Doctors of internal medicine ("internists") are medical specialists who focus on adult medicine and have had special study and training focusing on the prevention and treatment of adult diseases. At least three of their seven or more years of medical school and postgraduate training are dedicated to learning how to prevent, diagnose, and treat diseases that affect adults. Internists are sometimes referred to as the "doctor's doctor," because they are often called upon to act as consultants to other physicians to help solve puzzling diagnostic problems. While the name "internal medicine" may lead one to believe that internists only treat "internal" problems, this is not the case. Doctors of internal medicine treat the whole person, not just internal organs.

Definition of an internist

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Doctors of internal medicine may be referred to by several terms, including "internists," "general internists" and "doctors of internal medicine." They are not to be confused with "interns," who are doctors in their first year of residency training. Although internists may act as primary care physicians, they are not "family physicians," "family practitioners," or "general practitioners," whose training is not solely concentrated on adults and may include surgery, obstetrics and pediatrics. General internists practice medicine from a primary care perspective but they can treat and manage over 90% of all ailments.

Internal medicine subspecialists may also practice general internal medicine, but usually focus their practice on their particular subspecialty (like cardiology or pulmonology).

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Permanent Internal Medicine Jobs

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Current Opinion in Internal Medicine - Current Table Of Contents

Breastfeeding and allergies: time for a change in paradigm?.
Page: 539DOI: 10.1097/MCI.0b013e32831dae43Authors: Duncan, Joanne M; Sears, Malcolm R
New aspects in allergic contact dermatitis.
Page: 547DOI: 10.1097/MCI.0b013e32831dae50Authors: Mortz, Charlotte Gotthard; Andersen, Klaus Ejner
Contemporary approaches to the identification of athletes at risk for sudden cardiac death.
Page: 552DOI: 10.1097/MCI.0b013e32831daee4Authors: Drezner, Jonathan A

pubmed: 0003-4819

In the clinic. Influenza.
Hessen MT Related Articles In the clinic. Influenza. Ann Intern Med. 2009 Nov 3;151(9):ICT5-1-ICT5-15; quiz ICT5-16 Authors: Hessen MT PMID: 19894285 [PubMed - indexed for MEDLINE]
Fulminant hepatic failure after use of the herbal weight-loss supplement exilis.
McDonnell WM, Bhattacharya R, Halldorson JB Related Articles Fulminant hepatic failure after use of the herbal weight-loss supplement exilis. Ann Intern Med. 2009 Nov 3;151(9):673-4 Authors: McDonnell WM, Bhattacharya R, Halldorson JB PMID: 19884634 [PubMed - indexed for MEDLINE]
Comments and critiques on the EMBRACE health care reform plan.
Gibson GR Related Articles Comments and critiques on the EMBRACE health care reform plan. Ann Intern Med. 2009 Nov 3;151(9):672; author reply 672-3 Authors: Gibson GR PMID: 19884633 [PubMed - indexed for MEDLINE]
Comments and critiques on the EMBRACE health care reform plan.
O'Brien RL, Frey D Related Articles Comments and critiques on the EMBRACE health care reform plan. Ann Intern Med. 2009 Nov 3;151(9):671; author reply 672-3 Authors: O'Brien RL, Frey D PMID: 19884632 [PubMed - indexed for MEDLINE]
Comments and critiques on the EMBRACE health care reform plan.
Johnson CK Related Articles Comments and critiques on the EMBRACE health care reform plan. Ann Intern Med. 2009 Nov 3;151(9):671-2; author reply 672-3 Authors: Johnson CK PMID: 19884631 [PubMed - indexed for MEDLINE]
Management of hyperlipidemia in patients with abdominal aortic aneurysm.
Sethi A Related Articles Management of hyperlipidemia in patients with abdominal aortic aneurysm. Ann Intern Med. 2009 Nov 3;151(9):670; author reply 670 Authors: Sethi A PMID: 19884630 [PubMed - indexed for MEDLINE]

