Jump to content

Internal medicine

From Wikipedia, the free encyclopedia
(Redirected from General internal medicine)
"Internist" redirects here. For the medical intern, see Internship (medicine).

Internal medicine, also known as general internal medicine in Commonwealth nations, is a medical specialty for medical doctors focused on the prevention, diagnosis, and treatment of internal diseases in adults. Medical practitioners of internal medicine are referred to as internists, or physicians in Commonwealth nations.[1] Internists possess specialized skills in managing patients with undifferentiated or multi-system disease processes. They provide care to both hospitalized (inpatient) and ambulatory (outpatient) patients and often contribute significantly to teaching and research. Internists are qualified physicians who have undergone postgraduate training in internal medicine, and should not be confused with "interns",[2] a term commonly used for a medical doctor who has obtained a medical degree but does not yet have a license to practice medicine unsupervised.[3][4]

In the United States and Commonwealth nations, there is often confusion between internal medicine and family medicine, with people mistakenly considering them equivalent.

Internists primarily work in hospitals, as their patients are frequently seriously ill or require extensive medical tests. Internists often have subspecialty interests in diseases affecting particular organs or organ systems. The certification process and available subspecialties may vary across different countries.

Additionally, internal medicine is recognized as a specialty within clinical pharmacy and veterinary medicine.

Etymology and historical development

[edit]
Robert Koch, 19th century German physician and microbiologist[5]

The term internal medicine in English has its etymology in the 19th-century German term Innere Medizin. Originally,[6] internal medicine focused on determining the underlying "internal" or pathological causes of symptoms and syndromes through a combination of medical tests and bedside clinical examination of patients. This approach differed from earlier generations of physicians, such as the 17th-century English physician Thomas Sydenham, known as the father of English medicine or "the English Hippocrates." Sydenham developed the field of nosology (the study of diseases) through a clinical approach that involved diagnosing and managing diseases based on careful bedside observation of the natural history of disease and their treatment.[7] Sydenham emphasized understanding the internal mechanisms and causes of symptoms rather than dissecting cadavers and scrutinizing the internal workings of the body.[8]

In the 17th century, there was a shift towards anatomical pathology and laboratory studies, and Giovanni Battista Morgagni, an Italian anatomist of the 18th century, is considered the father of anatomical pathology.[9] Laboratory investigations gained increasing significance, with contributions from physicians like German physician and bacteriologist Robert Koch in the 19th century.[5] During this time, internal medicine emerged as a field that integrated the clinical approach with the use of investigations.[10] Many American physicians of the early 20th century studied medicine in Germany and introduced this medical field to the United States, adopting the name "internal medicine" in imitation of the existing German term.[6]

Internal medicine has historical roots in ancient India and ancient China.[11] The earliest texts about internal medicine can be found in the Ayurvedic anthologies of Charaka.[12]

Role of internal medicine specialists

[edit]

Internal medicine specialists, also referred to as general internal medicine specialists or general medicine physicians in Commonwealth countries,[13] are specialized physicians trained to manage complex or multisystem disease conditions that single-organ specialists may not be equipped to handle.[14] They are often called upon to address undifferentiated presentations that do not fit neatly within the scope of a single-organ specialty,[15] such as shortness of breath, fatigue, weight loss, chest pain, confusion, or alterations in conscious state.[13] They may manage serious acute illnesses that affect multiple organ systems concurrently within a single patient, as well as the management of multiple chronic diseases in a single patient.[14]

While many internal medicine physicians choose to subspecialize in specific organ systems, general internal medicine specialists do not necessarily possess any lesser expertise than single-organ specialists. Rather, they are specifically trained to care for patients with multiple simultaneous problems or complex comorbidities.[15]

Due to the complexity involved in explaining the treatment of diseases that are not localized to a single organ, there has been some confusion surrounding the meaning of internal medicine and the role of an "internist".[16] Although internists may serve as primary care physicians, they are not synonymous with "family physicians", "family practitioners", "general practitioners", or "GPs". The training of internists is solely focused on adults and does not typically include surgery, obstetrics, or pediatrics. According to the American College of Physicians, internists are defined as "physicians who specialize in the prevention, detection, and treatment of illnesses in adults."[17] While there may be some overlap in the patient population served by both internal medicine and family medicine physicians, internists primarily focus on adult care with an emphasis on diagnosis, whereas family medicine incorporates a holistic approach to care for the entire family unit. Internists also receive substantial training in various recognized subspecialties within the field and are experienced in both inpatient and outpatient settings. On the other hand, family medicine physicians receive education covering a wide range of conditions and typically train in an outpatient setting with less exposure to hospital settings.[18] The historical roots of internal medicine can be traced back to the incorporation of scientific principles into medical practice in the 1800s, while family medicine emerged as part of the primary care movement in the 1960s.[18][19][20]

Education and training

[edit]
Main article: Medical education

The training and career pathways for internists vary considerably across different countries.

