Internal medicine is a specialty of medicine that deals with the internal organs, their functions and possible diseases. A specialist in internal medicine is called an internist and practices diagnosis, treatment and follow-up of ailments. If possible, prevention, to prevent certain clinical pictures from developing in the first place, also falls within his scope.
What is internal medicine?
Internal medicine is a specialty of medicine that deals with the internal organs, their functions and possible diseases. The internist practices diagnosis, treatment and follow-up of ailments. The organs treated by internal medicine include the lungs, heart, liver, kidneys, digestive tract and spleen. The blood, vessels and connective and supporting tissues are also included. This results in an area of responsibility for internal medicine for clinical pictures that directly affect these or other organs or their functions. Examples of subfields directly related to organs are nephrology, cardiology, pneumology, etc. Areas such as endocrinology, immunology, diabetology, and others fall within the scope of organ function. This broad range of tasks results in overlaps with other specialties, such as neurology or laboratory medicine. Originally, surgery was not one of the tasks of internal medicine, but with newer diagnostic methods (mostly minimally invasive) there are interventions that can at least be called “diagnostic surgery”. These include endoscopies, which are performed for visual examination of organs and tissue sampling. In this procedure, two tubes are inserted through small incisions in the skin. One contains a camera whose view is transmitted to a screen, and the second usually contains cutting tools used for small procedures or tissue removal. Depending on the type of endoscopy, general anesthesia may be required, such as for laparoscopy. In Germany, further training to become an internist takes at least five years. The specialist for internal medicine can choose a focus, which extends the training period by one year. Furthermore, various additional qualifications are possible, such as, among other areas, in addiction or tropical medicine.
Function, effect and goals
Among the diagnostic procedures in internal medicine is the anamnesis, in which the doctor asks the patient to give as accurate a description of his complaints as possible. Viewing the patient, palpation, tapping, and listening, as well as functional testing, form a large part of the usual physical examination and are referred to as the IPAAF scheme: Inspection, palpation, percussion, auscultation, functional testing. Checking of blood pressure and pulse as well as fever measurement may also be required. Furthermore, cardiac activity can be measured by means of an electrocardiogram, also in the form of a long-term ECG. Ultrasound examinations, endoscopies, lung function tests as well as catheter examinations, laboratory tests and biopsies are also part of the diagnostic procedures of internal medicine. Once the internist has made a diagnosis, he or she suggests the most appropriate course of treatment for the patient. This often takes the form of medication, such as prescribing antibiotics for bladder or kidney infections or hormone replacement for endocrinological findings. However, treatment can also take place without medication, for example, if a change in the patient’s lifestyle habits can already lead to success (change in diet, giving up smoking or similar). However, the diagnosis made by the internist may also lead to a referral to other specialists if treatment methods are required for which he is not qualified. This is the case, for example, when surgery is needed. A referral may also be made from a general internist to an internist with a specialty if the findings turn out to be complex. The internist sees another task in prevention. For a patient whose constitution, behavior or genetic disposition puts him or her at higher risk for a particular disease, the internist can provide advice to help prevent or delay the onset of the disease.For example, people who are clearly overweight and whose blood glucose levels are in the borderline range should take measures to prevent the onset of diabetes. The internist should also consider administering supportive preparations, such as vitamin supplements. This plays a role especially in weakened or elderly patients and can also come into play even when deficiency symptoms are not yet prevalent, but they are to be feared.
Risks, side effects, and hazards
Internal medicine covers all vital organs and thus usually encounters very serious or acutely life-threatening findings more frequently than, for example, orthopedists, dermatologists and other physicians. In addition, internal organs are often directly connected with each other, so that a precise diagnosis is important in order to determine the cause of the complaints as quickly and accurately as possible. In the case of protracted inflammation or malignant changes in the tissue, the shortest possible time to make a diagnosis may even be life-saving – the longer it takes to make the diagnosis, the worse the findings can become. At the same time, there may be disease patterns that are either slow, barely noticeable, or cause vague symptoms for the patient. Because most organs are located in the chest and abdomen and close together, complaints such as pain may not be correctly localized right away. Thus, both a more serious and a much more harmless initial suspicion may be present than will later prove to be true. The most thorough possible diagnosis is therefore necessary even in the case of less intense complaints. Even very serious diseases such as cancer can cause no or only very mild complaints for a while. The same applies to hormonal dysfunctions. They often manifest themselves in diffuse complaints such as general malaise, dizziness or weakness and thus place high demands on the professional competence of the attending physician. Here, a good internist can save the patient a long path of suffering if a diagnosis is made quickly.