Archives of Internal Medicine current issue

Is It Time to Eliminate Consultation Codes?: An Analysis of Impact and Rationale [Special Article]
Shalowitz, J. I.Background  As issues of health care cost escalation and parity of payment between primary care and other physicians have become more important, one proposal has been to eliminate consultation codes. Little is known about the current payment accuracy or financial impact of such a change.Methods  To assess the impact of consultation code elimination, 2 assessments were conducted. First, from June 1, 2008, to July 1, 2009, 500 consecutive referrals from primary care physicians to other specialists were reviewed and matched with claims for accuracy of coding and billing. Second, to evaluate the financial impact of this change, year 2007 data on outpatient consultations from the Centers for Medicare and Medicaid Services were reviewed.Results  Of the 500 claims reviewed, 466 were appropriate for analysis. Overall, the coding error rate was 32.4%. When the requesting physician ordered a consultation, the error rate was 5.5%; however, with lower paid referral requests, the error rate was 78.0%. Changing ambulatory consultation codes to those for new patient visits would save Medicare $534.5 million per year.Conclusions  Consultation codes are being billed erroneously at a high rate. Furthermore, the differential cost to Medicare of these codes over those for new patient evaluation and management codes is over half a billion dollars per year. With the growing needs for cost savings as well as encouraging payment parity for cognitive services for primary care physicians, it is time these codes are reevaluated.Published online November 9, 2009 (doi:10.1001/archinternmed.2009.446).
About This Journal [About This Journal]

In This Issue of Archives of Internal Medicine [In This Issue of Archives of Internal Medicine]