Many programs require previous undergraduate education prior to medical school admission. This "pre-medical" education is typically four or five years in length. Graduate medical education programs vary in length by country. Medical education programs are tertiary-level courses, undertaken at a medical school attached to a university. In the US, medical school consists of four years. Hence, gaining a basic medical education may typically take eight years, depending on jurisdiction and university.[21]

Following completion of entry-level training, newly graduated medical practitioners are often required to undertake a period of supervised practice before their licensure, or registration, is granted, typically one or two years. This period may be referred to as "internship", "conditional registration", or "foundation programme". Then, doctors may follow specialty training in internal medicine if they wish, typically being selected to training programs through competition. In North America, this period of postgraduate training is referred to as residency training, followed by an optional fellowship if the internist decides to train in a subspecialty.[22]

In most countries, residency training for internal medicine lasts three years and centers on secondary and tertiary levels of health care, as opposed to primary health care. In Commonwealth countries, trainees are often called senior house officers for four years after the completion of their medical degree (foundation and core years). After this period, they are able to advance to registrar grade when they undergo a compulsory subspecialty training (including acute internal medicine or a dual subspecialty including internal medicine). This latter stage of training is achieved through competition rather than just by yearly progress as the first years of postgraduate training.[23][24]

Certification

[edit]

In the US, three organizations are responsible for the certification of trained internists (i.e., doctors who have completed an accredited residency training program) in terms of their knowledge, skills, and attitudes that are essential for patient care: the American Board of Internal Medicine, the American Osteopathic Board of Internal Medicine and the Board of Certification in Internal Medicine.[25][26] In the UK, the General Medical Council oversees licensing and certification of internal medicine physicians.[27] The Royal Australasian College of Physicians confers fellowship to internists (and sub-specialists) in Australia.[28] The Medical Council of Canada oversees licensing of internists in Canada.[29]

Subspecialties

[edit]

United States of America

[edit]

In the US, two organizations are responsible for certification of subspecialists within the field: the American Board of Internal Medicine and the American Osteopathic Board of Internal Medicine. Physicians (not only internists) who successfully pass board exams receive "board certified" status.

American Board of Internal Medicine
[edit]

The following are the subspecialties recognized by the American Board of Internal Medicine.[25]

American College of Osteopathic Internists
[edit]

The American College of Osteopathic Internists recognizes the following subspecialties:[26]

United Kingdom

[edit]

In the United Kingdom, the three medical Royal Colleges (the Royal College of Physicians of London, the Royal College of Physicians of Edinburgh and the Royal College of Physicians and Surgeons of Glasgow) are responsible for setting curricula and training programmes through the Joint Royal Colleges Postgraduate Training Board (JRCPTB), although the process is monitored and accredited by the independent General Medical Council (which also maintains the specialist register).[27]

Doctors who have completed medical school spend two years in foundation training completing a basic postgraduate curriculum. After two years of Core Medical Training (CT1/CT2), or three years of Internal Medicine Training (IMT1/IMT2/IMT3) as of 2019, since and attaining the Membership of the Royal College of Physicians, physicians commit to one of the medical specialties:[31]

Many training programmes provide dual accreditation with general (internal) medicine and are involved in the general care to hospitalised patients. These are acute medicine, cardiology, Clinical Pharmacology and Therapeutics, endocrinology and diabetes mellitus, gastroenterology, infectious diseases, renal medicine, respiratory medicine and often, rheumatology. The role of general medicine, after a period of decline, was reemphasised by the Royal College of Physicians of London report from the Future Hospital Commission (2013).[32]

European Union

[edit]

The European Board of Internal Medicine (EBIM) was formed as a collaborative effort between the European Union of Medical Specialists (UEMS) - Internal Medicine Section and the European Federation of Internal Medicine (EFIM) to provide guidance on standardizing training and practice of internal medicine throughout Europe.[33][34][35] The EBIM published training requirements in 2016 for postgraduate education in internal medicine, and efforts to create a European Certificate of Internal Medicine (ECIM) to facilitate the free movement of medical professionals with the EU are currently underway.[36][37]

The internal medicine specialist is recognized in every country in the European Union and typically requires five years of multi-disciplinary post-graduate education.[34] The specialty of internal medicine is seen as providing care in a wide variety of conditions involving every organ system and is distinguished from family medicine in that the latter provides a broader model of care the includes both surgery and obstetrics in both adults and children.[34]

Australia

[edit]

Accreditation for medical education and training programs in Australia is provided by the Australian Medical Council (AMC) and the Medical Council of New Zealeand (MCNZ).[38][39] The Medical Board of Australia (MBA) is the registering body for Australian doctors and provides information to the Australian Health Practitioner Regulation Agency (AHPRA).[40] Medical graduates apply for provisional registration in order to complete intern training. Those completing an accredited internship program are then eligible to apply for general registration.[41] Once the candidate completes the required basic and advanced post-graduate training and a written and clinical examination, the Royal Australasian College of Physicians confers designation Fellow of the Royal Australasian College of Physicians (FRACP). Basic training consists of three years of full-time equivalent (FTE) training (including intern year) and advanced training consists of 3–4 years, depending on specialty.[28] The fields of specialty practice are approved by the Council of Australian Governments (COAG) and managed by the MBA. The following is a list of currently recognized specialist physicians.[42]

Canada

[edit]

After completing medical school, internists in Canada require an additional four years of training. Internists desiring to subspecialize are required to complete two additional years of training that may begin after the third year of internist training.[43] The Royal College of Physicians and Surgeons of Canada (RCPSC) is a national non-profit agency that oversees and accredits medical education in Canada.[44] A full medical license in Internal Medicine in Canada requires a medical degree, a license from the Medical Council of Canada, completion of the required post-graduate education, and certification from the RCPSC.[29] Any additional requirements from separate medical regulatory authorities in each province or territory is also required.[29] Internists may practice in Canada as generalists in Internal Medicine or serve in one of seventeen subspecialty areas.[45] Internists may work in many settings including outpatient clinics, inpatient wards, critical care units, and emergency departments. The currently recognized subspecialties include the following:[43]

