American College of Physicians: Internal Medicine — Doctors for Adults ®

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PR campaign for internal medicine

ACP will explain why the public should choose internists

From the January 1997 ACP Observer, copyright 1997 by the American College of Physicians.

By Deborah Gesensway

Do these scenarios sound familiar?

  • Because you do her annual Pap smear, your patient refers to you as a gynecologist.
  • In picking a primary care physician (PCP) for her new HMO, a patient decides not to select you. She says she doesn't want a specialist who "can't take care of me as a whole patient."
  • You are constantly being asked if you are just out of training since you are an "intern."
  • One more person says to you, "It doesn't matter whom I pick. If they are in the book, they are all OK. Internal medicine and family practice are the same."

Maybe it's not you. Maybe the problem lies deeper, with a poorly defined public image of internal medicine. That is what the College, after a year of national market research, has concluded: More than half the American public doesn't know what an internist is. And of those who say they do know, a fair proportion are wrong. For them, an internist is everything from a trainee (intern) to the kind of doctor who will treat only "your internal organs."

But the research, which will form the basis of a forthcoming College public relations campaign, also showed that the public is interested in the differences among physician specialties. And when informed that internists are experts in adult health and are specially trained to deal with a broad range of adult health needs, two-thirds of the adults surveyed said they were likely to choose an internist as their PCP. (By comparison, only 18% of respondents said that their current PCP was an internist.)

"How can you select an internist if you don't know what one is or does?" asked Janet Arneson, ACP's Vice President for Marketing and Communications. Without detailed knowledge of what internists do, added ACP Executive Vice President Walter J. McDonald, FACP, patients' ability to make an informed decision when selecting a physician is compromised.

As a result, this spring the College plans to kick off a three- to five-year, multi-million-dollar national public relations and advertising campaign to educate the public about why, when and how to seek the care of an internist.

"This is about educating the public so patients can get the best health care that's available," Dr. McDonald said. "I want patients to know why I would want an internist to look after me."

Although Dr. McDonald says it is a long overdue effort, the timing in many ways couldn't be better. In part because many patients now have several years of managed care experience under their belts, people are beginning to express an interest in becoming more educated about how to distinguish among HMOs and their physicians.

"I've really been surprised that I've been explaining so much more recently," said Anjula Agrawal, ACP Associate, who joined a five-person internal medicine practice in downtown Washington, D.C., last summer. Now that she is in the throes of building up a practice, Dr. Agrawal said she sees that "people don't understand the difference between internal medicine and family practice." Even more basic, she said, "they don't understand that we specialize, or even what internship and residency are." And, she has been surprised by how many people think you're a surgeon when you say you practice medicine.

Helping Americans differentiate the kinds of primary care physicians could help doctors like Dr. Agrawal build up patient loyalty, particularly in managed care systems, explained C. Anderson Hedberg, FACP, chair of the steering committee overseeing the public relations effort. Dr. Hedberg is a former ACP Governor and assistant chair of the department of internal medicine at Rush University Medical School in Chicago.

"If people are going to be picking a doctor off a list, they have to have a better idea of what we do," he said. "This isn't about us vs. family practitioners. There's a place for both. What we want to do is find a way to tell people that we are sophisticated doctors for adults, trained to do 90% of what a patient needs, and that we also know best when to refer you to 11 subspecialties in internal medicine."

The public education campaign comes on the heels of ACP's work with the Federated Council of Internal Medicine to define, for the first time, the standard components of internal medicine training programs. It also follows the College's recent position that delivering primary care to women is "one of the core competencies of internal medicine," something that patients have trouble understanding.

"Being a female physician, I have mostly women calling me, and I now have my front office staff ask right from the beginning if patients want to have their Pap smear done too. Usually patients don't realize that internists do Pap smears and breast exams," said ACP Regent Sandra Adamson Fryhofer, FACP, an Atlanta internist. "That gives the front office staff an opportunity to do some education about what internists are." An unintended consequence of this policy, Dr. Fryhofer said, is that "sometimes I get called a gynecologist, and I have to explain that I'm not."