Reviewers Who Completed a Review During 2009 [Annual Reviewers List]
Redberg, R. F.
Cancer Risks and Radiation Exposure From Computed Tomographic Scans: How Can We Be Sure That the Benefits Outweigh the Risks? [Editorial]
Redberg, R. F.
A Double Take on Serial Measurement of Coronary Artery Calcification [Editorial]
O'Malley, P. G.
Coffee, Decaffeinated Coffee, and Tea Consumption in Relation to Incident Type 2 Diabetes Mellitus: A Systematic Review With Meta-analysis [Review Article]
Huxley, R., Lee, C. M. Y., Barzi, F., Timmermeister, L., Czernichow, S., Perkovic, V., Grobbee, D. E., Batty, D., Woodward, M. Background  Coffee consumption has been reported to be inversely associated with risk of type 2 diabetes mellitus. Similar associations have also been reported for decaffeinated coffee and tea. We report herein the findings of meta-analyses for the association between coffee, decaffeinated coffee, and tea consumption with risk of diabetes. Methods  Relevant studies were identified through search engines using a combined text word and MeSH (Medical Subject Headings) search strategy. Prospective studies that reported an estimate of the association between coffee, decaffeinated coffee, or tea with incident diabetes between 1966 and July 2009. Results  Data from 18 studies with information on 457 922 participants reported on the association between coffee consumption and diabetes. Six (N = 225 516) and 7 studies (N = 286 701) also reported estimates of the association between decaffeinated coffee and tea with diabetes, respectively. We found an inverse log-linear relationship between coffee consumption and subsequent risk of diabetes such that every additional cup of coffee consumed in a day was associated with a 7% reduction in the excess risk of diabetes relative risk, 0.93 [95% confidence interval, 0.91-0.95]) after adjustment for potential confounders. Conclusions  Owing to the presence of small-study bias, our results may represent an overestimate of the true magnitude of the association. Similar significant and inverse associations were observed with decaffeinated coffee and tea and risk of incident diabetes. High intakes of coffee, decaffeinated coffee, and tea are associated with reduced risk of diabetes. The putative protective effects of these beverages warrant further investigation in randomized trials.
Annual Progression of Coronary Calcification in Trials of Preventive Therapies: A Systematic Review [Review Article]
McCullough, P. A., Chinnaiyan, K. M. Background  Coronary artery calcification (CAC) measured by computed tomography is radiographic confirmation of atherosclerosis, predicts cardiovascular events, and has been evaluated as a surrogate measure in randomized trials. Methods  We performed a literature search for prospective randomized trials in which CAC was measured at baseline and at 1 year or more of follow-up. We computed the weighted mean annualized rate of CAC progression for a variety of therapies tested in these trials. Results  Ten trials (n = 2612) met our criteria and were included. Electron-beam, double-helix, and multislice computed tomography were used in 6, 2, and 2 trials, respectively. Agatston (8 trials) and volumetric (2 trials) methods were used for CAC evaluation. In 5 trials in subjects with cardiovascular disease (CVD) (n = 2135; age, ~64 years; ~39% women; follow-up, ~26 months), therapies included statins (n = 1370), placebo (n = 564), and antihypertensives (n = 201). In 5 trials in subjects with chronic kidney disease (n = 477; age, ~55 years; ~34% women; follow-up, ~14 months), interventions included low-phosphorus diet (n = 29), sevelamer hydrochloride (n = 229), and calcium-based phosphate binders (n = 219). The mean (SD) weighted annualized CAC increase overall and in patients with CVD and chronic kidney disease was 17.2% (6.7%), 16.9% (5.2%), and 18.4 (11.1%), respectively (P < .001). The rate among those assigned blinded placebo was 14.6% (1.0%) (2 trials). There was no consistent or reproducible treatment effect of any therapy on this outcome measured at 1 year. Conclusion  The 1-year change in CAC does not appear to be a suitable surrogate end point for treatment trials in patients with CVD or chronic kidney disease.
Projected Cancer Risks From Computed Tomographic Scans Performed in the United States in 2007 [Original Investigation]
Berrington de Gonzalez, A., Mahesh, M., Kim, K.-P., Bhargavan, M., Lewis, R., Mettler, F., Land, C. Background  The use of computed tomographic (CT) scans in the United States (US) has increased more than 3-fold since 1993 to approximately 70 million scans annually. Despite the great medical benefits, there is concern about the potential radiation-related cancer risk. We conducted detailed estimates of the future cancer risks from current CT scan use in the US according to age, sex, and scan type. Methods  Risk models based on the National Research Council's "Biological Effects of Ionizing Radiation" report and organ-specific radiation doses derived from a national survey were used to estimate age-specific cancer risks for each scan type. These models were combined with age- and sex-specific scan frequencies for the US in 2007 obtained from survey and insurance claims data. We estimated the mean number of radiation-related incident cancers with 95% uncertainty limits (UL) using Monte Carlo simulations. Results  Overall, we estimated that approximately 29 000 (95% UL, 15 000-45 000) future cancers could be related to CT scans performed in the US in 2007. The largest contributions were from scans of the abdomen and pelvis (n = 14 000) (95% UL, 6900-25 000), chest (n = 4100) (95% UL, 1900-8100), and head (n = 4000) (95% UL, 1100-8700), as well as from chest CT angiography (n = 2700) (95% UL, 1300-5000). One-third of the projected cancers were due to scans performed at the ages of 35 to 54 years compared with 15% due to scans performed at ages younger than 18 years, and 66% were in females. Conclusions  These detailed estimates highlight several areas of CT scan use that make large contributions to the total cancer risk, including several scan types and age groups with a high frequency of use or scans involving relatively high doses, in which risk-reduction efforts may be warranted.

Current Opinion in Internal Medicine - Current Table Of Contents

Breastfeeding and allergies: time for a change in paradigm?.
Page: 539DOI: 10.1097/MCI.0b013e32831dae43Authors: Duncan, Joanne M; Sears, Malcolm R
New aspects in allergic contact dermatitis.
Page: 547DOI: 10.1097/MCI.0b013e32831dae50Authors: Mortz, Charlotte Gotthard; Andersen, Klaus Ejner
Contemporary approaches to the identification of athletes at risk for sudden cardiac death.
Page: 552DOI: 10.1097/MCI.0b013e32831daee4Authors: Drezner, Jonathan A
How to break the vicious circle of antibiotic resistances?.
Page: 560DOI: 10.1097/MCI.0b013e32831dabd1Authors: Leone, Marc; Martin, Claude
Benefits of high-protein weight loss diets: enough evidence for practice?.
Page: 566DOI: 10.1097/MCI.0b013e32831daebdAuthors: Brehm, Bonnie J a; D'Alessio, David A b
Chronic pancreatitis.
Page: 572DOI: 10.1097/MCI.0b013e32831daddaAuthors: Conwell, Darwin L; Banks, Peter A

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