Medical diagnosis and treatment

[edit]

Medicine is mainly focused on the art of diagnosis and treatment with medication. The diagnostic process involves gathering data, generating one or more diagnostic hypotheses, and iteratively testing these potential diagnoses against dynamic disease profiles to determine the best course of action for the patient.[46]

Gathering data

[edit]

Data may be gathered directly from the patient in medical history-taking and physical examination.[46][47] Previous medical records including laboratory findings, imaging, and clinical notes from other physicians is also an important source of information; however, it is vital to talk to and examine the patient to find out what the patient is currently experiencing to make an accurate diagnosis.[46]

History and physical examination are a vital part of the diagnostic process.[46]

Internists often can perform and interpret diagnostic tests like EKGs and ultrasound imaging (Point-of-care Ultrasound – PoCUS).[48][49]

Internists who pursue sub-specialties have additional diagnostic tools, including those listed below.

Other tests are ordered, and patients are also referred to specialists for further evaluation.  The effectiveness and efficiency of the specialist referral process is an area of potential improvement.[50]

Generating diagnostic hypotheses

[edit]

Determining which pieces of information are most important to the next phase of the diagnostic process is of vital importance.[46][51] It is during this stage that clinical bias like anchoring or premature closure may be introduced.[52] Once key findings are determined, they are compared to profiles of possible diseases.  These profiles include findings that are typically associated with the disease and are based on the likelihood that someone with the disease has a particular symptom.  A list of potential diagnoses is termed the "differential diagnosis" for the patient and is typically ordered from most likely to least likely, with special attention given to those conditions that have dire consequences for the patient if they were missed.[53][54] Epidemiology and endemic conditions are also considered in creating and evaluating the list of diagnoses.[55]

The list is dynamic and changes as the physician obtains additional information that makes a condition more ("rule-in") or less ("rule-out") likely based on the disease profile.[56][57]  The list is used to determine what information will be acquired next, including which diagnostic test or imaging modality to order.  The selection of tests is also based on the physician's knowledge of the specificity and sensitivity of a particular test.[58][59][60]

An important part of this process is knowledge of the various ways that a disease can present in a patient.  This knowledge is gathered and shared to add to the database of disease profiles used by physicians. This is especially important in rare diseases.[61]

Communication

[edit]

Communication is a vital part of the diagnostic process. The Internist uses both synchronous and asynchronous communication with other members of the medical care team, including other internists, radiologists, specialists, and laboratory technicians.[62]  Tools to evaluate teamwork exist and have been employed in multiple settings.[63]

Communication to the patient is also important to ensure there is informed consent and shared decision-making throughout the diagnostic process.[64]

Treatment

[edit]

Treatment modalities generally include both pharmacological and non-pharmacological, depending on the primary diagnosis.[65][66][67][68][69] Additional treatment options include referral to specialist care including physical therapy and rehabilitation.[70]  Treatment recommendations differ in the acute inpatient and outpatient settings.[68][71] Continuity of care and long-term follow-up is crucial in successful patient outcomes.[72][73][74]

Prevention and other services

[edit]

Aside from diagnosing and treating acute conditions, the Internist may also assess disease risk and recommend preventive screening and intervention.  Some of the tools available to the Internist include genetic evaluation.[75][76]

Internists also routinely provide pre-operative medical evaluations including individualized assessment and communication of operative risk.[77]

Training the next generation of internists is an important part of the profession.  As mentioned above, post-graduate medical education is provided by licensed physicians as part of accredited education programs that are usually affiliated with teaching hospitals.[78] Studies show that there are no differences in patient outcomes in teaching versus non-teaching facilities.[79] Medical research is an important part of most post-graduate education programs, and many licensed physicians continue to be involved in research activities after completing post-graduate training.[80][81]

Ethics

[edit]

Inherent in any medical profession are legal and ethical considerations. Specific laws vary by jurisdiction and may or may not be congruent with ethical considerations.[82] Thus, a strong ethical foundation is paramount to any medical profession. Medical ethics guidelines in the Western world typically follow four principles including beneficence, non-maleficence, patient autonomy, and justice.[82] These principles underlie the patient-physician relationship and the obligation to put the welfare and interests of the patient above their own.[83]

Patient-physician relationship

[edit]

The relationship is built upon the physician obligations of competency, respect for the patient, and appropriate referrals while the patient requirements include decision-making and provides or withdraws consent for any treatment plan.  Good communication is key to a strong relationship but has ethical considerations as well, including proper use of electronic communication and clear documentation.[84][85]

Treatment and telemedicine

[edit]

Providing treatment including prescribing medications based on remote information gathering without a proper established relationship is not accepted as good practice with few exceptions.[86] These exceptions include cross-coverage within a practice and certain public health urgent or emergent issues.[82]

The ethics of telemedicine including questions on its impact to diagnosis, physician-patient relationship, and continuity of care have been raised.[82][87] However, with appropriate use and specific guidelines, risks may be minimized and the benefits including increased access to care may be realized.[82]

Financial issues and conflicts of interest

[edit]

Ethical considerations in financial include accurate billing practices and clearly defined financial relationships.  Physicians have both a professional duty and obligation under the justice principle to ensure that patients are provided the same care regardless of status or ability to pay.  However, informal copayment forgiveness may have legal ramifications and the providing professional courtesy may have negatively impact care.[82]

