As Internal Medicine is a specialty of medicine that deals with the internal organs, their functions and possible diseases. A specialist in internal medicine is called an internist and carries out diagnostics, treatment and follow-up care for complaints. If possible, prevention, in order to prevent certain clinical pictures from developing in the first place, also falls within his scope.
What is internal medicine?
The organs treated by internal medicine are, for example, the lungs, the heart, the liver, the kidneys, the digestive tract and the spleen. The blood, vessels and connective and supporting tissue are also part of it.
This results in an area of responsibility for internal medicine for clinical pictures that directly affect these or other organs or their functions. Examples of sub-areas directly connected to organs are nephrology, cardiology, pulmonology, etc. The area of organ functions includes areas such as endocrinology, immunology, diabetology and others. This wide range of tasks results in overlaps with other specialist areas, such as neurology or laboratory medicine.
Although operations were not originally part of the tasks of internal medicine, there are more recent diagnostic methods (mostly minimally invasive) interventions that can at least be called "diagnostic operations". These include endoscopies, which are performed for the visual examination of organs and for tissue removal. Two tubes are inserted through small incisions in the skin. In one there is a camera, the view of which is transmitted to a screen, in the second there is usually cutting tools that are used for small interventions or for tissue removal. Depending on the type of endoscopy, general anesthesia may be necessary, for example a laparoscopy.
Training to become an internist takes at least five years in Germany. The specialist in internal medicine can choose a focus, which extends the further training period by one year. Furthermore, various additional qualifications are possible, such as, among other areas, in addiction or tropical medicine.
Function, effect & goals
One of the diagnostic procedures in internal medicine is the anamnesis, in which the doctor allows the patient to describe his symptoms as precisely as possible. Looking at the patient, palpating, tapping and listening, and performing a functional test form a large part of the usual physical examination and are referred to as the IPAAF scheme: inspection, palpation, percussion, auscultation, functional test.
Checking blood pressure and pulse, as well as taking a temperature, may also be required. Furthermore, the heart activity can be measured by means of an electrocardiogram, also in the form of a long-term EKG. Ultrasound examinations, endoscopies, lung function tests as well as catheter examinations, laboratory examinations and biopsies are also part of internal medicine diagnostic procedures.
Once the internist has made a diagnosis, he suggests the most appropriate treatment route to the patient. This often takes the form of medication, for example the prescription of antibiotics for bladder or kidney infections or hormone replacement for endocrinological findings. However, treatment can also be carried out without medication, for example if a change in the patient's lifestyle can already lead to success (change in diet, stop smoking or the like).
However, the diagnosis made by the internist can also lead to a referral to other specialists if treatment methods are required for which he is not qualified. This is the case, for example, when an operation is necessary. A referral from a general internist to an internist with a focus can also be made if the finding turns out to be complex.
The internist sees another task in prevention. The internist can give advice to patients who, due to their constitution, behavior or genetic disposition, are at higher risk of developing a certain disease, to prevent or delay the onset of the disease. For example, clearly overweight people whose blood sugar levels are in the limit range should take measures to prevent possible diabetes from breaking out.
The internist should also think about giving supportive preparations, for example vitamin supplements. This is particularly important for weakened or elderly patients and can also come into play when there are no deficiency symptoms, but they are to be feared.
Risks, side effects & dangers
Internal medicine covers all vital organs and therefore usually comes across very serious or acutely life-threatening findings more often than orthopedists, dermatologists and other medical professionals, for example. In addition, internal organs are often in direct contact with one another, so that a dedicated diagnosis is important in order to determine the cause of the symptoms as quickly and accurately as possible.
In the case of postponed inflammation or malignant changes in the tissue, the shortest possible duration of the diagnosis can even be life-saving - the longer it takes to make the diagnosis, the worse the diagnosis. At the same time, there can be clinical pictures that are either slowly, barely or unclearly noticeable to the patient. Since most of the organs are in the chest and stomach area and are close to each other, symptoms such as pain may not be able to be localized correctly. So there can be both a more serious and a much more harmless initial suspicion than will later prove to be true.
A diagnosis that is as thorough as possible is therefore also necessary for less intense complaints. Even very serious illnesses like cancer can cause little or no symptoms for a while. The same goes for hormonal malfunctions. It is not uncommon for them to manifest themselves in diffuse complaints such as general malaise, dizziness or weakness and thus place high demands on the professional competence of the treating doctor. A good internist can save the patient a long ordeal here if a diagnosis is made quickly.
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