What is Internal Medicine?

Internal medicine is a medical specialty in which physicians apply scientific knowledge and clinical expertise to diagnose and treat adults with a very broad range of health concerns and illnesses. Physicians who specialize in internal medicine are known as internists or general internists.

DIFFERENCES BETWEEN INTERNAL MEDICINE AND GENERAL/FAMILY PRACTICE

While they are both primary care doctors — and the terms are frequently used interchangeably — internists are not the same as general practitioners and family physicians. One of the main differences is that internists see only adults, and family practitioners see both children and adults.

General Internists

General internists are particularly qualified to practice primary care and follow patients through their adult lives. Some internists work as hospitalists, delivering primary care in hospital settings; others offer only outpatient care. General internists might also practice in rehabilitation centers and long-term care facilities.

Internal medicine doctors are trained to offer:

Precise diagnoses of and immediate treatment for a broad range of symptoms and diseases
Expertise in the conditions that affect any of the body’s systems
Guidance, counseling, and preventive interventions to improve the overall health
Lifetime comprehensive care and palliative care
Care for mental health disorders, like depression and anxiety caused by abnormal activities in the brain, a chronic disease, or hormonal imbalance

General Family Practitioners

Unlike internists, general family practitioners do not solely concentrate on adults and might practice pediatrics, obstetrics, and do minor surgery.

Family physicians could treat a full range of medical issues and provide acute, chronic, and wellness services for patients.

Family physician training includes:

Adult critical care (1 month)
Care for children in the hospital or emergency settings (nearly 2 months)
Geriatric care (1 month)
Gynecology (1 month)
In-patient hospital experience (6 months minimum)
Musculoskeletal medicine (2 months)
Newborn encounters
Obstetrics (2 months)
Surgery (1 month)

Family medicine training also includes behavioral health, common skin conditions, population health, health system management, wellness, and disease prevention.

SPECIALIZED TRAINING

Internists are medical doctors who specialize in preventing, diagnosing, and treating a wide variety of diseases and other health problems that affect adults. They are experts in health promotion, disease prevention, and the treatment of problems both simple and complex, acute and chronic.

Internal medicine training involves general medical education, as well as time spent rotating among a variety of subspecialty clinics, both in-patient and out-patient.

Internal Medicine Subspecialties

Internal medicine trainees gain experience working in areas that involve:

Endocrinology
Rheumatology
Infectious diseases
Pulmonary diseases
Cardiovascular diseases
Critical care medicine
Hematology
Oncology
Gastroenterology
Nephrology
Neurology
Psychiatry
Dermatology
Ophthalmology
Gynecology
Otorhinolaryngology
Non-surgical orthopedics
Palliative medicine
Sleep medicine
Geriatrics
Rehabilitation medicine

Internal medicine trainees spend at least 1 year caring for hospitalized patients, with at least 3 months in intensive/critical care settings. They undergo hospital-based training for at least one 1, with additional exposure to in-patient subspecialties like cardiology, hematology-oncology, or gastroenterology.

Many internal medicine doctors have a specific subspecialty. To gain expertise for those subspecialties, students complete an additional 1 to 3 years of fellowship training after a required three-year internal medicine residency.

RECOGNIZED INTERNAL MEDICINE SUBSPECIALTIES ARE:

Allergy and Immunology (immune system)
Cardiovascular Disease (heart and vascular system)
Advanced Heart Failure and Transplant Cardiology
Interventional Cardiology (heart health)
Critical Care Medicine (patients whose organ system is failing)
Clinical Cardiac Electrophysiology (heart rhythm)
Endocrinology, Diabetes, and Metabolism (diabetes and other glandular and metabolic diseases)
Gastroenterology (gastrointestinal system, liver, and gallbladder)
Transplant Hepatology (liver)
Hematology (blood)
Infectious diseases (bacterial, viral, fungal, and parasitical infections)
Nephrology (kidneys)
Oncology (cancer)
Pulmonary Disease (lungs and respiratory system)
Rheumatology (joints and musculoskeletal system)

INTERNAL MEDICINE/BODY CONNECTION

Internal medicine is the study, diagnosis, and treatment of conditions that affect the internal organs — conditions like heart disease, hypertension, diabetes, obesity, and lung disease. Internal medicine specialists usually care for people with complex, chronic, and multisystem disorders.

Based on their subspecialties, internists might work with doctors in other medical specialties or consult on patients referred by another specialist.