Physicians must disclose all possible conflicts of interest including financial relationships, investments, research and referral relationships, and any other instances that may subjugate or give the appearance of subjugating patient care to self-interest.[82][88]

Other topics

[edit]

Other foundational ethical considerations include privacy, confidentiality, accurate and complete medical records, electronic health records, disclosure, and informed decision-making and consent.[82]

Electronic health records have been shown to improve patient care but have risks including data breaches and inappropriate and/or unauthorized disclosure of protected health information.[89]

Withholding information from a patient is typically seen as unethical and in violation of a patient's right to make informed decisions.  However, in situations where a patient has requested not to be informed or to have the information provided to a second party or in an emergency situation in which the patient does not have decision-making capacity, withholding information may be appropriate.[90][91]

See also

[edit]

References

[edit]
  1. ^ "What Is Internal Medicine?". Castle Connolly. 2019-12-10. Retrieved 2023-06-13.
  2. ^ Arneson, J; McDonald, WJ (July 1998). "Can we educate the public about internal medicine? Initial results". The American Journal of Medicine. 105 (1): 1–5. doi:10.1016/S0002-9343(98)00220-4. PMID 9688013.
  3. ^ "What is an Internist - Doctors for Adults". American College of Physicians. Retrieved 4 Apr 2012.
  4. ^ "Glossary of Terms" (PDF). ACGME. June 28, 2011. Archived from the original (PDF) on 15 November 2012. Retrieved 2 December 2012.
  5. ^ a b "Robert Koch". Encyclopaedia Britannica. Retrieved 26 June 2017.
  6. ^ a b Echenberg, D. (2007). "A history of internal medicine: medical specialization: as old as antiquity". Rev Med Suisse. 3 (135): 2737–9. PMID 18214228.
  7. ^ Meynell, G.G. (2006). "John Locke and the preface to Thomas Sydenham's Observationes medicae". Medical History. 50 (1): 93–110. doi:10.1017/s0025727300009467. PMC 1369015. PMID 16502873.
  8. ^ "Brought to Life: Exploring the History of Medicine: Thomas Sydenham (1624-89)". Science Museum, London. Archived from the original on 14 August 2017. Retrieved 17 May 2017.
  9. ^ Morgagnu, G.B. (1903). "Founders of Modern Medicine: Giovanni Battista Morgagni. (1682–1771)". Medical Library and Historical Journal. 1 (4): 270–277. PMC 1698114. PMID 18340813.
  10. ^ Berger, Darlene (1999). "A brief history of medical diagnosis and the birth of the clinical laboratory: Part 1—Ancient times through the 19th century" (PDF). MLO Med Lab Obs. 31 (7): 28–30, 32, 34–40. PMID 10539661. Retrieved 2018-06-26.
  11. ^ United States. Department of Health and Human Services. Physical Activity and Health: A Report of the Surgeon General. p. 12.
  12. ^ Frank Joseph Goes. The Eye in History. JP Medical Ltd. p. 93.
  13. ^ a b Poole, Philippa. "Restoring the Balance - The Importance of General Medicine in the New Zealand Health System". Internal Medicine Society of Australia and New Zealand. Archived from the original on 10 March 2017. Retrieved 27 June 2018.
  14. ^ a b "General and Acute Care Medicine". The Royal Australasian College of Physicians. Retrieved 27 June 2018.
  15. ^ a b Lowe, J.; Candlish, P.; Henry, D.; Wlodarcyk, J.; Fletcher, P. (2000). "Specialist or generalist care? A study of the impact of a selective admitting policy for patients with cardiac failure". Int J Qual Health Care. 12 (4): 339–45. doi:10.1093/intqhc/12.4.339. PMID 10985273.
  16. ^ Freeman, Brian S. (2012). The ultimate guide to choosing a medical specialty (3rd ed.). New York: McGraw-Hill Medical. pp. 229–250. ISBN 978-0-07-179027-7.
  17. ^ "ACP: Who We Are". American College of Physicians. Retrieved 2011-03-30.
  18. ^ a b "Internal Medicine vs. Family Medicine | ACP". www.acponline.org. Retrieved 2022-11-14.
  19. ^ Echenberg, Donald (2007-11-28). "[A history of internal medicine: medical specialization: as old as antiquity]". Revue Médicale Suisse. 3 (135): 2737–2739. doi:10.53738/REVMED.2007.3.135.2737. ISSN 1660-9379. PMID 18214228.
  20. ^ Abyad, Abdulrazak; Al-Baho, Abeer Khaled; Unluoglu, Ilhami; Tarawneh, Mohammed; Al Hilfy, Thamer Kadum Yousif (November 2007). "Development of family medicine in the middle East". Family Medicine. 39 (10): 736–741. ISSN 0742-3225. PMID 17987417.
  21. ^ "How To Become an Internal Medicine Doctor in 6 Steps". indeed.com. 2023-03-03.
