Internal medicine

Article Abstract:

The practice of internal medicine is changing as physicians spend more of their practice time in their offices and less in the hospital. This is partly due to the changing nature of hospital patients, who now are sicker, older, and, more often, mentally impaired. In addition, preventive care requires that physicians spend more time in contact with their patients. The federally created Agency for Health Care Policy and Research is dedicated to evaluating treatment outcomes and developing guidelines for medical practice. Preventive services and the education of internal medicine residents are two areas highlighted for change in the 1990s. The current emphasis on disease prevention may require skills that have not been part of internists' training, such as risk assessment and counseling. As patients play a more active role in treatment, new practical and ethical issues are also raised. The comprehensive history and physical examination may no longer be appropriate, as treatment tailored to the individual patient becomes more relevant. The issues raised by patients with mild hypertension (elevated blood pressure) illustrate the kinds of decisions internists make when they practice preventive medicine. Treatment involves communicating the possible side effects of therapeutic drugs and interpreting the 0.3 percent greater survival probability conferred by drug treatment. How an internist best achieves these goals is not clear. Internal medicine residencies are currently unpopular among medical students due to the specialty's reputation for overwork, poor supervision, and decreasing trainee quality. Suggestions for changes in internal medicine residency training programs are offered. In part, such changes should improve residents' professional development, emphasize skills of talking and listening, and promote new learning approaches, which allow residents to remain current with the rapid expansion of medical knowledge and techniques. The 1990s are a time of change for internal medicine. (Consumer Summary produced by Reliance Medical Information, Inc.)

Reports, Physician and patient, Physician-patient relations, Preventive medicine, Medicine, Preventive

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Educational resource sharing and collaborative training in family practice and internal medicine: a statement from the American Boards of Internal Medicine and Family Practice

Article Abstract:

The American Board of Internal Medicine and the American Board of Family Practice are uniting in a cooperative and collaborative effort to train the generalist physicians of the future. The benefits of collaboration include evening the ratio of generalist to specialist physicians to meet market demands and exploiting the overlapping clinical competencies that are required of both family practice and internal medicine residents. In addition, collaboration offers an opportunity to improve the quality of training in general medicine. Faculty and educational resources may be shared through combined conferences centered around a core curriculum, joint clinical rotations, and cooperative teaching of some procedural skills. The shared use of training sites would permit residents to customize their training to support their career interests. The Boards also present two models of training programs that combine internal medicine with family practice exemplify the use of extensive collaboration.

Family medicine, Study and teaching

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General internal medicine

Article Abstract:

As the medical profession continues to face the challenge of health care reform and the focus of health care, internal medicine practitioners face many responsibilities. These responsibilities involve more health education, early disease detection and treatment and helping the disabled return to daily responsibilities. Preventive measures include reducing death rates from colon cancer and heart attack by recommending aspirin, particularly for men, early treatment for high blood pressure, and improved screening for prostate and ovarian cancer with blood tests and ultrasound. Immunization for pneumonia is another preventive measure. The specialty has difficulty attracting residents in spite of the need and good training programs. Changes in training philosophy and focus on community-based health care and prevention will mandate a team approach with the general internist being the first contact for patients to access the health care system.

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