Occupational and environmental medicine: the internist's role

Article Abstract:

The environment in which people live and work has a profound effect on their health and longevity. These relationships are the subject matter of environmental and occupational medicine, two areas of medicine that are closely interrelated. An outline of a position paper by the American College of Physicians on the internist's responsibilities in these areas is presented. The internist's role in occupational and environmental medicine is to identify conditions that pose risks to the patient, as well as translating media reports on hazardous conditions of various sorts into concrete advice for patients. Many physicians are ill-equipped to deal with environmental and occupational medical issues. In some cases, this results from inadequate medical education and training, sometimes the methods and terminology of these areas may be unfamiliar; in other instances, the sudden onset and sensational nature of media-generated information that the public receives may be difficult to interpret in a way that is beneficial to the patient. Most of the documented cases of environmental pathogens inducing disease in humans come from studies of workers exposed to some deleterious influence; this does not imply that the non-work environment is any less influential in the maintenance of health and the induction of disease. The internist should be concerned with identifying potentially harmful chemical and physical environmental agents; with the estimation of risk resulting from exposure to these agents; and with putting this risk into proper perspective. To accomplish these goals, it is recommended that medical training at all levels be increasingly cognizant of these issues; that internists evaluate patients' environmental exposures during diagnostic interviews; that internists work constructively with public health authorities; and that improved informational sources are made available to internists. (Consumer Summary produced by Reliance Medical Information, Inc.)

Methods, Risk factors, Demographic aspects, Epidemiological research, Cross sectional studies, Medicine, Industrial, Industrial medicine, Environmentally induced diseases, Environmental illness

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The time has come for vascular medicine

Article Abstract:

Vascular medicine, which is concerned with the study of blood vessels, has become a specialty of internists who confine their expertise to treating vascular diseases. The development of vascular medicine as a specialty is due to advances in the diagnosis and treatment of vascular disease and to the rapid growth in the field of vascular biology. The blood vessel is recognized as a complex organ that controls its own tone and growth, as well as regulating blood flow. The roles of various substances (factors) released by blood vessels in normal physiologic functioning, including blood coagulation and blood vessel constriction, dilation, and growth, as well as the contribution of these substances to disease processes, are being elucidated. Although there is a need for vascular disease specialists, there are few formal training programs in vascular medicine. Comprehensive programs for vascular medicine should be developed with the collaboration of cardiologists, radiologists, vascular surgeons, vascular biologists, and other allied professionals with expertise in various vascular disorders. Internists trained in vascular medicine will be able to clinically apply research advances made by vascular biologists. In addition, vascular specialists will be able to provide optimum care for patients with vascular diseases and associated disorders with their knowledge of recently developed diagnostic and therapeutic tools. (Consumer Summary produced by Reliance Medical Information, Inc.)

Care and treatment, Peripheral vascular diseases, Medical education, editorial

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Reflections on internal medicine and family medicine

Article Abstract:

Improvements in the mutual respect and understanding of practice style differences between family doctors and general internists may result in more cooperation and interaction between these two medical specialties. This cooperation may be necessary as the delivery and organization of medical care changes. General internists tend to view patient care on an individual basis while family doctors view patient care on a family basis. Students training to be family doctors currently spend 8 to 12 months working with internal medicine doctors while few internal medicine students spend any time working with family doctors. Changes in internal medicine curriculum and efforts to establish conferences that allow for more interaction with family doctors might improve future relationships between the specialties.

Family medicine, Study and teaching, Physicians (General practice), General practitioners, Internal medicine

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