  22. ^ "How To Become an Internal Medicine Specialist". Doctorly.org. Retrieved 2023-06-13.
  23. ^ Freeman 2012, pp. 236
  24. ^ Schierhorn, Carolyn (Dec 6, 2012). "Like to puzzle over diagnoses? Internal medicine may be for you". The DO. Archived from the original on October 20, 2013.
  25. ^ a b "abim.org". Retrieved 2022-01-26.
  26. ^ a b "Subspecialty Section Membership | American College of Osteopathic Internists".
  27. ^ a b General Medical Council (2022). "Registration and Licensing". General Medical Council. Retrieved 2022-11-14.
  28. ^ a b Physicians, The Royal Australasian College of, The Royal Australasian College of Physicians, The Royal Australasian College of Physicians, retrieved 2022-11-14
  29. ^ a b c "StackPath". mcc.ca. Retrieved 2022-11-14.
  30. ^ "aaaai.org". Archived from the original on 2016-03-24. Retrieved 2015-07-08.
  31. ^ "Approved specialty and subspecialty training curricula by Royal College". General Medical Council. Retrieved 3 February 2014.
  32. ^ "Future hospital: Caring for medical patients" (PDF). Royal College of Physicians. 16 September 2013. Retrieved 3 February 2014.
  33. ^ "European Board of Internal Medicine – EBIM Educational Platform of Internal Medicine". Retrieved 2022-11-10.
  34. ^ a b c "What is Internal Medicine? | European Federation of Internal Medicine". efim.org. Retrieved 2022-11-10.
  35. ^ "Main UEMS - Home". www.uems.eu. Retrieved 2022-11-10.
  36. ^ "Main UEMS - European Standards in Medical Training - ETRs". www.uems.eu. Retrieved 2022-11-10.
  37. ^ "European Certification in Internal Medicine – European Board of Internal Medicine". 28 August 2020. Retrieved 2022-11-10.
  38. ^ "Australian Medical Council | The AMC's purpose is to ensure that standards of education, training and assessment of the medical profession promote and protect the health of the Australian community". Retrieved 2022-11-10.
  39. ^ "Medical Council of New Zealand · Te Kaunihera Rata o Aotearoa". Medical Council. 2019-02-27. Retrieved 2022-11-10.
  40. ^ Medical Board of Australia (January 2022). "Regulating Australia's Medical Practitioners". Medical Board AHPRA. Retrieved November 10, 2022.
  41. ^ Medical Board of Australia (January 2022). "Registration Standards". Medical Board AHPRA. Retrieved November 10, 2022.
  42. ^ Medical Board of Australia (May 2021). "Recognition of Medical Specialties". Medical Board AHPRA. Retrieved November 10, 2022.
  43. ^ a b Canadian Medical Association (December 2019). "General Internal Medicine Profile" (PDF). Canadian Medical Association. Retrieved 2022-11-10.
  44. ^ "The Royal College of Physicians and Surgeons of Canada". www.royalcollege.ca. Retrieved 2022-11-10.
  45. ^ "Information By Discipline :: The Royal College of Physicians and Surgeons of Canada". www.royalcollege.ca. Retrieved 2022-11-10.
  46. ^ a b c d e Detsky, Allan S. (2022-05-10). "Learning the Art and Science of Diagnosis". JAMA. 327 (18): 1759–1760. doi:10.1001/jama.2022.4650. ISSN 0098-7484. PMID 35435931. S2CID 248228742.
  47. ^ Bernstein, Jonathan A.; Fox, Roger W.; Martin, Vincent T.; Lockey, Richard F. (May 2013). "Headache and facial pain: differential diagnosis and treatment". The Journal of Allergy and Clinical Immunology. In Practice. 1 (3): 242–251. doi:10.1016/j.jaip.2013.03.014. ISSN 2213-2201. PMID 24565480.
  48. ^ Olgers, T. J.; Azizi, N.; Blans, M. J.; Bosch, F. H.; Gans, R. O. B.; Ter Maaten, J. C. (June 2019). "Point-of-care Ultrasound (PoCUS) for the internist in Acute Medicine: a uniform curriculum". The Netherlands Journal of Medicine. 77 (5): 168–176. ISSN 1872-9061. PMID 31264587.
  49. ^ Möckel, M.; Störk, T. (September 2017). "[Acute chest pain]". Der Internist. 58 (9): 900–907. doi:10.1007/s00108-017-0299-8. ISSN 1432-1289. PMID 28765984. S2CID 21364030.
  50. ^ Akbari, Ayub; Mayhew, Alain; Al-Alawi, Manal Alawi; Grimshaw, Jeremy; Winkens, Ron; Glidewell, Elizabeth; Pritchard, Chanie; Thomas, Ruth; Fraser, Cynthia (2008-10-08). "Interventions to improve outpatient referrals from primary care to secondary care". The Cochrane Database of Systematic Reviews. 2008 (4): CD005471. doi:10.1002/14651858.CD005471.pub2. ISSN 1469-493X. PMC 4164370. PMID 18843691.
  51. ^ Hegedus, Eric J.; Goode, Adam P.; Cook, Chad E.; Michener, Lori; Myer, Cortney A.; Myer, Daniel M.; Wright, Alexis A. (November 2012). "Which physical examination tests provide clinicians with the most value when examining the shoulder? Update of a systematic review with meta-analysis of individual tests". British Journal of Sports Medicine. 46 (14): 964–978. doi:10.1136/bjsports-2012-091066. ISSN 1473-0480. PMID 22773322. S2CID 2373599.
