For many patients, navigating the medical landscape can be a challenge. While most individuals only require an annual checkup with their physician, more complex issues often require the attention of an internist.
Dr. Stephen Gist always knew he wanted to pursue a career in medicine. He has been practicing as an internist in Dallas, Texas, at Medical Specialists Associated for more than 21 years. Dr. Gist shares the ins and outs of internal medicine to give a better understanding of the profession.
Internal medicine has roots that go back centuries to Ancient India and China, where some of the earliest texts have been found, including the Ayurvedic anthologies of Charaka. Modern internal medicine can be traced back to the 1800s, when German physicians began incorporating different sciences to treat adults. Using bacteriology, physiology, and pathology, these physicians incorporated the knowledge they had to treat “inner” illnesses, which began to be known as “innere medizin”, or in common day English, internal medicine.
Internal medicine physicians are specialists that treat and manage complex medical issues for adult patients, explains Dr. Stephen Gist. Unlike family medicine physicians who manage a variety of patient loads, Dr. Gist explains that his patient load consists of patients with multisystem diseases or chronic illnesses that would benefit from specialized care that a single specialist would not cover adequately. His scope of practice covers a multitude of diagnoses that are not dependent on one disease process alone. Many internists practice in a clinic setting with hospital privileges to follow their own patients while some prefer to practice only in the hospital setting as hospitalists.
Although internists manage a wide variety of diseases and illnesses, some are common such as diabetes, hypertension, hypercholesterolemia, and heart and lung conditions. Internists help manage conditions through a multisystem approach, and can refer patients to subspecialists as needed, or when unsure of proper management plans for patients with worsening symptoms.
The path to becoming an internist generally takes a minimum of 11 years after completing high school. Most students will choose to take health or life science related courses during the first four years of undergraduate studies, during which time they will also study and sit for the Medical College Admissions Test (MCAT). After completing this standardized test, students apply for admission to medical schools, which at most schools is another four years. During the first two years, students take a variety of basic science courses such as microbiology, pharmacology, and pathology to get a basis of medicine before beginning their clinical rotations for two years. During these rotations, students go through different fields of medicine such as internal medicine, surgery, pediatrics, and psychiatry. It is during this time that students get a better idea of which field of medicine they would like to pursue and apply to residencies in. Once accepted, internal medicine residency programs are three years in length, in which residents get further training in the field and begin to transition to independent physicians.
For internists, daily schedules can vary depending on their hospital patient load and scheduled appointments. Generally, internists prefer to round at least once daily at the hospital to check up on their admitted patients, and if need be admitting new ones. Most internists have privileges at one or two hospitals in the area of their practice, explains Dr. Stephen Gist. The rest of their day is generally spent seeing patients in their clinic. Many who work at academic centers may have medical students and residents that work with them, and their schedules are similar, although they also tend to set aside teaching time as well.
For many physicians, internal medicine is the stepping-stone to further specialization in one of the many subspecialties recognized by the American Board of Internal Medicine. After completing a residency in internal medicine, physicians continue their training as a fellow for usually a minimum of three years. For those who want to be board-certified in multiple specialties, training can include multiple fellowships. Some common specialties include:
Cardiology- Cardiologists specialize to treat diseases that pertain to the cardiovascular system, namely the heart and blood vessels. Common conditions they see and manage include heart failure, peripheral vascular disease, heart blockages, and irregular heartbeats. Cardiologists could take part in procedures as well, such as performing angioplasty and stent placements in their patients.
Nephrology- Nephrologists are specialized to treat and manage conditions in relation to our kidneys explains, Dr. Stephen Gist. Most common conditions include nephropathies, chronic kidney disease, and patients on dialysis.
Pulmonology- Pulmonologists are responsible for seeing and managing patients with a variety of lung disorders such as pulmonary fibrosis, lung cancer, asthma, and chronic obstructive pulmonary disease. Many pulmonologists have dual specialization in both pulmonary and sleep medicine.
Gastroenterology- Gastroenterologists are responsible for seeing patients with issues related to the digestive system such as the stomach and intestines. Conditions such as intestinal bowel disease, irritable bowel syndrome, and stomach ulcers can be diagnosed and managed. Gastrohepatologists are physicians that help manage conditions related to the liver.
Geriatric Medicine- Like pediatricians, geriatric physicians are responsible for seeing a specific age group, the elderly. Geriatricians are involved in both preventative medicine efforts in the elderly, as well as managing conditions that are typically seen in older patients.
Dr. Stephen Gist Connects the Dots
Many of the conditions that specialists see and manage daily are ones that internists also see in their patient population, however usually when symptoms are not as severe. Dr. Stephen Gist notes that all specialists and internists work hard together to help their patients achieve the best health outcomes.