I think it may be difficult for most MD's trained in allopathic medicine to effectively treat chronic disease since it is pharma centric. Some MD's after decades of practice realize that something is wrong with what they were taught in medical school, then they begin to relearn. Dr David Brownstein, Dr Jerry Tennant and Dr Nadir Ali are excellent examples. Dr Tennant's book Healing is Voltage, The Handbook should be read by healthcare professionals and anyone interested in how our bodies work.
I am an emergency physician working in Appalachia. As my patient population grows older, sicker and more complicated, I have so much love and respect for the internists who work as hospitalists. There was a time when I looked back on my training and wished that I had spent more time in surgery or anesthesia doing procedures. Maybe. But really I wish I had spent more time with internal medicine and medical ICU. Every day I feel as if I'm increasingly out of my league. I tip my hat to internists.
I have enormous respect for family med docs who do a job that, in a million years, I could not. And I get a few referrals a year from them to help with people that me and my clinic are more prepared to offer what's needed. We work together.
Love the article! Having done 4 years in the IHS after 1st year categorical IM, and a little ER after that, I'm fairly comfortable with most common primary care problems. After developing a serious chronic illness myself, I switched over to psychiatry and eventually child psychiatry. Try that one out for size! I frequently did more peds primary care than anything else, & ended up having to send the kids to Peds anyway, although I could tell what that rash under the patient's sister's nose was as soon as the family walked in the door. Same problem as the article above, although switched around, subspecialty to primary care.
The takeaway I guess, for me at least, in this day & age of less & less ppl entering primary care, is that no matter how busy we are in our own field, we must never forget that we are first of all physicians, and the (put in specialty or subspecialty of choice here). Cheers to all!!
Another very important role for the internist is to be actively involved and the one in charge for his hospitalized patients. In today's medical world patients need their own internist as their primary physician and medical advocate. It sickens me to hear about people hospitalized under the care of a hospitalist who doesn't really know them and then brings in several specialists that may further muddle the management.
I was a third year medical student on internal medicine rotation. Late one evening we were called to see a patient in the orthopedics section. The referral was for evaluation of chest pain. We inquired what had inspired the referral request of the patient.
He told us that he had been suffering substernal heaviness post-operatively for the past 2 to 3 weeks (he had a prolonged hospital stay due to a wound infection).
Apparently the orthopedic surgeons paid no heed to his chest pain. But one evening the janitor was in the room cleaning up and inquired of the patient" how are you doing?" The patient replied. "I'm doing okay. My leg is getting better but I've been having this heaviness in my chest for the last couple of weeks."
"That's Angina" the janitor quickly replied. "you need to tell your doctor about that"
Is there any such thing as a “family doctor” anymore? I still see intake forms that ask for my family doctor. I fill in my internist. But the truth is my husband and I mostly see a whole raft of specialists the internist refers us to.
Acronym definitions: (saw some comments about this, those in the know just ignore this)
PCP = primary care provider, can be MD, DO, NP, PA. Sees patient in office for just about anything, does physicals
MD = medical doctor , traditionally 4 year med school after getting bachelors in something, then minimum 3 years residency (depends on specialty)
DO = doctor of osteopathic medicine
Pretty same as MD but they get training in manual medicine too, so like MD plus a chiropractor-lite (do not yell, one of my DO colleagues put it that way)
They then do essentially same residencies as MDs
FP = family practice medicine, “everyone but the dog” (we had T-shirts) babies to elderly, some also deliver babies (with OB back up if needed)
GIM = general internal medicine as Dr Cifu explains
PA = physicians assistant. Usually 2 year program after getting bachelors.
States differ but need a MD/DO to oversee
Can specialize but I confess not sure how they do that
NP = nurse practitioner. also about 2 year program after having Bachelors in nursing, also need MD/DO collaborator.
Same with specialty, I know the neonatal NPs have a lot more training (those people rock by the way)
ANY PCP can be either great or not so much, the general idea is the good ones can handle 80-90% of what walks in the door (colds, chronic disease, pain of any body part, mood issues, etc etc), knows when to punt to the specialist, can coordinate care between specialists (this is a BIG issue, many specialists end up working at cross purposes because they do not know what the others are up to), and can convince you to take better care of yourself at least a little bit (most of us could do better😁). The trick is finding the good ones…
Unlike everyone here, I am still confused. PCP, GIM, MD, DO, etc. All I know is I am shuffled around by my doctor like a playing card in a midnight back alley poker game. Why must I go to different doctors if what my H&P shows is mild, chronic issues. HTN, Depression, bilateral shoulder pain - (ortho did surgery for rotator cuff - unsuccessful - and now don't want to go to any ortho as I believe they are born with a scalpel in their hands), muscle pain & fatigue - sent to Rheumatologist and given dx of Fibromyalgia (<- do I really have that?), rash - sent to dermatologist and given dx of Psoriasis (yes I probably have this, but did I need a specialist? (with a little investigation adding to my nursing background I could've diagnosed myself.). I want 1 doctor who can just help me through these annoying conditions I have till I die. I am a DNR and will not treat any life threatening diseases, but want enough comfort measures to have a quality of life. 1 doctor.