  52. ^ Saposnik, Gustavo; Redelmeier, Donald; Ruff, Christian C.; Tobler, Philippe N. (2016-11-03). "Cognitive biases associated with medical decisions: a systematic review". BMC Medical Informatics and Decision Making. 16 (1): 138. doi:10.1186/s12911-016-0377-1. ISSN 1472-6947. PMC 5093937. PMID 27809908.
  53. ^ Weingart, C.; Schneider, H.-J.; Sieber, C. C. (September 2017). "[Syncope, falls and vertigo]". Der Internist. 58 (9): 916–924. doi:10.1007/s00108-017-0292-2. ISSN 1432-1289. PMID 28717918.
  54. ^ Kwok, Chun Shing; Bennett, Sadie; Azam, Ziyad; Welsh, Victoria; Potluri, Rahul; Loke, Yoon K.; Mallen, Christian D. (2021-09-01). "Misdiagnosis of Acute Myocardial Infarction: A Systematic Review of the Literature". Critical Pathways in Cardiology. 20 (3): 155–162. doi:10.1097/HPC.0000000000000256. ISSN 1535-2811. PMID 33606411. S2CID 231961318.
  55. ^ Fusco, Francesco Maria; Pisapia, Raffaella; Nardiello, Salvatore; Cicala, Stefano Domenico; Gaeta, Giovanni Battista; Brancaccio, Giuseppina (2019-07-22). "Fever of unknown origin (FUO): which are the factors influencing the final diagnosis? A 2005-2015 systematic review". BMC Infectious Diseases. 19 (1): 653. doi:10.1186/s12879-019-4285-8. ISSN 1471-2334. PMC 6647059. PMID 31331269.
  56. ^ Knuuti, Juhani; Ballo, Haitham; Juarez-Orozco, Luis Eduardo; Saraste, Antti; Kolh, Philippe; Rutjes, Anne Wilhelmina Saskia; Jüni, Peter; Windecker, Stephan; Bax, Jeroen J.; Wijns, William (2018-09-14). "The performance of non-invasive tests to rule-in and rule-out significant coronary artery stenosis in patients with stable angina: a meta-analysis focused on post-test disease probability". European Heart Journal. 39 (35): 3322–3330. doi:10.1093/eurheartj/ehy267. hdl:11380/1286682. ISSN 1522-9645. PMID 29850808.
  57. ^ Westwood, Marie; Ramaekers, Bram; Grimm, Sabine; Worthy, Gill; Fayter, Debra; Armstrong, Nigel; Buksnys, Titas; Ross, Janine; Joore, Manuela; Kleijnen, Jos (May 2021). "High-sensitivity troponin assays for early rule-out of acute myocardial infarction in people with acute chest pain: a systematic review and economic evaluation". Health Technology Assessment. 25 (33): 1–276. doi:10.3310/hta25330. ISSN 2046-4924. PMC 8200931. PMID 34061019.
  58. ^ Hegedus, E. J.; Goode, A.; Campbell, S.; Morin, A.; Tamaddoni, M.; Moorman, C. T.; Cook, C. (February 2008). "Physical examination tests of the shoulder: a systematic review with meta-analysis of individual tests". British Journal of Sports Medicine. 42 (2): 80–92, discussion 92. doi:10.1136/bjsm.2007.038406. ISSN 1473-0480. PMID 17720798. S2CID 9717602.
  59. ^ Wacker, Christina; Prkno, Anna; Brunkhorst, Frank M.; Schlattmann, Peter (May 2013). "Procalcitonin as a diagnostic marker for sepsis: a systematic review and meta-analysis". The Lancet. Infectious Diseases. 13 (5): 426–435. doi:10.1016/S1473-3099(12)70323-7. ISSN 1474-4457. PMID 23375419.
  60. ^ Garcia-Casal, Maria Nieves; Pasricha, Sant-Rayn; Martinez, Ricardo X.; Lopez-Perez, Lucero; Peña-Rosas, Juan Pablo (2021-05-24). "Serum or plasma ferritin concentration as an index of iron deficiency and overload". The Cochrane Database of Systematic Reviews. 2021 (5): CD011817. doi:10.1002/14651858.CD011817.pub2. ISSN 1469-493X. PMC 8142307. PMID 34028001.
  61. ^ Al-Mogairen, Sultan M. (August 2011). "Lupus protein-losing enteropathy (LUPLE): a systematic review". Rheumatology International. 31 (8): 995–1001. doi:10.1007/s00296-011-1827-9. ISSN 1437-160X. PMID 21344315. S2CID 21008365.
  62. ^ Vermeir, P.; Vandijck, D.; Degroote, S.; Peleman, R.; Verhaeghe, R.; Mortier, E.; Hallaert, G.; Van Daele, S.; Buylaert, W.; Vogelaers, D. (November 2015). "Communication in healthcare: a narrative review of the literature and practical recommendations". International Journal of Clinical Practice. 69 (11): 1257–1267. doi:10.1111/ijcp.12686. ISSN 1742-1241. PMC 4758389. PMID 26147310.
  63. ^ Havyer, Rachel D. A.; Wingo, Majken T.; Comfere, Nneka I.; Nelson, Darlene R.; Halvorsen, Andrew J.; McDonald, Furman S.; Reed, Darcy A. (June 2014). "Teamwork assessment in internal medicine: a systematic review of validity evidence and outcomes". Journal of General Internal Medicine. 29 (6): 894–910. doi:10.1007/s11606-013-2686-8. ISSN 1525-1497. PMC 4026505. PMID 24327309.
