostic and therapeutic; an understanding of the sensitivity, specificity, risk-benefit, and cost-benefit of a broad array of diagnostic techniques and therapeutic options; and knowledge of the increasingly complex science that underlies gastroenterological practice. It is a procedure-intense specialty that requires some manual dexterity and the ability to solve problems analytically.
Geriatric medicine is a subspecialty of internal medicine or family medicine that deals with the complex medical and psychosocial problems of older adults. A geriatrician has special knowledge of the aging process and special skills in the diagnostic, therapeutic, preventive, and rehabilitative aspects of illness in the elderly. In response to the rapidly aging population, geriatrics has emerged as an area of medicine focusing on health promotion and the treatment of disease and disability in later life. While most care of the elderly will continue to be provided by primary care physicians, family physicians, and general internists, all physicians will treat increasing numbers of elderly patients primarily over the age of 75. Elderly patients often have multiple co-morbidities, use multiple medications, and may face social disadvantages, emotional vulnerability, or financial challenges. Communication may be complicated by hearing or visual loss. Given the types of problems that elderly adults and their families face, geriatric medicine clinicians employ varied skills to treat challenging acute and chronic diseases. They can take a whole-person and family approach that utilizes biopsychosocial and functional models in the context of working with an interdisciplinary group. These physicians provide care for geriatric patients in the patient's home, office, long-term care settings such as nursing homes, and the hospital.
Hematology is a subspecialty of internal medicine or pathology concerned with the development, function, and diseases of the blood, bone marrow, vascular system, spleen, and lymph glands. A hematologist specializes in the diagnosis, treatment, prevention, and investigation of disorders of the hematopoietic, hemostatic, and lymphatic systems as well as disorders of the interaction between blood cells and blood vessel walls. Through investigation and treatment of hematologic malignancies (leukemias and lymphomas), hematology also shares areas of interest and activity with medical oncology. Hematologists use the medical history, physical findings, specialized clinical laboratory tests, and evaluation of tissue or cytological specimens to diagnose and treat disorders of red and white blood cells, platelets, and the blood clotting system, as well as benign and malignant disorders of the bone marrow and lymph glands. They use a broad range of approaches to treat these diseases, including blood products and blood derivatives, nutritional supplements, immunosuppressants, chemotherapy and other anti-tumor agents, pain management, drugs that prevent or promote blood clotting, and stem cell therapies (bone marrow/hematopoietic stem cell transplantation). Not only must hematologists have the clinical skills of general internists, they also need a broad knowledge of cell biology, biochemistry, and laboratory techniques.
Hematology And Oncology
Hematology and oncology is a subspecialty of Internal Medicine and involves physicians who are trained in the diagnosis, management and treatment of patients with a wide variety of blood and neoplastic disorders, and organ-specific cancers.
An area of medicine within the subspecialty of cardiovascular disease, or cardiology, which uses specialized imaging and other diagnostic techniques to evaluate blood flow and pressure in the coronary arteries and chambers of the heart. Interventional cardiologists also employ technical procedures and medications to treat abnormalities that impair the function of the cardiovascular system, alleviate valvular stenosis, and treat valvular and structural heart disease.
Nephrology is a subspecialty of internal medicine concerned with diagnosing and managing diseases of the kidneys and urinary system. Nephrologists commonly encounter conditions such as hypertension; fluid, electrolyte, acid-base, and mineral imbalances; glomerulonephritis; and polycystic kidney. Patients with end-stage renal disease, often caused by diabetes or hypertension, may require hemodialysis or peritoneal dialysis. Physicians in this specialty also consult with surgeons about potential kidney transplant recipients and help manage their immunosuppressive regimen after transplantation. This is a focused specialization requiring a broad knowledge of internal medicine. Nephrologists usually practice in partnerships or groups with other nephrologists, because the care of patients with renal disease often involves intensive, around-the-clock professional service.
