Who’s Who at the doctor’s office

An internist is a doctor who specializes in adult medicine. It is like a pediatrician, who is a specialist in the treatment of children up to 16 years of age.

An intern , on the other hand, is a “just-graduated” physician, who usually gets his clinical experience working grueling 24 hour shifts seeing a variety of patients in a hospital for one or two years.

A general physician is a doctor who has graduated from six years of medical school and also completed two years of internship.

But more training is ahead for an internist.

Like, completing the general practitioner requirements, taking a three-year residence in internal medicine, and learning how to diagnose and treat adult illnesses. A doctor who has completed this training is designated a Generalist in Internal Medicine.

Some internal medicine specialists take a subspecialty (usually lasting two years), like Gastroenterology, Rheumatology, Cardiology, Endocrinology, Neurology, and Pulmonary Medicine.

Phew! I know all these terms and specialties can be confusing, but believe me, there are a number of advantages in visiting a generalist in internal medicine first, rather than going directly to a sub-specialist.

For example: Mary Ann, is a 39 year-old patient who has been having knee pain for the last two days, and she also has some swelling around the knee.

Due to this problem, she went directly to an orthopedic surgeon, because her aunt told her that “she had a similar pain, and he gave her a shot in the joint and she got much better”.

The orthopedic surgeon saw her, ordered some X-rays, and gave her anti-inflammatory medicines. He also advised her that she might have osteoarthritis (a painful, debilitating bone disease), due to damage in the cartilages.

After five days, the pain was worse and her leg was swollen larger. Her friend Natalie advised her to see an internist. (At this point, you may be seeing that friends and relatives, though, well-meaning can give you right and wrong medical advice).

The internist did a complete medical history where he learned that she had been taking birth control pills. With that his only clue, he looked more into her circulatory system and found that she had trombophlebitis (a dangerous blood clot in the vein that can kill if it is dislodged).

He recommended bed rest for several days and Heparin shots, followed by oral anticoagulant (blood thinners) for a few months. With this treatment, Mary avoided getting a pulmonary embolism (blood clot in the lung veins) which is a life-threatening condition.

Mary could have died after getting the “best” specialized advice available. Why?

The problem with seeing the sub-specialist, first, is that he will be more oriented to his scope of practice, and will not see the patient as a whole, taking in consideration other illnesses, the patient’s environment, other medications that are being taken, or other factors that might cause or influence the malady.

And worse, if you visit a surgical-oriented sub-specialty, more probably you will end up having surgery.

OUCH!

That is why most of the medical plans in the United States are using more internists or family practitioners as Primary Care Providers for complete evaluation and to serve in the best interest of the patient (and the insurance plans) to avoid unneeded tests or surgery.

Think of an internist as your medical gatekeeper.

He knows you personally, with all your adorable and annoying quirks and foibles.

Best of all, you’ll have someone who knows which specialist to call and when to make that call. The best medicine is common sense.

Chances are, if you are old enough to have used a manual typewriter, or you used an old style dial telephone, you’re about the right age to see an internist.