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

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From the President

Promoting internal medicine: Is it time for change?

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

By Christine K. Cassel, FACP

Throughout the past year, the College's leadership has been examining new ways to promote internal medicine. What does this effort mean and why do we need to do it?

We need to promote internal medicine because our specialty offers not only the skills to provide effective primary care for adults, but also the subspecialty training that allows internists to function as consultants in challenging and complex clinical situations. The content of our discipline, and its special strengths, are frequently undervalued and misunderstood.

For example, medical students may not understand that training in internal medicine allows them to serve as primary care providers for adults or to focus on more intensive specialty areas.

The public is another group that needs to better understand internal medicine. Medical care, at least for insured patients, is a consumer-driven marketplace, and we need to make sure that patients have enough information to make good decisions. Many patients who select their physicians from health plan panels do not even know what an internist is. How many times have you told someone that you are an internist and received a blank stare in response?

As ACP research has shown, many people think internists are interns just beginning medical training (see PR campaign for internal medicine in this issue). Some have a vague idea that internists deal with disease and pathology, while others simply have no idea at all. Even patients who have an internist as their primary care physician describe that physician as a general practitioner. In order to promote the specialty we think so highly of, we must tell people who we are and what we do. On behalf of all our members, the College wants to make sure that consumers, health plan directors and medical students making choices understand the growing practice of internal medicine and its exciting future for health promotion and patient care.

Sometimes we wonder whether it would be easier to simply take on a different name. While the terms "family practitioner," "pediatrician" and "surgeon" are well-recognized by the public, the word "internist" does not convey the notion of a specialty that deals comprehensively with the medical problems of adults.

The name internal medicine comes from the German "innere medezin" and reflects the truly scientific approach to medical care. Our name reflects honorable and historical roots, but because that history is not recognized by the public, some argue—convincingly—that we should change our name. If we were to change our name to "adult medicine," internists would be seen as experts in adult medicine. There is no doubt that the name recognition would be stronger. On the other hand, some argue that if we more aggressively promoted the identity and values of internal medicine, changing the name would be unnecessary.

Internal medicine is constantly changing to take advantage of advances that are helping improve the health of the American public, fight disease and improve the function of those with chronic illness. Incorporating these advances requires scientific knowledge and a strong intellectual curiosity which, linked with a commitment to excellence and continued learning, will keep internists at the forefront of medical science.

At the same time, internists as physicians for adults need to act as communicators and understand the role of the doctor-patient relationship in healing and in comforting those who face untreatable illness. What I am describing is the science and the art of medicine, aspects that will always be a part of our specialty no matter what we call ourselves.

I am asking not a question of who we are, but a question of how we can better identify ourselves to our public and to our students. This is not only an interesting philosophical musing, it is a real question of whether it is time for action, of whether it is time for change.

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