Internal Medicine is the medical specialization focused on the comprehensive diagnosis and non-surgical treatment of diseases in adults. These physicians, often called internists, are experts in managing complex, chronic illnesses that affect multiple organ systems. While the core of Internal Medicine is cognitive—synthesizing patient history, physical exams, and lab results—internists also perform a range of necessary medical procedures. These procedures span from routine, low-risk tests in an outpatient clinic to high-acuity interventions in a hospital setting. The breadth of these skills reflects the internist’s role as the primary physician for adults.
Common Diagnostic and Monitoring Procedures
Internal Medicine doctors routinely perform procedures in the office setting, primarily for diagnostic clarity or to monitor chronic conditions. These in-office procedures are generally minimally invasive and allow for immediate interpretation within the context of the patient’s medical history. Performing and interpreting these tests immediately accelerates the diagnostic process and treatment adjustment.
Electrocardiograms (EKG) are a foundational tool, recording the heart’s electrical activity to screen for arrhythmias or signs of heart muscle damage. Spirometry, a type of Pulmonary Function Test (PFT), is another common office procedure. It measures how much air a person can inhale and exhale, and how quickly they can exhale, providing objective data to diagnose and monitor conditions like asthma and Chronic Obstructive Pulmonary Disease (COPD).
For skin lesions or suspicious moles, the internist may perform minor dermatological procedures, such as a punch or shave biopsy. These procedures involve removing a small tissue sample for microscopic analysis to confirm or rule out skin cancer. Basic phlebotomy, or the collection of blood samples, is frequently performed directly in the office for routine wellness screenings or specialized laboratory analysis. Interpreting a Complete Blood Count (CBC) or a comprehensive metabolic panel immediately allows the internist to make timely adjustments to medication or order further imaging.
Targeted Therapeutic Injections and Aspirations
Internists frequently utilize minimally invasive procedures for localized therapeutic intervention, particularly for musculoskeletal and inflammatory conditions. These procedures differ from diagnostic tests because their primary goal is to deliver medication directly to a localized area or relieve pressure. This targeted approach offers symptom relief and can serve as an alternative to systemic medication.
Joint aspirations, also known as arthrocentesis, involve inserting a needle into a joint space, such as the knee or shoulder, to remove excess fluid. This procedure can be therapeutic, draining fluid to relieve pressure and pain, or diagnostic. Diagnostic fluid is sent for analysis to check for infection, gout crystals, or inflammatory markers, helping differentiate between various types of arthritis.
Steroid injections, typically involving a corticosteroid combined with a local anesthetic, treat inflammation in joints, tendons, and bursae. These injections are effective for conditions such as tendonitis, bursitis, and localized arthritis by suppressing the localized inflammatory response. Trigger point injections are another common therapeutic procedure where a needle is inserted into a tight band of muscle, known as a trigger point. The injection of a local anesthetic or saline solution aims to break the cycle of muscle spasm and pain, providing temporary relief for chronic muscle pain.
Critical Care and Inpatient Procedural Skills
While not all General Internists perform them, a specialized subset of Internal Medicine physicians, particularly Hospitalists and Critical Care specialists, maintain procedural competency for high-acuity, inpatient care. These procedures are usually performed at the bedside and are necessary to manage life-threatening conditions or support failing organ systems. Performing these procedures allows for rapid intervention in unstable patients.
One frequently performed high-acuity procedure is the placement of a central venous catheter, or “central line.” This involves inserting a catheter into a large vein (internal jugular, subclavian, or femoral) to administer concentrated medications, fluids, or monitor central venous pressure. Critical care physicians also place arterial lines, which are small catheters inserted into an artery, most commonly the radial artery. Arterial lines provide continuous, real-time blood pressure monitoring, offering a level of detail not possible with a standard cuff.
For patients with fluid accumulation around the lungs or in the abdomen, internists perform therapeutic and diagnostic drainage procedures. Thoracentesis removes fluid from the pleural space (the area between the lungs and the chest wall) to improve breathing or diagnose the cause of the buildup. Paracentesis involves draining fluid, or ascites, from the peritoneal cavity in the abdomen, often required for patients with severe liver disease or cancer. These procedures require a high degree of technical skill and are fundamental to managing severely ill, hospitalized patients.