  64. ^ Land, Victoria; Parry, Ruth; Seymour, Jane (December 2017). "Communication practices that encourage and constrain shared decision making in health-care encounters: Systematic review of conversation analytic research". Health Expectations. 20 (6): 1228–1247. doi:10.1111/hex.12557. ISSN 1369-7625. PMC 5690232. PMID 28520201.
  65. ^ Gay, C.; Chabaud, A.; Guilley, E.; Coudeyre, E. (June 2016). "Educating patients about the benefits of physical activity and exercise for their hip and knee osteoarthritis. Systematic literature review". Annals of Physical and Rehabilitation Medicine. 59 (3): 174–183. doi:10.1016/j.rehab.2016.02.005. ISSN 1877-0665. PMID 27053003.
  66. ^ Fu, Jinming; Liu, Yupeng; Zhang, Lei; Zhou, Lu; Li, Dapeng; Quan, Hude; Zhu, Lin; Hu, Fulan; Li, Xia; Meng, Shuhan; Yan, Ran; Zhao, Suhua; Onwuka, Justina Ucheojor; Yang, Baofeng; Sun, Dianjun (2020-10-20). "Nonpharmacologic Interventions for Reducing Blood Pressure in Adults With Prehypertension to Established Hypertension". Journal of the American Heart Association. 9 (19): e016804. doi:10.1161/JAHA.120.016804. ISSN 2047-9980. PMC 7792371. PMID 32975166.
  67. ^ Malesker, Mark A.; Callahan-Lyon, Priscilla; Ireland, Belinda; Irwin, Richard S.; CHEST Expert Cough Panel (November 2017). "Pharmacologic and Nonpharmacologic Treatment for Acute Cough Associated With the Common Cold: CHEST Expert Panel Report". Chest. 152 (5): 1021–1037. doi:10.1016/j.chest.2017.08.009. ISSN 1931-3543. PMC 6026258. PMID 28837801.
  68. ^ a b Viniegra Domínguez, M. Adela; Parellada Esquius, Neus; Miranda de Moraes Ribeiro, Rafaela; Parellada Pérez, Laura Mar; Planas Olives, Carme; Momblan Trejo, Cristina (June 2015). "[An integral approach to insomnia in primary care: Non-pharmacological and phytotherapy measures compared to standard treatment]". Atencion Primaria. 47 (6): 351–358. doi:10.1016/j.aprim.2014.07.009. ISSN 1578-1275. PMC 6983700. PMID 25443769.
  69. ^ Leite, Renata Giacomini Oliveira Ferreira; Banzato, Luísa Rocco; Galendi, Julia Simões Corrêa; Mendes, Adriana Lucia; Bolfi, Fernanda; Veroniki, Areti Angeliki; Thabane, Lehana; Nunes-Nogueira, Vania Dos Santos (2020-01-12). "Effectiveness of non-pharmacological strategies in the management of type 2 diabetes in primary care: a protocol for a systematic review and network meta-analysis". BMJ Open. 10 (1): e034481. doi:10.1136/bmjopen-2019-034481. ISSN 2044-6055. PMC 7045081. PMID 31932394.
  70. ^ "Guidelines for referral and management of systemic lupus erythematosus in adults. American College of Rheumatology Ad Hoc Committee on Systemic Lupus Erythematosus Guidelines". Arthritis and Rheumatism. 42 (9): 1785–1796. September 1999. doi:10.1002/1529-0131(199909)42:9<1785::AID-ANR1>3.0.CO;2-#. ISSN 0004-3591. PMID 10513791.
  71. ^ A, Pérez; A, Ramos; G, Carreras (Jan–Feb 2020). "Insulin Therapy in Hospitalized Patients". American Journal of Therapeutics. 27 (1): e71–e78. doi:10.1097/MJT.0000000000001078. ISSN 1536-3686. PMID 31833876. S2CID 209340414.
  72. ^ Jackson, Claire; Ball, Lauren (October 2018). "Continuity of care: Vital, but how do we measure and promote it?". Australian Journal of General Practice. 47 (10): 662–664. doi:10.31128/AJGP-05-18-4568. hdl:10072/391610. ISSN 2208-7958. PMID 31195766. S2CID 169207062.
  73. ^ Kripalani, Sunil; LeFevre, Frank; Phillips, Christopher O.; Williams, Mark V.; Basaviah, Preetha; Baker, David W. (2007-02-28). "Deficits in communication and information transfer between hospital-based and primary care physicians: implications for patient safety and continuity of care". JAMA. 297 (8): 831–841. doi:10.1001/jama.297.8.831. ISSN 1538-3598. PMID 17327525.
  74. ^ Goodwin, James S.; Li, Shuang; Hommel, Erin; Nattinger, Ann B.; Kuo, Yong-Fang; Raji, Mukaila (2021-08-02). "Association of Inpatient Continuity of Care With Complications and Length of Stay Among Hospitalized Medicare Enrollees". JAMA Network Open. 4 (8): e2120622. doi:10.1001/jamanetworkopen.2021.20622. ISSN 2574-3805. PMC 9026593. PMID 34383060.
  75. ^ Laukaitis, Christina M. (January 2012). "Genetics for the general internist". The American Journal of Medicine. 125 (1): 7–13. doi:10.1016/j.amjmed.2011.07.034. ISSN 1555-7162. PMC 3246053. PMID 22079017.
  76. ^ Neugut, Alfred I.; MacLean, Sarah A.; Dai, Wei F.; Jacobson, Judith S. (February 2019). "Physician Characteristics and Decisions Regarding Cancer Screening: A Systematic Review". Population Health Management. 22 (1): 48–62. doi:10.1089/pop.2017.0206. ISSN 1942-7905. PMID 29889616. S2CID 48359458.
