The Future of General Internal Medicine

Eric B. Larson, MD, MPH; Stephan D. Fihn, MD, MPH; Lynne M. Kirk, MD; Wendy Levinson, MD; Ronald V. Loge, MD; Eileen Reynolds, MD; Lewis Sandy, MD, MBA; Steven Schroeder, MD; Neil Wenger, MD, MPH; Mark Williams, MD

In This Article

Core Values

As medicine advances and becomes more chaotic, general internal medicine must adapt, while remaining true to its strengths—its core values and competencies. These time-honored core values, which patients appreciate,[17] have distinguished and sustained general internal medicine (see Table 1 ).

Our field's hallmark is expertise in caring for adult patients, especially those with complex and chronic illnesses. Most general internists provide high-value, comprehensive, and longitudinal patient care for both the healthy and infirm and coordinate complex treatment within a health care system. That longitudinal care can last decades, through health and illness, as medical issues come, go, and grow in number and complexity. It can be delivered primarily to outpatients, with inpatient care provided by hospitalists, who as general internists provide the high-value, complex care our field values; or the same general internist can act as both an outpatient and hospitalist physician. Now, especially in mature practices, older patients receive much of that care.[10]

Some may dismiss lifelong care to individuals as anachronistic; but patients seek and value such care in their doctor-patient relationship.[18,19] Patient care depends on effective communication, with patients and other health professionals alike. General internists value a close, at times intimate, personal connection[18,19,20] and are "adult-tricians" as in the American College of Physicians (ACP)'s slogan, "Doctors for Adults."

Although not unique to general internal medicine, strong emphases on quality outcomes and both primary and secondary preventive services mark the field. General internists have cultivated a commitment to evidence-based practice—with scientific and intellectual rigor, adhering to evidence-based medicine, and expecting to use and share this knowledge. Like all professionals, general internists place a high value on education, including lifelong learning. Many also promote education for their colleagues, other health professionals, and trainees. General internists also place high value on educating their patients, as well as the lay public in general. We are often the information managers for our colleagues and patients.[21]

Adaptability has been a hallmark of the specialty of general internal medicine. This is demonstrated by a willingness to take on the newer realms of clinical medicine (e.g., refugee care and HIV care), therapeutics, communications, and diagnostic and information technologies.

Leadership is emerging as a core value in general internal medicine. Internists appreciate that understanding context is key to good outcomes—especially for patients, but also for the institutions and societies where internists work.

Professionalism, a widely held value in medicine, is particularly respected in general internal medicine and draws many to the field.[22] Empathy and compassion, which ground patient-centered medical care, have sustained many internists during these troubled times.