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Internal medicine is the medical specialty concerned with the diagnosis and nonsurgical treatment of unusual or serious diseases, especially where there is difficulty in diagnosis or management. A specialty in Medicine is a branch of medical science other than General practice. Diagnosis is the identification by Process of elimination, of the nature of anything In North America, specialists in internal medicine are commonly called internists. Elsewhere, especially in Commonwealth nations, such specialists are often called physicians, in the older, narrow sense of the word (in North America, physician now commonly applies to any medical practitioner). A physician, medical practitioner or medical doctor who practices Medicine, and is concerned with maintaining or restoring human Health

Because their patients are often seriously ill or require complex investigations, internists do much of their work in hospitals. Many are in consultant practice, only seeing patients referred by other medical practitioners, to help solve complex problems. Because of this tradition, internists have sometimes been described as the "doctor's doctor".

Formerly, many internists were not subspecialized (general physicians in Commonwealth parlance), and would see any complex nonsurgical problem; this style of practice has become much less common.

In modern urban practice, most internists are subspecialists: that is, they generally limit their medical practice to problems of one organ system or to one particular area of medical knowledge. For example, gastroenterologists and neurologists specialize respectively in diseases of the gut and the nervous systems. Gastroenterology ( MeSH heading is the branch of Medicine whereby the Digestive system and its disorders are studied Specialist or consultant pediatricians and geriatricians could also be described as internists who have subspecialized by the age of their patient, rather than by organ system. Pediatrics (also spelled paediatrics) is the branch of Medicine that deals with the medical care of Infants Children and Adolescents Geriatrics is the branch of Medicine that focuses on health care of the elderly

Internists have a lengthy clinical and scientific training in their areas of medical interest, and have special expertise in the use of drugs or other medical therapies (as opposed to surgery). Surgery (from the χειρουργική cheirourgikē, via chirurgiae meaning "hand work" is a medical specialty that uses operative manual and instrumental While the name "internal medicine" may suggest that internists only treat problems of "internal" organs, this is not the case. Internists are trained to treat patients as whole people, not mere organ systems.

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Definition of an internist

Internists hold a medical degree. They are not to be confused with "medical interns," who are either physicians in their first year of residency training (in countries like the USA), or last-year medical students (in countries like Colombia). A medical intern is a term used for a Physician in training who has completed Medical school. The United States of America —commonly referred to as the Colombia (kəˈlʌmbɪə officially the Republic of Colombia () is a country in northwestern South America. Although Internists may act as primary care physicians, they are not "family physicians," "family practitioners," or "general practitioners" (whose training in certain countries includes the medical care of children, and may include surgery, obstetrics and pediatrics). A primary care physician, or PCP, is a Physician / medical doctor who provides both the first contact for a person with an undiagnosed health concern as well General Internists practice medicine from a primary care perspective but they can treat and manage many ailments and are usually the most adept at treating a broad range of diseases affecting adults.

Internal Medicine sub-specialists may also practice general internal medicine, but can focus their practice on their particular subspecialty like cardiology or pulmonology after completing a fellowship. A fellowship is the period of medical training that a Physician may undertake after completing a specialty training program. (Additional training of 2-3 years)

In the USA, adult primary care is usually provided by either family practice or general internal medicine physicians. The United States of America —commonly referred to as the The primary care of adolescents is provided by family practice, internists and pediatricians. The primary care of children and infants is provided by Family Practice or Pediatricians, thus, there is overlap. These physicians can have either an MD,DO, MBBS, MBChB, BMBS, BMed, MBBChir, Degree. Doctor of Medicine ( MD or MD, from the Latin Medicinæ Doctor meaning "Teacher of Medicine" is a doctoral Bachelor of Medicine and Bachelor of Surgery, or in Latin Medicinae Baccalaureus et Baccalaureus Chirurgiae (abbreviated MB BChir, BM BCh,

Caring for the whole patient

Internists are trained to solve puzzling diagnostic problems and handle severe chronic illnesses and situations where several different illnesses may strike at the same time. They also bring to patients an understanding of preventive medicine, men's and women's health, substance abuse, mental health, as well as effective treatment of common problems of the eyes, ears, skin, nervous system and reproductive organs. Most older adults in the United States see an internist as their primary physician.

Education and Training of Internists

Main article: Medical education

The training and career pathways for internists vary considerably across the world. Medical education is education related to the practice of being a medical practitioner, either the initial training to become a doctor (i

First, they must receive the "entry-level" education required of any medical practitioner in the relevant jurisdiction. In all developed countries, entry-level medical education programs are tertiary-level courses, undertaken at a medical school attached to a university. Tertiary education, also referred to as third stage third level and' post-secondary education', is the educational level following the completion of a school providing In US Education, a course is a unit of teaching that typically lasts one Academic term, is led by one or more instructors ( Teachers or Professors Medical education A medical school or faculty of medicine is a Tertiary educational institution—or part of such an institution—that teaches Medicine A university is an institution of Higher education and Research, which grants Academic degrees in a variety of subjects Depending on jurisdiction and university, entry may follow directly from secondary school or require pre-requisite undergraduate education. Secondary school is a term used to describe an educational Institution where the final stage of compulsory schooling known as Secondary education, takes In some Educational systems undergraduate education is Post-secondary education up to the level of a Bachelor's degree. The former commonly take five or six years to complete. Programs that require previous undergraduate education (typically a three or four year degree, often in Science) are usually four or five years in length. Hence, gaining a basic medical degree may typically take from five to eight years, depending on jurisdiction and university.

