What is it:

Internal medicine physicans are doctors who specialse in diagnosing and treating adult patients that have a variety of health conditions or diseases. Physicians who specialise in this field of medicine are often referred to internists or even general internists.

They provide primary care and often have the same patients for a long period of time, as they follow them through their adult lives. They are trained to provide the following:

• Diagnose internal illnesses
• Provide course of treatments
• Guidance and counselling for any health concerns
• Life-long care (including palliative)

Unlike surgeons, internists are trained to see the big picture. Due to the fact that they don’t focus on one specific body part or system, they are able to see how everything works together, in unsion. Internalists conduct examinations, tests and multiple data sets to connect the dots and come to the ultimate diagnosis. It is one of the hardest medical specialties, as you need expansive and wellrounded knowledge of the entire human body.

A quick tip: If this was hard for you to understand, just think of it this way. There is two branches of medicine; internal and surgical. Interal medicine focuses more on fixing problems inside the body, without having to cut it open.

Internal vs General Medicine

Although these two specialties are often confused, general medicine physicians and internists are not the same. The following diagram highlights some of the key similarities and differences of these two fields of medicine:

As you can see, both internal medicine physicans and general medicine physicans focus on diagnosing and treating general health concerns. However their duties and responsibilities differ.

General medicine physicians (or GPs) focus more on less complex illnesses, such as communicable diseases. They’re able to provide care to patients of any age. They see many patients throughout the day, and often treat the same family for multiple generations.

Although both internists and general practitioners can function as primary caregivers, the main difference between the two is that GP’s focus on all ages and require training in many fields, such as internal medicine, psychiatry, obstetrics and gynecology, pediatrics and geriatrics. Even though not every individual doctor practices all of these types of medicine.

Internal medicine, however, is the study and treatment of diseases and conditions that occur within the body’s systems. These include digestive disorders, cancers and diseases of the major organs. Internists focus more on complex medical disorders and solving problems while GP’s are more involved with their patients and general health concerns.

Subspecialties:

Just like surgery, internal medicine has many subspecialties. Some internalists decide to subspecialise, yet it is also very common for them to practise a bit of everything and refer patients to subspecialties when the cases become too complex. The most common subspecialties of internal medicine include:

Field of medicine	Description
Adolescent medicine	Focuses on the overall well-being of young adults. This subspecialty includes physical, psychological, social and sexual development of adolescents and young adults. After board certification in internal medicine, then study conditions specific to adolescents for 1-3 years.
Cardiovascular disease	Specialists treat patients with acute and chronic cardiovascular conditions. This is the non-surgical treatment regarding the heart and lungs. Some routine cases a cardiovascular specialist might encounter includes coronary artery disease, congestive heart failure or arrythmias. This subspecialty requires a 3 year fellowship after completing an internal medicine residency.
Endocrinology	Specialises in hormone regulation of normal physiology, such as pituitary, thyroid, adrenal, pancreas, ovaries/testes. Endocrinologists can diagnose endocrine conditions, develop treatment and provide medication as well as create treatment plans. Common diseases that endocrinologists treat include menopause, diabetes and addison’s disease.
Sports medicine	Sports medicine specialists concern themselves with all problems, injuries and illnesses that are sports related. They are in charge of a person’s recovery and decide whether the patient should be sent to a further specialists (eg. surgeon) or physical therapists.
Medical oncology	Deals with the diagnosis and treatment of cancer. It includes on-surgical treatment, namely therapies such as chemotherapy. Oncologists often work together with surgeons to provide the best medical care and offer better outcomes.
Infectious disease	Infectious disease specialists diagnose and treat communicable diseases. Often these specialists also offer general internal medicine treatments as there is a low demand for this specialty.
Geriatrics	Specialty of internal medicine that focuses on health of elders. Study conditions especially related to aging, including preventative medicine and long-term care.

Benefits and drawbacks:

Becoming an internists will be a challanging process, because you will be required to learn and know a little about a lot. Even if you decide to subspecialise, your first and foremost responisibility is still to investigate how the body’s different systems work together in unison. Choosing a career in internal medicine has many benefits, don’t worry, but it is not without its drawback.

