Background & Scope
Internal medicine is a branch of medicine that deals with the diagnosis and treatment of adult illnesses. It encompasses a wide range of acute and chronic illnesses and conditions that affect the internal organs of the body such as the heart, lungs, kidneys, and digestive system.
The scope of internal medicine includes the prevention, diagnosis, and treatment. The scope runs from the simple, like flu, to more complex like pneumonia, diabetes, and heart disease. This branch of medicine also includes subspecialties such as cardiology (heart and blood vessel diseases), pulmonology (lung diseases), nephrology (kidney diseases), endocrinology, hematology, oncology, rheumatology, hospitalist medicine, critical care medicine, and gastroenterology (digestive diseases).
Internal medicine physicians, also known as internists, are specialists in adult medicine and have completed additional training beyond medical school to become experts in the diagnosis and treatment of adult illnesses. They often serve as primary care physicians, providing ongoing care to adult patients and coordinating care with other specialists as needed.
One of the key aspects of internal medicine is the focus on the whole person, rather than just their illness. Internists take into account a patient's overall health and well-being, including physical, emotional, and social factors, when making a diagnosis and developing a treatment plan.
Internal medicine also has a strong focus on preventive care, including screenings and immunizations, to help prevent the onset of illnesses and conditions. This includes the management of chronic conditions such as high blood pressure, diabetes, and heart disease to help prevent the progression of these conditions and reduce the risk of complications.
Qualifications, Training, and Certifications
Internal medicine is a highly specialized field of medicine that requires a significant amount of education and training.
After completing medical school, prospective internists then do postgraduate training, known as residency for three years in internal medicine. This includes rotations through various subspecialties, such as cardiology, pulmonology, nephrology, and gastroenterology.
After completing residency training, internists are then eligible to sit for board certification in internal medicine. Board certification is a process that ensures that a physician has met certain standards of education, training, and knowledge in their field of expertise. In addition to board certification in internal medicine, many internists choose to pursue additional training (called fellowship) and certification in a fellowship field.
Conditions, Diseases, Treatments, and Procedures
Conditions:
Internists diagnose, treat, and provide a wide variety of medical illnesses and conditions, from diabetes to cancer to infections to minor musculoskeletal injuries; the field is very broad. Internists treat conditions affecting the heart, blood, kidneys, joints, and the digestive, respiratory, and vascular systems. Examples of conditions treated by internists include:
hepatitis
cirrhosis
gastroesophogeal reflux disease (GERD)
thrombotic thrombocytopenic purpura (TTP)
aortic regurgitation
bacterial meningitis
bronchitis
cholecystitis
cholangitis
diverticulitis
heart failure
asthma
migraine
myocardial infarction
pancreatitis
pericarditis
pharyngitis
pulmonary embolism
respiratory distress syndrome
sinusitis
variceal hemorrhage
gastroenteritis
adrenal insufficiency
(COPD)
hyponatremia
otitis media
thrombolysis
gastrointestinal infections
cardiogenic shock
myocardial infarction
cellulitis
skin abscess
hemophilia
gangrene
cognitive impairment
dementia
peripheral ischemia
gout
HELLP syndrome (hemolysis, elevated liver enzymes, and low platelets)
hyperkalemia
hyponatremia
intestinal ischemia
streptococcal infections
toxic shock syndrome
rhinitis
anal fissure
angioedema
meningitis
pneumonia
atrial fibrillation
peptic ulcers
cardiac arrest
pericarditis
epilepsy
metabolic alkalosis
mitral valve prolapse
hypertensive encephalopathy
QRS-complex tachycardias
neuropathies
atrial fibrillation
ventricular tachycardia
mesenteric ischemia
osteonecrosis (avascular necrosis of bone)
pelvic inflammatory disease
perianal and perirectal abscess
peripheral nerve disease
acute tubular necrosis
pulmonary infections
retinal detachment
pneumothorax
diverticulosis
Crohn's disease
hypovolemia or hypovolemic shock
ulcerative colitis
sickle cell disease
Stevens-Johnson syndrome and toxic epidermal necrolysis
Streptococcal pharyngitis
supraventricular arrhythmias
acute coronary syndrome
kidney stones
gall stones
unstable angina
non-ST elevation (non-STEMI) myocardial infarction
ST elevation (STEMI) myocardial infarction
upper gastrointestinal bleeding
urinary tract obstruction
rhabdomyolysis
Lyme disease
hemoptysis
small-bowel obstruction
mesenteric venous thrombosis
endocarditis
atrioventricular blocks
pregnancy complications
sinus bradycardia
syncope
thoracic aortic aneurysm
thyroiditis
Transient ischemic attack (TIA)
thrombocytopenia
hydronephrosis
ventricular arrhythmias
vertigo
viral encephalitis
tachycardia
corneal abrasions
Cushing's syndrome
diabetic ketoacidosis
hyperosmolar hyperglycemia
dysphagia
chronic obstructive pulmonary disease
spinal epidural abscess
bacterial peritonitis
toxic shock syndrome
osteomyelitis
aortic stenosis
lactic acidosis
lower gastrointestinal bleeding
metabolic acidosis
pneumothorax
Diagnoses:
Internists are responsible for making diagnoses of a wide range of illnesses and conditions, including:
Cardiovascular diseases such as heart disease, hypertension, and stroke
Respiratory diseases such as asthma, chronic obstructive pulmonary disease (COPD), and lung cancer
Gastrointestinal diseases such as acid reflux, inflammatory bowel disease (IBD), and liver disease
Kidney and urinary tract diseases such as kidney stones and chronic kidney disease
Endocrine and metabolic diseases such as diabetes and thyroid disorders
Infectious diseases such as HIV and hepatitis
Blood disorders such as anemia and leukemia
Neurological disorders such as Alzheimer's disease, multiple sclerosis, and Parkinson's disease
Rheumatologic disorders such as rheumatoid arthritis and lupus
Treatments:
Internists use a variety of treatments to manage and treat illnesses and conditions, including:
Medications to manage symptoms and slow the progression of diseases
Lifestyle changes such as diet and exercise to prevent and manage chronic conditions
Procedures such as diagnostic tests (e.g.,electrocardiograms), laboratory tests (e.g., blood tests, urinalysis), and imaging studies (e.g., xrays) to help make a diagnosis
Referral to specialists as needed
Preventive care including screenings and immunizations to help prevent the onset of illnesses and conditions
Ongoing management of chronic conditions such as high blood pressure, diabetes, and heart disease to help prevent the progression of these conditions and reduce the risk of complications
Procedures:
Internists and/or subspecialist within internal medicine may be trained to perform a variety of procedures, including:
Physical exams
Diagnostic tests such as blood tests and imaging studies
Procedures such as skin biopsies, joint injections, and lumbar punctures
Procedures for the diagnosis and treatment of heart and blood vessel diseases, such as stress tests and electrocardiograms (ECGs)
Procedures for the diagnosis and treatment of lung diseases, such as bronchoscopies and lung biopsies
Procedures for the diagnosis and treatment of digestive diseases, such as colonoscopies and endoscopies
Procedures for the diagnosis and treatment of kidney diseases, such as kidney biopsies
Related Medical Specialties
Internal medicine is a broad field of medicine that encompasses a wide range of illnesses and conditions that affect the internal organs of the body. As a result, it is closely related to several other medical specialties that also focus on specific organs and systems within the body.
One of the most closely related specialties to internal medicine is family medicine. Family medicine physicians, also known as family practitioners, are primary care physicians who provide comprehensive care to patients of all ages, including adults and also includes the core of what is obstetrics and gynecology. Like internists, family medicine physicians focus on the whole person and take into account a patient's overall health and well-being when making a diagnosis and developing a treatment plan.
Another closely related specialty is pediatrics, which deals with the diagnosis and treatment of illnesses and conditions in children. While pediatrics is focused on the care of children, internists and pediatricians often work together to provide continuity of care as children transition into adulthood.
Other specialties that are related to internal medicine include:
Cardiology, which deals with the diagnosis and treatment of heart and blood vessel diseases
Pulmonology, which deals with the diagnosis and treatment of lung diseases
Gastroenterology, which deals with the diagnosis and treatment of digestive diseases
Nephrology, which deals with the diagnosis and treatment of kidney diseases
Endocrinology, which deals with the diagnosis and treatment of endocrine and metabolic diseases
Rheumatology, which deals with the diagnosis and treatment of rheumatologic disorders
Geriatrics, which deals with the diagnosis and treatment of illnesses and conditions in older adults
Infectious disease, which deals with the diagnosis and treatment of infectious diseases
Hematology, which deals with the diagnosis and treatment of blood disorders
Oncology, which deals with the diagnosis and treatment of cancers
These specialties are considered subspecialties of internal medicine, and internists who choose to pursue additional training and certification in these areas are referred to as "subspecialists."
Internists typically are the first physician to see a patient with a condition outside their field or that need treatment by another physician: a broken bone, a dog bite, a nail in a foot, an unusual neurologic syptom, and much more, so their scope of knowledge is very broad.
In addition to these medical specialties, internists also often work closely with other healthcare professionals such as pharmacists and radiologists provide comprehensive care to their patients.
Medical-Legal Cases Involving Internal Medicine
Medical malpractice is the most common type of medical-legal case involving internists. One example involving an internist is a failure to diagnose, for example, a cardiac condition leading to a heart attack and the patient suffering additional heart damage as a result.
Another example is misdiagnosis--diagnosing the wrong illness or condition leading to delayed or inadequate treatment.
Another example is a failure to treat, for example, failing to prescribe medication, perform a necessary procedure, or refer the patient to a specialist.