Following completion of entry-level training, newly graduated medical practitioners are often required to undertake a period of supervised practice before full licensure, or registration, is granted, typically one or two years. Licensure refers to the granting of a License, which gives a 'permission to practice This period may be referred to as "internship" or "conditional registration". A medical intern is a term used for a Physician in training who has completed Medical school. Then, internists require specialist training in internal medicine or one of its subspecialities. In North America, this postgraduate training is often referred to as residency training; in Commonwealth countries, such trainees are often called registrars. Residency is a stage of graduate medical training. A resident physician or resident is a person who has received a Medical degree ( MD

Training in medical specialties typically takes from three to six years, and sometimes more, depending on specialty and jurisdiction. Any medical practitioner who completes specialist training in internal medicine (or in one of its sub-specialties) is an internist, or a specialist physician in the older, narrower sense. In some jurisdictions, training in internal medicine is begun immediately following completion of entry-level training, or even before. In other jurisdictions, junior medical doctors must undertake generalist (un-streamed) training for one or more years before commencing specialization. Hence, depending on jurisdiction, an internist (specialist physician) often does not achieve recognition as a specialist until twelve or more years after commencing basic medical training — five to eight years at university to obtain a basic medical qualification, and up to another six years to become a specialist.

Subspecialties of internal medicine

Internists can choose to focus their practice on general internal medicine, or may take additional training to "subspecialize" in one of 13 areas of internal medicine, generally organized by organ system. Cardiologists, for example, are doctors of internal medicine who subspecialize in diseases of the heart. The training an internist receives to subspecialize in a particular medical area is both broad and deep. Subspecialty training (often called a "fellowship") usually requires an additional one to three years beyond the standard three year general internal medicine residency. (Residencies come after a student has graduated from medical school. )

In the United States, there are two organizations responsible for certification of subspecialists within the field, the American Board of Internal Medicine, and the American Osteopathic Board of Internal Medicine. The United States of America —commonly referred to as the

The following are the subspecialties recognized by the American Board of Internal Medicine[1]. The American Board of Internal Medicine ( ABIM) is a Non-profit, independent Physician organization in the U

The ABIM also recognizes additional qualifications in the following areas

Internists may also specialize in allergy and immunology. Adolescent medicine is a medical subspecialty that focuses on care of patients who are in the Adolescent period of development Cardiac Electrophysiology (also referred to as clinical cardiac electrophysiology, Arrhythmia Services, or electrophysiology) is a branch of the medical Intensive Care Medicine or critical care medicine is a branch of medicine concerned with the provision of Life support or organ support systems in patients Geriatrics is the branch of Medicine that focuses on health care of the elderly Interventional cardiology is a branch of the medical specialty of Cardiology that deals specifically with the catheter based treatment of structural Heart diseases Sports medicine specializes in preventing diagnosing and treating injuries related to participating in sports and/or exercise specifically the rotation or deformation of joints or The American Board of Allergy, Asthma, and Immunology is a conjoint board between internal medicine and pediatrics.

The American College of Osteopathic Internists recognizes the following subspecialties. The American College of Osteopathic Internists is one of two medical associations in the United States for Internal medicine physicians the other being the American Board of Internal [2]

Principles of diagnosis

The main tools of the doctors are the medical history and the physical examination, but this holds particularly true for internal medicine. Allergy is a disorder of the Immune system often also referred to as Atopy. Immunology is a broad branch of biomedical Science that covers the study of all aspects of the Immune system in all Organisms It deals with Cardiology (from Greek grc καρδίᾱ kardiā, "heart" and grc -λογία -logia) is the branch of Internal medicine Intensive Care Medicine or critical care medicine is a branch of medicine concerned with the provision of Life support or organ support systems in patients Endocrinology (from Greek grc ἔνδον endon, "within" grc κρῑνω krīnō, "to separate" and grc -λογία Gastroenterology ( MeSH heading is the branch of Medicine whereby the Digestive system and its disorders are studied Geriatrics is the branch of Medicine that focuses on health care of the elderly Hematology ( American English) or haematology ( British English) is the branch of biology (physiology Pathology, Clinical laboratory Oncology is the branch of medicine that studies Tumors ( Cancer) and seeks to understand their development diagnosis treatment and prevention An infectious disease is a clinically evident Disease resulting from the presence of Pathogenic microbial agents including Pathogenic viruses Pathogenic Nuclear medicine is a branch of Medicine and Medical imaging that uses the nuclear properties of matter in diagnosis and therapy Nephrology (from Greek nephros, " Kidney " and λόγος Logos, "speech" lit In Medicine, pulmonology (aka pneumology) is the specialty that deals with Diseases of the Lungs and the Respiratory tract. Rheumatology is a sub-specialty in Internal medicine and Pediatrics, devoted to the Diagnosis and therapy of Rheumatic diseases. Physical examination or clinical examination is the process by which a Health care provider investigates the body of a Patient for signs Subtle descriptions of disease (e. g. cyclic shallow and deep breathing, as in Cheyne-Stokes's respiration, or persistently deep breathing as in Kussmaul's) or physical signs (e. g. clubbing in many internal diseases) are important tools in guiding the diagnostic process. In Medicine, clubbing, finger clubbing, or digital clubbing is a deformity of the Fingers and fingernails that is associated with a In the medical history, the "Review of Systems" serves to pick up symptoms of disease that a patient might not normally have mentioned, and the physical examination typically follows a structured fashion.