TREATING AN EXTENSIVE RANGE OF INTERNAL MEDICINE CONDITIONS

Internal medicine doctors diagnose, manage, and treat a broad range of conditions. These are cancer, infections, and conditions affecting the heart, blood, kidneys, joints, and the digestive, respiratory, and vascular systems. Examples of conditions treated by internists are:

Abnormal liver biochemical and function tests
Abnormal uterine bleeding
Acid peptic disease related to upper gastrointestinal bleeding
Acquired thrombotic thrombocytopenic purpura (TTP)
Acquired von Willebrand syndrome
Acute aortic dissection
Acute aortic regurgitation
Acute bacterial meningitis
Acute bronchitis
Acute calculous cholecystitis
Acute cholangitis
Acute colonic diverticulitis
Acute decompensated heart failure
Acute diverticulitis
Acute exacerbations of asthma
Acute ischemic stroke
Acute liver failure
Acute lower extremity ischemia
Acute mesenteric arterial occlusion
Acute migraine
Acute myocardial infarction
Acute pancreatitis
Acute pericarditis
Acute pharyngitis
Acute pulmonary embolism
Acute respiratory distress syndrome
Acute sinusitis and rhinosinusitis
Acute variceal hemorrhage
Acute viral gastroenteritis
Adrenal insufficiency
Airway foreign bodies
Allergic rhinitis
Anal fissure
Angioedema
Aseptic meningitis
Aspiration pneumonia
Atrial fibrillation
Bacterial brain abscess
Balanitis and balanoposthitis in children and adolescents
Bell’s palsy
Bleeding peptic ulcers
Cancer pain
Cardiac arrest
Cardiogenic shock complicating acute myocardial infarction
Cellulitis and skin abscesses
Chronic complications as well as age-associated comorbidities in people suffering from hemophilia
Chronic limb-threatening ischemia
Clostridial myonecrosis (“gas gangrene”)
Clostridioides difficile (“C. Diff”) infection (formerly called Clostridium difficile)
Cognitive impairment and dementia
Colonic ischemia
Constrictive pericarditis
Convulsive status epilepticus in adults
Corneal abrasions and corneal foreign bodies
Cushing’s syndrome
Diabetic ketoacidosis as well as the hyperosmolar hyperglycemic condition in grown-ups
Disseminated intravascular coagulation
Dysphagia in adults
Electrocardiographic abnormalities indicating myocardial ischemia and infarction
Emergency contraception
Epilepsy and electroencephalogram (EEG)
Esophageal disease
Exacerbations of chronic obstructive pulmonary disease (COPD)
Exercise-associated hyponatremia
External otitis
Failed fibrinolysis (thrombolysis) and threatened reocclusion in acute ST-elevation myocardial infarction
Fasting ketosis and alcoholic ketoacidosis
Gastrointestinal infections
Giant-cell arteritis
Gout flares
HELLP syndrome (hemolysis, high liver enzymes, and low platelets)
Hepatic encephalopathy
Hereditary thrombotic thrombocytopenic purpura (TTP)
Hyperkalemia
Hypotonic hyponatremia
Infections of cerebrospinal-fluid shunts and other devices
Ingested foreign bodies and also food impactions on adults
Intestinal ischemia
Intracranial epidural abscess
Invasive group A streptococcal infection and also toxic shock syndrome
Lactic acidosis
Lower gastrointestinal bleeding
Lyme disease
Malignancy-related superior vena cava syndrome
Massive hemoptysis
Mechanical colorectal obstruction
Mechanical small-bowel obstruction
Mesenteric venous thrombosis
Metabolic acidosis
Metabolic acidosis in chronic kidney disease
Metabolic alkalosis
Mineral and bone metabolism
Mitral-valve prolapse and flail mitral leaflet
Moderately to severely hypertensive retinopathy as well as hypertensive encephalopathy
Myopericardial disease
Narrow QRS complex tachycardias
Necrotizing soft-tissue infections
Neoplastic epidural spinal-cord compression
Neuromuscular disease
Neuropathies
New-onset atrial fibrillation
Non-HIV viral infections
Non-sustained ventricular tachycardia
Nonocclusive mesenteric ischemia
Open-angle glaucoma
Osmotic demyelination syndrome (ODS) as well as over-rapid correction of hyponatremia
Osteonecrosis (avascular necrosis of bone)
Ovarian and fallopian-tube torsion
Pelvic inflammatory disease
A perianal and perirectal abscess
Peripheral nerve and muscle disease
Pneumothorax
Pregnancy complications
Prerenal disease and acute tubular necrosis in acute kidney injury
Pulmonary infections
Retinal detachment
Rhabdomyolysis
Right-sided native-valve infective endocarditis
Second- and third-degree atrioventricular blocks
Secondary spontaneous pneumothorax
Segmental colitis related to diverticulosis
Severe Crohn’s disease
Severe hypovolemia or hypovolemic shock
Severe ulcerative colitis
Sickle cell disease
Simple and mixed acid-base disorders
Sinus bradycardia
Spinal epidural abscess
Spontaneous bacterial peritonitis
Staphylococcal toxic shock syndrome
Stevens-Johnson syndrome and toxic epidermal necrolysis
Streptococcal pharyngitis
Subacute kidney injury
Supraventricular arrhythmias after myocardial infarction
Suspected acute coronary syndrome (myocardial infarction, unstable angina)
Suspected nephrolithiasis
Suspected nonvertebral osteomyelitis
Sustained monomorphic ventricular tachycardia in patients suffering from the structural heart disease
Symptomatic aortic stenosis
Syncope
Thoracic aortic aneurysm
Thyroid storm
Transient ischemic attack (TIA)
Tubo-ovarian abscess
Tumor lysis syndrome
Unexplained thrombocytopenia
Unstable angina and non-ST elevation myocardial infarction
Upper gastrointestinal bleeding
Urinary tract obstruction and hydronephrosis
Ventricular arrhythmias
Ventricular arrhythmias during acute myocardial infarction
Vertigo
Viral encephalitis
Wide QRS complex tachycardias

