Posted by IM physician from IP 184.108.40.206 on February 10, 2010 at 00:04:08:
please read this:
The future of outpatient internal medicine6Posted by rcentor | Posted on 06-11-2008
Category : Medical Rants
I personally dislike using the term primary care for internists, because of the misuse of this word. Those who do not understand the value of outpatient internists use the label primary care, and then opine that we could get nurse practitioners to do primary care. Obviously we have a problem of semantics.
Semantics are powerful. The words we use to describe things provides a context that redefines those things. By calling internists primary care physicians, internists proudly view themselves as providing comprehensive, continuous, complex care, while many non-physicians think of sore throats, urinary tract infections and routine hypertension management.
I chose internal medicine for the blend of intelletual stimulation and emotional satisfaction. Internal medicine always provides diagnostic puzzles. I (and most inernists) love the detective work. We all love presenting "cool cases" to our colleagues. But inernal medicine also provides very meaningful doctor patient interactions.
The current problem with outpatient medicine, as I type repeatedly, is one of time. Both the detective work and the emotional piece take appropriate time to develop.
I am currently visiting Mt. Sinai in New York (giving Grand Rounds this morning.) Last night at dinner, one internist opined that retainer physicians once again love outpatient medicine.
So if we are to save outpatient internal medicine, and I believe that it needs saving, we must convince policy makers of its value. Unless they understand the value, and develop reasonable payment schemes, internists will choose other great careers. Hospital medicine has all the attributes that we seek, except the long term relationships. But the short term relationships are wonderful and powerful. Many subspecialties provide excellent options.
Outpatient internists are an endangered species. We internists all know this, but no one else seems to care. I challenge other internal medicine bloggers to join me in making this concept known to the decision makers.
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