Oncology is a subspecialty of internal medicine concerned with diagnosing and treating benign and malignant tumors and other forms of cancer. It was originally a part of hematology and, in some training programs, these two disciplines are still taught together. Oncologists typically identify individuals at risk for malignancy and counsel them regarding risk reduction and screening, investigate clinical symptoms and syndromes suggestive of underlying malignancy, undertake the palliative care of patients with solid and hematologic tumors, identify neoplasms with a potential for cure, and manage appropriately. They administer chemotherapy for malignancy and work with surgeons and radiotherapists on other treatments for cancer. They often see patients who are seriously ill and require extensive treatment. Although the specialty is mainly office-based, oncologists provide a significant amount of consultation and primary inpatient care.
A pulmonologist is an internist who treats diseases of the lungs and airways. Pulmonologists diagnose and treat cancer, pneumonia, pleurisy, asthma, occupational and environmental diseases, bronchitis, sleep disorders, emphysema, and other complex disorders of the lungs.
Pulmonary Disease And Critical Care Medicine
Pulmonary/critical care medicine is a broad subspecialty of internal medicine that includes the diagnosis and management of disorders of the lungs, upper airways, thoracic cavity, and chest wall as well as the management of patients in intensive care units. The pulmonary specialist has expertise in neoplastic, inflammatory, and infectious disorders of the lung parenchyma, pleura, and airways; pulmonary vascular disease and its effect on the cardiovascular system; and detection and prevention of occupational and environmental causes of lung disease. Other specialized areas include respiratory failure and sleep-disordered breathing. Critical care physicians generally work in the intensive care units of hospitals and focus on critical illnesses and conditions (e.g., acute and chronic pulmonary disorders, trauma, and heart attacks). Most are internists specializing in pulmonary medicine and manage mechanical ventilators, place pulmonary artery catheters, and perform bronchoscopies; however, some intensivists specialize in anesthesiology, pediatrics, or surgery. The specialty spans the various phases of treatment, from the ambulance to the emergency room, surgical suite, and intensive and cardiac care units. Critical care physicians must be familiar with the surgical and medical problems that put patients in the intensive care unit. They must also know the cardiovascular, fluid, and respiratory management that is required to maintain critically ill patients. The care of critically ill patients raises many complicated ethical and social issues, and the intensivist must be competent in such areas such as end-of-life decisions, advance directives, estimating prognosis, and counseling of patients and their families. Pulmonologists treat a diverse clinical population and can work in private practices or in various hospital settings, including the respiratory therapy department, the pulmonary function laboratory, or the intensive care unit. An in-depth knowledge of internal medicine is useful to these physicians because pulmonary medicine touches upon other subspecialties.
Rheumatology is a subspecialty of internal medicine dealing with diseases of joints, muscles, bones, and tendons. Rheumatic diseases encompass more than 100 discrete disorders, some with multisystem involvement, and many with a wide variety of clinical manifestations and outcomes. The rheumatologist diagnoses and treats both chronic and acute conditions, including arthritis, systemic rheumatic diseases, back pain, gout, lupus, bursitis, muscle strains, collagen and other soft-tissue diseases, and athletic injuries. Because these diseases are often difficult to diagnose and treat, the rheumatologist's orientation is toward cognitive skills. It is important for rheumatologists to have a good background in biochemistry, immunology, radiology, internal medicine, neurology, orthopaedics, psychiatry, and rehabilitative medicine.
A physician with special knowledge in sports medicine is responsible for continuous care in the field of sports medicine, not only for the enhancement of health and fitness, but also for the prevention of injury and illness. Knowledge about special areas of medicine such as exercise physiology, biomechanics, nutrition, psychology, physical rehabilitation, epidemiology, physical evaluation, injuries (treatment and prevention), and the role of exercise in promoting a healthy lifestyle are essential to the practice of sports medicine. The sports medicine physician requires special education to provide the knowledge to improve the health care of the individual engaged in physical exercise (sports) whether as an individual or in team participation. Sports medicine is a subspecialty of emergency medicine, family medicine, internal medicine, or pediatrics.
An internist with special knowledge and the skills required of a gastroenterologist to care for patients prior to and following hepatic transplantation that spans all phases of liver transplantation. Selection of appropriate recipients requires assessment by a team having experience in evaluating the severity and prognosis of patients with liver disease.