INTERNAL MEDICINE TESTS, PROCEDURES, AND SURGERIES

Internal medicine specialists conduct or order tests, procedures, and surgeries based on patients’ condition, overall health, and wellness goals. With the increase in the incidence of head and neck cancers, internists are on the front lines of oropharyngeal cancer screening.

The Centers for Disease Control and Prevention (CDC) suggests that all adults 18 and older get screened annually.

Internists — as well as nurses and other providers — are trained to perform many types of medical procedures, the use of which could vary greatly by specialty, diagnosis, and treatment. Providers require experience and skill — and in many cases, additional training and medical credentials — to perform these procedures, as well as to minimize patient discomfort, optimize outcomes, and reduce side effects.

Internal medicine specialists commonly conduct procedures that include:

Venipuncture (“blood draw”) to test blood
Arterial puncture to analyze blood gases
Endotracheal intubation
Flexible sigmoidoscopy
Intravenous (IV) line insertion
Nasogastric (NG) tube placement
Urinary catheters placement

Some internists have been trained in more complex and/or invasive diagnostic and therapeutic procedures, like thoracentesis, lumbar puncture, and paracentesis.

Categories and other types of tests and procedures an internist may perform include:

Allergy – Skin testing, rhinoscopy
Cardiology – Cardiac stress testing, echocardiograms, coronary catheterization, angioplasty, stent insertion, pacemakers, electrophysiology testing as well as ablation, implantable defibrillators, cardioversion, placement of intra-aortic and intra-ventricular devices
Endocrinology – Thyroid biopsy, dynamic hormone testing, and bone density testing
Gastroenterology – Upper and lower endoscopy, esophageal manometry, endoscopic retrograde cholangiopancreatography (ERCP), stent insertion, endoscopic ultrasound, and liver biopsy
Hematology/oncology – Bone marrow biopsy, stem cell transplant, lymph node biopsy, and plasmapheresis
Pulmonary – Intubation and ventilator management, bronchoscopy, chest tube thoracostomy, and tracheostomy placement
Renal – Kidney biopsy, dialysis
Rheumatology – Joint aspiration and therapeutic injection

Internal medicine and several other medical specialties use ultrasound, computed tomography (CT), and magnetic resonance imaging (MRI) to guide invasive procedures. Flexible fiberoptic instruments might be used to access hard-to-reach areas of the body.

MAJOR PROFESSIONAL SOCIETIES FOR INTERNAL MEDICINE

Major professional societies for internists include:

Alliance for Academic Internal Medicine
American Association for the Study of Liver Diseases (AASLD)
American College of Cardiology
American College of Gastroenterology
American College of Physicians (ACP)
American Diabetes Association
American Geriatrics Society
American Heart Association
American Medical Association
American Society of Gastrointestinal Endoscopy
American Society of Hematology
American Thoracic Society
Endocrine Society
Infectious Diseases Society of America

If you or anyone you know is suffering from diseases, disorders, and illnesses, our expert providers at Specialty Care Clinics will take care of your health and help you recover.

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