Hi Bonnie. Nice to meet you. I've been a nurse for 50 years. It's not only me, but I've met doctors who say they aren't going to be tested for specific things because they won't be treated for it either. I have a notary signed POLST in my purse, which I update every 2 years. I have a medical ID bracelet that says DNR/DNI and gives my daughter's number. (She has agreed to honor my wishes). Please, just keep me as comfortable as possible while alive and then at the end of my life. I'll be a happy camper.
I’ve been a mostly hospital-based PA for four decades. I am privileged to see a superb general internist/geriatrician, who I feel is my advocate, my medical guardian angel, my friend. Thank you to all the general internists who take the time and endure the brain damage to see and hear us, and who work with such skill and compassion to keep us well.
I am an internist too. I explained it like this. I do for adults what a pediatrician does for children. I wanted to be really good at what I do. General practitioners and family docs have to know three books--internal medicine, pediatrics, and ob-gyn. Internists only need to master the internal medicine book. All of the books are 4-5 inches thick and the information is constantly changing. I decided it would be all that I could do to keep up with one book and then I decided to focus further on chronic disease management.
I started headed to pulm/crit. Was tempted by emergency medicine. Decided I like the relationships and (masochistic) challenges of GIM. I was lucky to be mentored by some incredible specialists in general medicine. I've never had second thoughts.
I think it may be difficult for most MD's trained in allopathic medicine to effectively treat chronic disease since it is pharma centric. Some MD's after decades of practice realize that something is wrong with what they were taught in medical school, then they begin to relearn. Dr David Brownstein, Dr Jerry Tennant and Dr Nadir Ali are excellent examples. Dr Tennant's book Healing is Voltage, The Handbook should be read by healthcare professionals and anyone interested in how our bodies work.
I am an emergency physician working in Appalachia. As my patient population grows older, sicker and more complicated, I have so much love and respect for the internists who work as hospitalists. There was a time when I looked back on my training and wished that I had spent more time in surgery or anesthesia doing procedures. Maybe. But really I wish I had spent more time with internal medicine and medical ICU. Every day I feel as if I'm increasingly out of my league. I tip my hat to internists.
Never in the history of the world has family medicine doctor ever referred a patient to your highness to sort out. Get over yourself.
I have enormous respect for family med docs who do a job that, in a million years, I could not. And I get a few referrals a year from them to help with people that me and my clinic are more prepared to offer what's needed. We work together.
Love the article! Having done 4 years in the IHS after 1st year categorical IM, and a little ER after that, I'm fairly comfortable with most common primary care problems. After developing a serious chronic illness myself, I switched over to psychiatry and eventually child psychiatry. Try that one out for size! I frequently did more peds primary care than anything else, & ended up having to send the kids to Peds anyway, although I could tell what that rash under the patient's sister's nose was as soon as the family walked in the door. Same problem as the article above, although switched around, subspecialty to primary care.
The takeaway I guess, for me at least, in this day & age of less & less ppl entering primary care, is that no matter how busy we are in our own field, we must never forget that we are first of all physicians, and the (put in specialty or subspecialty of choice here). Cheers to all!!
In short, if to explain to a patient, an “internist” is like a paediatrician but for children of ages 18 to 98 or older sometimes 🥵
Another very important role for the internist is to be actively involved and the one in charge for his hospitalized patients. In today's medical world patients need their own internist as their primary physician and medical advocate. It sickens me to hear about people hospitalized under the care of a hospitalist who doesn't really know them and then brings in several specialists that may further muddle the management.
I was a third year medical student on internal medicine rotation. Late one evening we were called to see a patient in the orthopedics section. The referral was for evaluation of chest pain. We inquired what had inspired the referral request of the patient.
He told us that he had been suffering substernal heaviness post-operatively for the past 2 to 3 weeks (he had a prolonged hospital stay due to a wound infection).
