When my children were young, they repeatedly asked, “Dad, what does ‘internal medicine’ mean?” The term “internal medicine” is not intuitive to what we do as internal medicine physicians and continues to be an enigma to so many.
Defining the role of internal medicine within the health care system has been a challenge since the field began in the late 1800s in Germany. That’s when a group of “inner medizine” physicians started applying medically related scientific knowledge of the care of their patients, which differed significantly from the way medicine was practiced at the time. Sir William Osler introduced this approach to patient care in America, and with it came the name “internal medicine.” It’s a confusing name that contributes to a lack of popular understanding about the range of clinical activities, types of practice settings, and professional responsibilities that the specialty of internal medicine encompasses.
Adding to this confusion is the fact that those who specialize in internal medicine are often called “internists.” This is a confusing and dated term, one that has persisted over time out of tradition, and out of practicality as a shortened reference to the field of “internal medicine.” One clear problem with being called “internists” is that people often mistakenly confuse us with medical interns — physicians in training who have completed medical school but do not yet have a license to practice medicine unsupervised. This means patients may not always understand why or when they are seeing an internal medicine physician or how the role of one of these physicians is different than a medical intern.
The confusion is furthered because some subspecialists have titles clearly based on the organ or system they care for (e.g. cardiology, pulmonology, gastroenterology, nephrology), while others have titles that are more easily understood, such as a pediatrician’s role in care for children, or a surgeon’s in the operating room. Some people wonder whether we internal medicine physicians deal exclusively with internal organs. (We don’t.)
It’s time for us to shift from calling ourselves “internists” and officially claim the title “internal medicine physician,” which more clearly denotes our training, knowledge, and clinical expertise. This change would help us unify as critical thinkers who are uniquely trained to understand a multitude of diseases, connections in the body, and the patients’ social environment.
Confusion and ambiguity about our name and our role is detrimental, keeping people from understanding the depth and breadth of our specialty and the range of activities, types of practices and professional roles it includes. Without a clearer sense of identity and understanding of our collective professional impact, we risk the erosion of credibility and influence, and a lack of appreciation or understanding for the role and the value of internal medicine physicians in today’s health care environment.
Uniting those who’ve trained in internal medicine under the umbrella of “internal medicine physicians” clarifies our training and professional status. It also allows us to harness the power of our collective contributions across the health system and across the globe, influencing better health outcomes, and healthier communities.
As a specialty, internal medicine is wide-ranging and includes both general internal medicine physicians and internal medicine subspecialists, which makes it difficult to succinctly articulate the breadth and depth of knowledge with which internal medicine physicians are equipped. The diversity within the specialty of internal medicine affords us the opportunity and ability to practice in the variety of clinical settings we do, and the types of care we provide to patients.
Despite the ambiguity of the term, internal medicine is the cornerstone of comprehensive health care, vital to both patients and other health care professionals. Our diverse roles within health care and our ability to thrive as critical thinkers, make our specialty an essential component in health care. Thus, it is welcome news to see the record high number of medical students who matched in internal medicine residency programs this year.
I was drawn to this field because I was intrigued by the complex diagnostic challenges, which required not only a broad depth of knowledge, but also a unique and engaging opportunity to connect with and support patients throughout their adult life. I was also inspired by the relationships and perspective internal medicine provides with internal medicine colleagues, trainees, and leaders across the breadth of medicine, working to evolve and align health care to enhance the well-being of the patients that I serve. Finally, I loved the prospect of being a part of a community of internal medicine physicians working in many roles and settings across health care who could provide me with invaluable feedback, support, advice, and collaboration.
There’s no question about the value and impact that internal medicine physicians bring to patients and health care systems. Internal medicine is an incredibly diverse community of professionals. Our comprehensive training provides a solid foundation that creates opportunities for a variety of career paths as specialists and subspecialists, in clinical care settings and well beyond.
So, to my fellow internal medicine physicians across the country and around the world, join me in celebrating our profession, embracing our shared roots, and claiming the title of ”internal medicine physicians” with pride, to help shine a light on this specialty. Let’s embrace a true retirement of the term “internist.” Together, we improve the lives and experiences of patients, create healthier communities, and help shape effective, innovative healthcare for the future.
Ryan D. Mire, MD, MACP, is president of the American College of Physicians.
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