But let’s start on a more positive note. The benefits of being an internist are wide and endless. You get to explore all different areas of the body and gain an overall understanding of how it works. Internists aren’t obsessed with cutting things open and fixing it; this specialty is all about observation. However boring that might sound, it is one of the more interesting things you can do as a physician. Also, you don’t only fix what’s right in front of you. A huge part of internal medicine is also preventative care, to ensure your patient doesn’t suffer in the future. As internists are highly educated, you will most likely be able to provide the most effective treatment. You won’t be focused on specific body parts like a surgeon would be, as you’re trained to understand the entire body and how it works together. Internal medicine physicians don’t just fix what is broken, they ensure the best quality of life for their patients and make sure that one illness won’t lead to another in the future.

On the other hand, internal medicine is extremely difficult. Whether you subspecialise or not, you still will need to go through extrensive medical training and a residency, where you’re expected to know everything. Many internists say that the work that they do is underappriciated by other physicians. As you’re dealing with a lot of specialties, you will not have as much knowledge about a particular disease as someone in that specialty would have. Especially surgeons might look down on doctors who do internal medicine, even though it is one of the hardest fields of medicine to do. An internists also sees many patients in one day, making for many long hours. This however is a drawback in all fields of medicine; as a doctor you’re expected to work a lot, no matter your specialty.

Now you see there are many ups-and-downs to becoming an internist. But one guarantee I can make you is that you will never be bored. Working with so many different cases and getting to experience all different conditions and illnesses makes for a very interesting career.

Skills and attributes

1. Communication: Internal medicine physicians are required to work with many specialties- whether you subspecialise or not. For the best possible health outcome for your patient, it is essential that you work together with other doctors to create a treatment plan. As internists focus on many complex medical cases, a second opinion is very valuable. You will also need to possess good communication skills when talking to your patient. As many internal medicine cases are rather long-term, it’s important that your patient feels safe and comfortable with you as their primary care doctor.
2. Creative thinking: Often the cases you are presented with will not be straightforward. GPs will usually handle those cases. As an internist, you will need to come up with creative solutions and think outside the box when coming up with a diagnosis. Unlike other fields of medicine, internal medicine is not simple; there is a huge variety of conditions you will need to be familiar with. Sometimes the answer to the problem is not evident, therefore an internist needs to be able to think creatively to find the solution.
3. Decision-making and confidence: Although internists do not usually deal with hectic cases, it does not benefit you or the patient if you drag out decisions for too long. You need to be certain in what you are doing, as any hesitation will also make your patient uneasy. Therefore confidence in yourself and your abilities is key to a good patient experience. Quick decision-making will aid you to find a diagnosis faster and be able to create a treatment plan.
4. Attention to detail: As I already mentioned, many of your cases as an internist will not be straightforward. Therefore, even the tiniest detail can lead to everything clicking into place. In the field of internal medicine, the details are key to a correct diagnosis. They can help you narrow down the possibilities and aid your patient to the best of your abilities. If you overlook the slightest detail, you might draw the wrong conclusion and prolong the necessary course of treatment.
5. Strong Work Ethic:

Education process

As you probably already figured, the education process for internal medicine is extremely similar to those fields of medicine you’ve already read about. High school, medical school, residency and then it depends on your decision of specialty. However, the residency process is slightly different. Internal medicine training includes general medical education, as well as time spent rotating among a variety of subspecialty clinics, both in-patient and out-patient. The residency will not only focus on one specialty, but rather a variety of cases and specialties. After this residency, you can either go on to subspecialise in one or more fields, or just directly earn your certification as an internalist. If you do decide to subsepcialise, the education process would take longer, depending on which subspecialty you choose.

Summary:

So, to just sum up the key points; Internal medicine focuses on the big picture. It’s not a straight-forward specialty, where you see a problem and fix it. No, internal medicine is the study of how everything in the body works together. Even if you subspecialise further on, you will still have more knowledge of the entitre body than many other specialties. It’s not a hectic speciality, such as emergency medicine, but it is also by far not boring; you get to experience a range of cases on a daily basis.

Fun fact: Internists are often described as the “doctor’s doctor” because of their expansive knowledge!