GENERAL INTERNAL MEDICINE: WHAT’S IN A NAME?

I have always believed that general internal medicine physicians have much in common whether we work primarily in the hospital, outpatient setting, or community. It is the breadth of our clinical experience that gives us a unique view of health care, medical education, and research. I was a bit confused when I heard that some hospitalists do not consider themselves general internists. I’m not alone. The public and many of our patients are confused, too. I did a Google search looking for a definition or description of general internal medicine. I found a myriad of similar queries and varying descriptions and definitions of general internal medicine. The first known use of the term internal medicine was in 1835 and defined as “a branch of medicine that deals with diseases not requiring surgery.”¹ Prior to the early 20th century, internal medicine physicians could do little to treat disease but were known for their diagnostic and prognostic capabilities and served as diagnosticians.

As the field of medical research learned more about diseases and developed treatments for these diseases, subspecialities based on organ systems evolved. We then had two categories for internal medicine physicians, subspecialists, and general internists.² Subspecialists work within the bounds of organ systems, whereas general internal medicine physicians deal with all acute and chronic diseases of adults. We are not limited to one type of medical problem or organ system, and we extend our view to the social and cultural factors that affect health and provide care that includes health maintenance and prevention of disease. We are specially trained to solve puzzling diagnostic problems and can handle severe chronic illnesses and situations where several different illnesses may be present at the same time. We like a good puzzle.

In addition to providing direct patient care, general internists often work closely with other healthcare professionals in teams—including nurses, pharmacists, social workers, physician assistants, and specialists—to coordinate care and ensure the best possible outcomes for patients. These characteristics span all settings where general internists provide care. General internal medicine is a broad dynamic field that requires ongoing learning and skill development, a feature that attracted many of us into general medicine.

Last year, the American College of Physicians (ACP) launched a campaign to remind the public that “internal medicine physicians are specialists who apply scientific knowledge and clinical expertise to the diagnosis, treatment and compassionate care of adults across the spectrum from health to complex illness,” are “experts in complexity,” and “see the big picture.”² This campaign is much like SGIM’s Proud to be GIM campaign launched in 2015.³ ACP goes on to differentiate between general internal medicine and internal medicine subspecialties and specifically notes that GIM physicians “lead in diverse roles and settings” and provide care in hospitals, outpatient offices and clinics, long-term care facilities, and other settings. I was relieved to see that ACP viewed general internal medicine as a practice that unites us, even though there are differences based on where we provide care.

Why is this important? First, we care for the same patients. Hospital-based colleagues care for our primary care patients when they are hospitalized. Primary care-based colleagues participate in the transition of patients from the hospital back to primary care to complete the treatment plan started in the hospital. Successful care transitions depend on our collaboration. Furthermore, the lines between where we deliver care are blurring. For example, hospitalists now staff hospital at home programs once the purview of outpatient-based general internists and geriatricians^{4, 5} or discharge clinics for patients with severe heart failure or other conditions where close follow-up is important. Patient care and continuity of care are enhanced by close collaboration of general internists across all care settings. As a general internist who works in the outpatient clinic and staffs an inpatient ward team eight weeks a year, I see this in action, and research done by SGIM members addresses improvements in transitions in care between these two settings.

Second, general internal medicine physicians have flexibility in their careers over time. I know many people who have practiced in one setting and later in other settings. One of our former chief residents started in hospital medicine, transitioned to nursing home care and leadership, and is now back in our primary care clinic with a desire to teach residents in this setting. This is an important career advantage that I discuss with residents on the fence between subspecialty medicine and general internal medicine.

Finally, and most important, we are better and more persuasive together. SGIM members are academic general internists, adding education, research, and clinical leadership to our clinical roles. We are a vibrant Society with people passionate about clinical care, education, research, and advocacy. When collaborating and bringing together our diverse perspectives, skills, and knowledge, we have a better view of a challenge, not unlike our ability to see the whole patient instead of one disease. Because of this broad perspective and our diverse viewpoints, we are more likely to find creative ways forward. We need each other as we face the complex challenges of health, health care, and society. I look forward to meeting these challenges together.