Apparently the orthopedic surgeons paid no heed to his chest pain. But one evening the janitor was in the room cleaning up and inquired of the patient" how are you doing?" The patient replied. "I'm doing okay. My leg is getting better but I've been having this heaviness in my chest for the last couple of weeks."
"That's Angina" the janitor quickly replied. "you need to tell your doctor about that"
And so we were consulted....
Forwarded directly to my child applying to med school!
🤞
Is there any such thing as a “family doctor” anymore? I still see intake forms that ask for my family doctor. I fill in my internist. But the truth is my husband and I mostly see a whole raft of specialists the internist refers us to.
Acronym definitions: (saw some comments about this, those in the know just ignore this)
PCP = primary care provider, can be MD, DO, NP, PA. Sees patient in office for just about anything, does physicals
MD = medical doctor , traditionally 4 year med school after getting bachelors in something, then minimum 3 years residency (depends on specialty)
DO = doctor of osteopathic medicine
Pretty same as MD but they get training in manual medicine too, so like MD plus a chiropractor-lite (do not yell, one of my DO colleagues put it that way)
They then do essentially same residencies as MDs
FP = family practice medicine, “everyone but the dog” (we had T-shirts) babies to elderly, some also deliver babies (with OB back up if needed)
GIM = general internal medicine as Dr Cifu explains
PA = physicians assistant. Usually 2 year program after getting bachelors.
States differ but need a MD/DO to oversee
Can specialize but I confess not sure how they do that
NP = nurse practitioner. also about 2 year program after having Bachelors in nursing, also need MD/DO collaborator.
Same with specialty, I know the neonatal NPs have a lot more training (those people rock by the way)
ANY PCP can be either great or not so much, the general idea is the good ones can handle 80-90% of what walks in the door (colds, chronic disease, pain of any body part, mood issues, etc etc), knows when to punt to the specialist, can coordinate care between specialists (this is a BIG issue, many specialists end up working at cross purposes because they do not know what the others are up to), and can convince you to take better care of yourself at least a little bit (most of us could do better😁). The trick is finding the good ones…
Unlike everyone here, I am still confused. PCP, GIM, MD, DO, etc. All I know is I am shuffled around by my doctor like a playing card in a midnight back alley poker game. Why must I go to different doctors if what my H&P shows is mild, chronic issues. HTN, Depression, bilateral shoulder pain - (ortho did surgery for rotator cuff - unsuccessful - and now don't want to go to any ortho as I believe they are born with a scalpel in their hands), muscle pain & fatigue - sent to Rheumatologist and given dx of Fibromyalgia (<- do I really have that?), rash - sent to dermatologist and given dx of Psoriasis (yes I probably have this, but did I need a specialist? (with a little investigation adding to my nursing background I could've diagnosed myself.). I want 1 doctor who can just help me through these annoying conditions I have till I die. I am a DNR and will not treat any life threatening diseases, but want enough comfort measures to have a quality of life. 1 doctor.
Another retired RN here who also wants comfort measures only and DNR!
Hi Bonnie. Nice to meet you. I've been a nurse for 50 years. It's not only me, but I've met doctors who say they aren't going to be tested for specific things because they won't be treated for it either. I have a notary signed POLST in my purse, which I update every 2 years. I have a medical ID bracelet that says DNR/DNI and gives my daughter's number. (She has agreed to honor my wishes). Please, just keep me as comfortable as possible while alive and then at the end of my life. I'll be a happy camper.
I’ve been a mostly hospital-based PA for four decades. I am privileged to see a superb general internist/geriatrician, who I feel is my advocate, my medical guardian angel, my friend. Thank you to all the general internists who take the time and endure the brain damage to see and hear us, and who work with such skill and compassion to keep us well.
I am an internist too. I explained it like this. I do for adults what a pediatrician does for children. I wanted to be really good at what I do. General practitioners and family docs have to know three books--internal medicine, pediatrics, and ob-gyn. Internists only need to master the internal medicine book. All of the books are 4-5 inches thick and the information is constantly changing. I decided it would be all that I could do to keep up with one book and then I decided to focus further on chronic disease management.
Would it have been?
I started headed to pulm/crit. Was tempted by emergency medicine. Decided I like the relationships and (masochistic) challenges of GIM. I was lucky to be mentored by some incredible specialists in general medicine. I've never had second thoughts.
Curious. If you had decided to specialize, in what would it have been?
A good generalist is the best doctor you can have on your side. A bad generalist is simply a referral machine.
In my experience the best specialists are also competent generalists which lets them discern when the problem cannot be addressed by their specialty.