Other internists hope that a coordinated public relations campaign will help the specialty clarify its role in the evolving health care delivery system for insurance companies, HMOs and even medical students.

Susan Thompson, ACP Associate, chief resident at Georgetown University Medical Center, for instance, was shocked this fall to discover that several of the intern applicants she interviewed clearly didn't understand the difference between family practice and internal medicine. "And these are people about ready to graduate from medical school," Dr. Thompson said. "If that's any indicator, our own physicians don't understand the difference. So how can we expect the lay public to?"

The public relations and advertising campaign scheduled to begin later this year follows a year of intensive research, including surveys and focus groups that explored both the public's perceptions of internal medicine and internists' views on whether the College should invest in such a campaign. Researchers found that nearly 90% of ACP members polled favored the idea of the College undertaking an aggressive public relations campaign to define the role of the internist.

Curtis R. Holzgang, FACP, a general internist in Portland, Ore., said this kind of effort could only help in heavily managed- care-penetrated communities like his. There, he explained, the prevailing view among health plan administrators is that family physicians are cheaper and more productive than internists. "I really like the idea of trying to educate the public that an internist is more than just a standard primary physician because of our training, understanding of diseases and ability to manage seriously ill patients," Dr. Holzgang said.

In terms of the public's understanding, the surveyors found that only a quarter of the respondents in a national telephone poll correctly identified internists as "specialists of internal medicine." Another quarter said they thought internists were "interns" or "just out of school." The rest thought internists were everything from "surgeons with primary care responsibilities" to "someone who works in a hospital." About half reported that they thought internists and family physicians were one and the same or that they didn't know the difference.

From 10 focus groups across the country, ACP learned that when selecting a primary care physician, Americans are first and foremost looking for someone who will respect them and listen to them. Only a quarter of the people surveyed, however, reported that they thought internists are good at listening. (More than 60% said they thought family physicians were "best at listening and treating you with respect.")

In addition, only 23% of the respondents said they thought internists would be best at treating you as a whole patient, compared to 49% who attributed that to family physicians. And family physicians, not internists, were more frequently identified with taking a preventive approach to health and wellness.

"These were disturbing findings because internists probably spend more time with patients than most physicians and are trained to listen to patients about all aspects of the problems that adults have," said Dr. McDonald. "I think this is a problem of perception and is tied into a problem that centers around the name 'internal medicine.' "

Although there is currently no proposal to change the name "internal medicine," Dr. McDonald noted that the College has discussed the idea recently with other internal medicine organizations and that it will continue to be a topic of discussion.

Later this spring, the College will select communications consultants to begin drafting the campaign, which will include both television and national magazine ads as well as brochures and media interviews, Ms. Arneson said. The idea will be to link this description of an internist to some sort of public health message, such as preventing osteoporosis or dealing with stress. "We are going to keep it focused on patients," she said.

The College's efforts alone, however, will not be enough to change the public's perception of internal medicine. People choose their doctors not just based on what they hear, but also on what they see.

Keith Michl, FACP, a general internist who is the College's Governor for Vermont, said that an internist can advertise himself as a responsive, accessible physician, "but he isn't accessible if you can never get through to him. And she isn't a comprehensive physician if she is totally flustered by dealing with medical problems that would make that person want to see a family physician" like taking off a wart or doing contraceptive counseling.


In the know?

Surveyors asked 1,900 people across the country to describe the kinds of medical situations for which they thought it would be appropriate to see an internist. Here are the areas most commonly identified with internal medicine.

Management of a disease (e.g., diabetes): 59%
Routine physicals: 53%
Severe symptoms (e.g., chest pains): 52%
Minor symptoms (e.g., a cold): 50%
Minor surgery (e.g., stitching a wound): 39%
Women's health issues (e.g., menopause): 34%
Preventive women's health (e.g., Pap smears): 31%

* Female respondents only.

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