At this stage, a doctor is generally able to generate a differential diagnosis, or a list of possible diagnoses that can explain the constellation of signs and symptoms. A differential diagnosis (sometimes abbreviated DDx, ddx A Sign is an indication of some fact or quality and a medical sign is an objective indication of some medical fact or quality that is detected by a Physician A symptom' (from Greek σύμπτωμα, "accident misfortune that which befalls" from συμπίπτω, "I befall" from Occam's razor dictates that, when possible, all symptoms should be presumed to be manifestations of the same disease process, but often multiple problems are identified. Occam's razor (sometimes spelled Ockham's razor) is a principle attributed to the 14th-century English Logician and Franciscan Friar,

In order to "narrow down" the differential diagnosis, blood tests and medical imaging are used. A blood test is a laboratory analysis performed on a Blood sample that is usually extracted from a Vein in the arm using a needle, or via Medical imaging refers to the techniques and processes used to create Images of the human body (or parts thereof for clinical purposes ( Medical procedures seeking to They can also serve screening purposes, e. g. to identify anemia in patients with unrelated complaints. Anemia ( AmE) or anæmia/anaemia ( BrE) (from the Ancient Greek grc-Latn anaîmia, meaning “without blood” is defined as a qualitative Commonly performed screening tests, especially in older patients, are an X-ray of the chest, a full blood count, basic electrolytes, renal function and blood urea nitrogen. X-radiation (composed of X-rays) is a form of Electromagnetic radiation. A complete blood count ( CBC) also known as full blood count ( FBC) or full blood exam ( FBE) or blood panel, is An electrolyte is any substance containing free Ions that behaves as an electrically conductive medium Renal function, in Nephrology, is an indication of the state of the Kidney and its role in Renal physiology.

At this stage, the physician will often have already arrived at a diagnosis, or maximally a list of a few items. Specific tests for the presumed disease are often required, such as a biopsy for cancer, microbiological culture etc. A biopsy (in Greek: βίος life and όψη look/appearance is a Medical test involving the removal of cells or tissues Cancer (medical term Malignant Neoplasm) is a class of Diseases in which a group of cells display uncontrolled A microbiological culture, AKA microbial culture, is a method of multiplying microbial organisms by letting them reproduce in predetermined culture media under controlled laboratory

Treatment

Medicine is mainly focused on the art of diagnosis and treatment with medication, but many subspecialties administer surgical treatment:

Pulmonology: Bronchoscopy

See also

External links

Medication, also referred to as medicine, can be loosely defined as any substance intended for use in the diagnosis cure mitigation treatment or prevention of disease Cardiology (from Greek grc καρδίᾱ kardiā, "heart" and grc -λογία -logia) is the branch of Internal medicine Angioplasty is the technique of mechanically widening a narrowed or totally obstructed Blood vessel; typically as a result of Atherosclerosis. Synchronized electrical cardioversion is the process by which an abnormally fast Heart rate or Cardiac arrhythmia is terminated by the delivery of a therapeutic dose Radio Frequency Ablation ( RFA) of Lung kidney breast bone and Liver tumors RFA is performed to cure tumors in lung liver kidney bone and rarely in other The Intra-aortic balloon pump (IABP is a mechanical device that is used to decrease myocardial oxygen demand while at the same time increasing Cardiac output. Gastroenterology ( MeSH heading is the branch of Medicine whereby the Digestive system and its disorders are studied Endoscopy means looking inside and typically refers to looking inside the body for medical reasons using an instrument called an endoscope. Endoscopic retrograde cholangiopancreatography ( ERCP) is a technique that combines the use of Endoscopy and Fluoroscopy to diagnose and treat certain problems Nephrology (from Greek nephros, " Kidney " and λόγος Logos, "speech" lit In Medicine, dialysis (from Greek "dialusis" meaning dissolution "dia" meaning through and "lusis" meaning loosening is primarily Intensive Care Medicine or critical care medicine is a branch of medicine concerned with the provision of Life support or organ support systems in patients In Medicine, mechanical ventilation is a method to mechanically assist or replace spontaneous breathing when patients cannot do so on their own The Royal College of Physicians and Surgeons of Canada, (RCPSC is a national private nonprofit organization established in 1929 by a special Act of Parliament The Royal Australasian College of Physicians, or RACP, is the organisation responsible for training educating and representing over 9000 physicians and Paediatricians
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