COMMENTARY

Why I Love General Internal Medicine

Adam B. Possner, MD

Disclosures

October 12, 2011

When it comes to choosing a specialty, most medical students fall into 1 of 3 categories: 1) those who know exactly what they want to do; 2) those who have a sense of what they want to do but aren't sure; and 3) those who have no clue what they want to do, either because they haven't yet found something they like or because they like multiple specialties.

As a medical student, I fell into the latter camp, for the latter reason. A few years later, I'm an outpatient general internist, which means that I'm a primary care physician for adults, and I couldn't be happier. Here are some reasons why.

Variety Is the Spice of Life

Show me a career where the same thing happens day-in and day-out and I'll show you a bored human being. As a physician, I want to see a variety of patients -- men and women, young and old, rich and poor, and so on -- and I want to treat a mix of medical conditions.

As an outpatient general internist, I see all kinds of people for acute and chronic problems involving anything from their head to their toes. Each day is an adventure. Any medical concern that doesn't make the person first go to the emergency department is fair game.

Now, I'm not saying that every patient I see is different from the last, with a new and fascinating illness. I see plenty of people with colds, painful backs, and other run-of-the-mill concerns.

And, sometimes being able to see "everything" can feel overwhelming. Frankly, I don't always know what to do for every patient who walks through my door, although I usually know where to start, or whom to ask for help.

Still, I find the patient mix intriguing. On any given day, I may treat someone with a sinus infection in 1 room, and diagnose someone else with a rectal mass in the next. Not every kind of physician gets to do that.

Continuity and Coordination of Care Are Key

While I enjoy working with a variety of patients, I also enjoy getting to know my patients over time. I wouldn't be satisfied practicing in a specialty where I see a particular patient only once or twice, until the problem resolves, and never again.

One of the things I love about being an outpatient general internist is the continuity. As a primary care physician, I'm expected to be the expert on my patients -- both their medical problems and who they are as people -- and I generally know them better than any other physician involved in their care.

It's a huge responsibility, and it comes with a price. Getting to know a patient and coordinating care takes time, from requesting outside records to reviewing them and communicating with consultants. Time is the one thing that most doctors will tell you they lack.

That said, during my career as a general internist I'll get to work with some patients for 20, 30, or even 40 years or more. Furthermore, I learn from my communications with consultants, which helps me stay on top of the latest developments in multiple specialties. And that, my friend, is priceless.

Practicing Prevention

Finally, as an outpatient general internist I get to see patients every day in their own clothes, going about their lives, feeling well.

Certainly, a large part of primary care is helping sick people feel better. But an equally significant part is focused on preventing disasters by diagnosing and treating conditions -- or simply by counseling patients -- before their conditions mushroom into something major.

Unfortunately, when it comes to reimbursement, our healthcare system hasn't yet fully realized the value of preventive care. For example, the cardiologist who stents a clogged artery is paid far more than the general internist who prevents an artery from becoming clogged in the first place, by addressing the patient's hyperlipidemia, hypertension, and diabetes.

I'd like to think that 1 day preventive care will be reimbursed as much as procedures. In the meantime, I derive great satisfaction from knowing that I not only put out fires, but that I also prevent them from starting. As a primary care physician, I stand by my patients in both sickness and in health.

In conclusion, choosing which field of medicine to pursue can be daunting, especially if -- like I did as a medical student -- you find yourself drawn to several different specialties. My parting advice: Ask yourself what you want out of a career in medicine. Talk to practitioners you admire and respect. And, for the variety, for the continuity and coordination of care, as well as for the preventive care, I hope you'll consider a career in outpatient general internal medicine.

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