Internal medicine, the "queen of
specialties" - as it was formerly called - is indispensable today. We
assert this, starting from the definition of this medical specialty. Internal
medicine deals with the prevention, diagnosis, and non-surgical treatment of internal organ disorders: lungs, heart, liver, digestive tract, spleen,
kidneys, metabolism, joints, and even the bone system. This branch of medicine
deals also with the treatment of most diseases affecting adult persons.
In the modern days, dominated by technological
progress and due to some exceptional progress in research, a real conflict of
interests has occurred, between the internist, on the one hand, and the
over-specialized medical consultant: cardiologist, gastroenterologist, nephrologist,
pneumologist, haematologist, etc., on the other hand. These over-specialties,
all derived from internal medicine, approach the patient strictly limited
to the pathology of the respective organ. But the body must be approached as a
unitary whole and an organ cannot be extracted to be investigated, diagnosed,
and later treated, omitting any potential pathologies of other organs.
The internal medicine consultant integrates complex
cases affecting several organs and establishes the subsequent course for people with multiple pathologies.
If the patient does not know which medical doctor they
should address, then it would be advisable to start with a consultation with
the internist. Through the consultation offered by the internist, the patient
avoids excessive medical consultations that could be not necessary. The
internist performs the initial consultation, prescribes the treatment, and if
the patient requires additional investigations, he sends him to the appropriate
medical consultant (e.g., diabetes has been diagnosed - the patient is guided
to the diabetologist, for cancer suspicion - the patient is sent to the surgeon
and oncologist, etc.).
When the patient does not know which medical doctor
he should address, after the consultation with the family doctor, it is
advisable to start with a consultation with the internist. Through the
consultation offered by the internist, the patient avoids excessive medical
consultations that could be not necessary.
Is internal medicine different from family
medicine (or general medicine as it was known until recently)? Here is a
question, to which, maybe, even many confreres, would have hesitations to
answer. Yes. Definitely, yes. The family physician is the patient's first
contact with the health system. The family physician treats the patient in an
office. He deals with chronic disorders, immunizations, preventions, and
monitoring, according to the recommendations of specialized medical
consultants. Once suspicions of serious pathologies occur, that cannot and
should not be diagnosed in an office or at home, the family physician has to
guide the patient to a polyclinic or to a hospital. The inherent question
arises: which specialty should he guide him to? Immediately - the inherent response:
to the internist medical doctor.
The internist medical doctor performs the initial
consultation, prescribes the treatment, and if the patient requires additional
investigations, sends it to the appropriate specialized medical consultant. For
example, the patient diagnosed with high blood pressure should no longer
address to the cardiologist. The internist medical doctor is empowered to
monitor the blood pressure, to recommend the necessary investigations to
diagnose possible high blood pressure causes - so-called secondary
hypertension, and in the event of diagnosing another disease causing hypertension, only then the patient can, and it is necessary to address to the
respective specialty (e.g., nephrology or endocrinology).
The internist medical doctor, having an overview of
the various pathologies, from the most common to the most complex ones, is the
ablest to elaborate, make associations, discern and rank the
priorities, in order to find the real diagnosis of a patient, from the
multitude of differential diagnoses determined by certain signs and symptoms,
by clinical examination and strictly directed investigations. After the
diagnosis, the internist medical doctor will proceed to the effective treatment
of the patient, if his pathology is in his area of competence, otherwise, he
will guide the patient to the over-specialty corresponding to the diagnosis.
What else does internal medicine deal with?
Answer: with the reception and treatment of patients with multiple, serious
pathologies, directed by some (over) specialized medical consultants from one
to another - cardiologists, nephrologists, diabetes, etc., each reasoning that
the treatment of the pathologies related to other specialty is beyond their
competence, although, as I have shown above, the body is a unitary whole, which
cannot be approached sequentially and isolated. Here comes the major role of
the internist medical doctor: to admit in the hospital and treat these patients
with complex pathologies, sometimes derived one from another, and each
pathology of one organ taken separately, aggravating, or complicating the
other/other coexisting diseases (i.e., comorbidities).
As an argument for the above-mentioned, I point out
that in the United States, for any of the medical specialties, the residency
means 3 years of internal medicine, followed by another 2 years of
over-specialization ("Fellowship") in cardiology, gastroenterology,
hematology, etc. (called sub-specialties of the internal medicine).
Medical doctor
Mariana Mihaila, UMF „Carol Davila”, Medical Clinic - Fundeni Clinical
Institute