Internal medicine is the medical specialty dedicated to the prevention, diagnosis, and treatment of adult diseases, focusing on patients typically over the age of eighteen. Internists, often called “doctors for adults,” are trained to handle a wide spectrum of health concerns, particularly complex and chronic conditions. Unlike surgeons, who primarily address disease through operative procedures, internists use non-surgical methods. These methods include medication, lifestyle changes, and detailed clinical follow-up to manage illness.
The Foundational Role: Diagnosis and Management
The vast majority of an internist’s daily activity is focused on cognitive work rather than procedural tasks. This cognitive focus centers on complex diagnostics, especially when patients present with undifferentiated or multi-system disease processes. Internists synthesize information from symptoms, test results, and medical histories to arrive at a precise diagnosis. They possess specialized skills in managing patients with multiple co-morbidities, which is common in adult populations.
A major component of their role is the long-term management of chronic diseases like diabetes, hypertension, and heart failure. This longitudinal care can span decades, requiring continuous adjustment of treatment plans based on the patient’s evolving health status. They emphasize primary and secondary preventive services, including vaccinations, health screenings, and lifestyle counseling. Internists also coordinate care for patients seeing multiple specialists, ensuring all treatments align with the patient’s overall goals.
The internist acts as the central hub of a patient’s healthcare, receiving referrals and consulting with other specialists. They are uniquely trained to manage complex situations, such as caring for patients with underlying medical conditions during the peri-operative period. Their expertise lies in the application of evidence-based medicine to develop individualized disease and symptom management plans. This extensive diagnostic and management competency distinguishes them from physicians who focus mainly on surgical interventions.
Procedures Performed by General Internists
While the general internist primarily engages in cognitive medicine, they perform a range of minor diagnostic and therapeutic procedures. These procedures are typically less invasive and do not require an operating room environment. Common examples include interpreting electrocardiograms (EKGs) to assess heart rhythm and electrical activity. They also manage peripheral intravenous (IV) line insertion and the placement of nasogastric (NG) tubes or urinary catheters.
In a hospital setting, general internists, particularly hospitalists, may perform more invasive bedside procedures for immediate diagnosis or relief. These include thoracentesis, which involves draining fluid from the pleural space surrounding the lungs for evaluation or symptomatic relief. Paracentesis, the removal of fluid from the abdominal cavity, is performed to diagnose ascites or reduce patient discomfort. Some general internists also perform joint aspirations or injections, often targeting the knee or shoulder, to relieve pain or analyze joint fluid.
In outpatient primary care settings, some internists may perform minor dermatological procedures. These involve simple skin biopsies to evaluate suspicious lesions or the drainage of small abscesses. The performance of these procedures varies significantly based on the practice setting and individual training. They represent the extent of the procedural scope for the non-subspecialized general internist.
Procedural Scope of Internal Medicine Subspecialties
The most complex and invasive procedures associated with Internal Medicine are performed by subspecialists who have completed extensive additional training called a fellowship. After completing a three-year residency in general Internal Medicine, doctors pursue an extra two to four years of highly focused training. General internists refer patients to these subspecialists when specific, high-level procedural interventions are necessary.
Gastroenterologists (GI), who focus on the digestive system, perform procedures like upper endoscopy and colonoscopy. Endoscopy uses a flexible tube with a camera to visualize the upper gastrointestinal tract. Colonoscopy examines the large intestine, often for cancer screening or to diagnose inflammatory conditions. Advanced GI procedures include Endoscopic Retrograde Cholangiopancreatography (ERCP), which combines endoscopy and X-rays to treat problems in the bile and pancreatic ducts.
Cardiology subspecialists, particularly interventional cardiologists, are highly procedural, focusing on the heart and circulatory system. They perform cardiac catheterization, inserting a catheter into a blood vessel to diagnose and treat heart conditions. Interventional cardiologists are experts in angioplasty and stent placement, used to open blocked coronary arteries and restore blood flow. Cardiac electrophysiologists, another cardiology subspecialty, perform ablation therapy and the implantation of pacemakers and defibrillators to manage heart rhythm disorders.
Pulmonary/Critical Care
Pulmonary/Critical Care specialists manage diseases of the lungs and critical illness. They routinely perform bronchoscopy, inserting a scope into the airways to visualize the lungs, collect tissue samples, or remove obstructions. These physicians are also skilled in placing central venous lines and performing endotracheal intubation for patients requiring mechanical ventilation in the ICU.
Nephrology
Nephrology specialists focus on kidney disorders and manage procedures related to dialysis. This includes the placement and maintenance of dialysis catheters for patients with kidney failure.