  77. ^ Pham, Clarabelle T.; Gibb, Catherine L.; Fitridge, Robert A.; Karnon, Jonathan D. (2017-12-03). "Effectiveness of preoperative medical consultations by internal medicine physicians: a systematic review". BMJ Open. 7 (12): e018632. doi:10.1136/bmjopen-2017-018632. ISSN 2044-6055. PMC 5736040. PMID 29203506.
  78. ^ Bowen, Judith L.; Salerno, Stephen M.; Chamberlain, John K.; Eckstrom, Elizabeth; Chen, Helen L.; Brandenburg, Suzanne (December 2005). "Changing habits of practice. Transforming internal medicine residency education in ambulatory settings". Journal of General Internal Medicine. 20 (12): 1181–1187. doi:10.1111/j.1525-1497.2005.0248.x. ISSN 1525-1497. PMC 1490278. PMID 16423112.
  79. ^ Au, Anita G.; Padwal, Raj S.; Majumdar, Sumit R.; McAlister, Finlay A. (March 2014). "Patient outcomes in teaching versus nonteaching general internal medicine services: a systematic review and meta-analysis". Academic Medicine: Journal of the Association of American Medical Colleges. 89 (3): 517–523. doi:10.1097/ACM.0000000000000154. ISSN 1938-808X. PMID 24448044. S2CID 44730113.
  80. ^ Levi, M. (June 2010). "Abundance of research talent in internal medicine". The Netherlands Journal of Medicine. 68 (6): 234–235. ISSN 1872-9061. PMID 20558852.
  81. ^ Ng, Ercan-Fang; Ma, Mahmoud; C, Cottrell; Jp, Campbell; Dm, MacDonald; T, Arayssi; Dc, Rockey (January 2021). "Best Practices in Resident Research- A National Survey of High Functioning Internal Medicine Residency Programs in Resident Research in USA". The American Journal of the Medical Sciences. 361 (1): 23–29. doi:10.1016/j.amjms.2020.08.004. ISSN 1538-2990. PMID 33288205. S2CID 225377201.
  82. ^ a b c d e f g h Sulmasy, Lois Snyder; Bledsoe, Thomas A.; for the ACP Ethics, Professionalism and Human Rights Committee (2019-01-15). "American College of Physicians Ethics Manual: Seventh Edition". Annals of Internal Medicine. 170 (2_Supplement): S1–S32. doi:10.7326/M18-2160. ISSN 0003-4819. PMID 30641552. S2CID 58004782.
  83. ^ Pellegrino, E. D.; Relman, A. S. (1999-09-08). "Professional medical associations: ethical and practical guidelines". JAMA. 282 (10): 984–986. doi:10.1001/jama.282.10.984. ISSN 0098-7484. PMID 10485685.
  84. ^ Farnan, Jeanne M.; Snyder Sulmasy, Lois; Worster, Brooke K.; Chaudhry, Humayun J.; Rhyne, Janelle A.; Arora, Vineet M.; American College of Physicians Ethics, Professionalism and Human Rights Committee; American College of Physicians Council of Associates; Federation of State Medical Boards Special Committee on Ethics and Professionalism* (2013-04-16). "Online medical professionalism: patient and public relationships: policy statement from the American College of Physicians and the Federation of State Medical Boards". Annals of Internal Medicine. 158 (8): 620–627. doi:10.7326/0003-4819-158-8-201304160-00100. ISSN 1539-3704. PMID 23579867. S2CID 24921697.
  85. ^ "Policy Finder | AMA". policysearch.ama-assn.org. Retrieved 2022-11-10.
  86. ^ "Model Guidelines for the Appropriate Use of the Internet in Medical Practice". Journal of Medical Regulation. 88 (2): 81–87. 2002-06-01. doi:10.30770/2572-1852-88.2.81. ISSN 2572-1852. S2CID 244874327.
  87. ^ Snyder, Lois; Weiner, J (2005). "Ethics and Medicaid patients". In Snyder, L (ed.). Ethical choices : case studies for medical practice. American College of Physicians. pp. 130–5. ISBN 1-930513-57-7. OCLC 1034917748.
  88. ^ Snyder, L; Hillman, AL (2005). "Financial incentives and physician decision making". In Snyder, L (ed.). Ethical choices : case studies for medical practice (2nd ed.). Philadelphia: American College of Physicians. pp. 169–75. ISBN 1-930513-57-7. OCLC 56531440.
  89. ^ Sulmasy, Lois Snyder; López, Ana María; Horwitch, Carrie A.; American College of Physicians Ethics, Professionalism and Human Rights Committee (August 2017). "Ethical Implications of the Electronic Health Record: In the Service of the Patient". Journal of General Internal Medicine. 32 (8): 935–939. doi:10.1007/s11606-017-4030-1. ISSN 1525-1497. PMC 5515784. PMID 28321550.
  90. ^ "Withholding Information from Patients". American Medical Association. Retrieved 2022-11-10.
  91. ^ Berger, Jeffrey T. (2005). "Ignorance is bliss? Ethical considerations in therapeutic nondisclosure". Cancer Investigation. 23 (1): 94–98. doi:10.1081/CNV-46392. ISSN 0735-7907. PMID 15779872. S2CID 22167459.

Further reading

[edit]
[edit]
Wikibooks has more on the topic of: Internal medicine
Retrieved from "https://wiki.riteme.site/w/index.php?title=Internal_medicine&oldid=1256937973"