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



From the February 2001 ACP-ASIM Observer, copyright 2001 by the American College of Physicians-American Society of Internal Medicine.

Name change

I wholeheartedly agree that internists have an identity crisis. ("Do internists need a name change?" November ACP-ASIM Observer, page 1.) Too often I find myself describing internal medicine practice in terms of what it is not: I don't see kids, deliver babies or do surgery. And while the College's Doctors for Adults campaign may be effective in raising public awareness, I find it about as trite as my own explanation of what I do.

But make no mistake, changing the name of our field to "adult medicine" is fraught with its own problems. I for one would rather continue to explain the differences between interns and internists than "adultists" and adulterers.

Brian D. Schroeder, ACP-ASIM Associate
Kalamazoo, Mich.

As an internist and an emergency physician, I have faced two identity crises in my career. While a senior medical student, I first announced my career choice of internal medicine and received many puzzled looks from relatives and friends. Thus began a long series of explanatory discussions, which continue to this day.

When my career path led to emergency medicine, I had even more explaining to do. Twenty years ago, emergency medicine was still a fledgling specialty. At the time, only 17 or 18 residency programs for this new field existed in the entire country. Emergency physicians not only suffered from a lack of recognition by the lay public but also by their medical colleagues. I remember, on occasions too numerous to count, explaining to the internists, surgeons and other specialists what we do and why emergency medicine should rightly be considered a real specialty. They all had fond (or not so fond) memories of their "moonlighting" experience in the ER and quite naturally assumed that little had changed.

I wish I could say that political activism, hard work, diligence, excellent training, outstanding leadership and an active professional organization have given emergency physicians the widespread recognition we have achieved. Emergency physicians certainly have done all these things. I'm sure they have helped, but the fact of the matter is the recognition came from a television show.

When Michael Crichton first wrote the screenplay that became the wildly successful TV series "ER," he based it on his memories of the "good old days" in a resident-run emergency room. Emergency physicians were appalled at what appeared to be a caricature of our specialty. But at the same time, this was recognized as a great opportunity.

Emergency physicians, under the aegis of the American College of Emergency Physicians, contacted the series' producer. The physicians offered to help by contributing real life scenarios for the show. At the same time, it was possible to correct the things that from our professional standpoint were problems.

What great public relations! Almost overnight, the public began to accept and understand our specialty. Cocktail party conversation was suddenly transformed from, "Emergency medicine? Are you still an intern?" To, "Emergency medicine, Wow! Is it really like what you see on TV?" That visual image did more than any verbal or printed description ever could.

I don't mean to trivialize this issue, or to suggest that we should all start writing screenplays for the new blockbuster series, "Office Practice." (Is Michael Crichton available?) I do think, however, that merely changing the name from "internist" to "adultologist" will not have the desired effect. The term emergency physician, after all, was always fairly descriptive.

Perhaps we need to "think outside the box" and develop a character for the popular media. He could be a cross between Sir William Osler and Sherlock Holmes; someone like the role models who inspired all of us to choose internal medicine in the first place.

In any case, the media—for better or worse—is the key to image in the 21st century. If internal medicine is to be recognized by the public, we must learn how to use the media effectively.

Mark L. Friedman, FACP
Naperville, Ill.

The artwork for the name change article showed the current name of "doctor of internal medicine" and the text suggested a change to "doctor of adult medicine." Inevitably, however, this will lead to acronyms. I will then have to explain to my patients that I am no longer a DIM doctor but am now a DAM doctor.

Randy Watson, ACP-ASIM Member
Aiken, S.C.

You are right. We are not easily labelable. Up into the 1970s, my patients would ask, "When are we doing my internal exam? You're an internalist, aren't you? It's up there on the wall."

I'm not sure that we or our patients understand or respect the term "physician," or ever use it as our British cohorts do. Our surgeons have combined the terms "physicians and surgeons" to try to separate their jobs from the barber surgeons of yesteryear.

It may be too late, but "physician" does apply: a diagnostician who understands much of the mechanism of most illnesses and treats them with roots, leaves, herbs, berries and sometimes complex chemicals devised by pharmaceutical corporations.

Edward H. McGehee, FACP
Wyndmoor, Pa.

Protesting Recertification

I have concerns about the ABIM's new Continuous Professional Development recertification program. ("As recertification deadline nears, concerns keep growing," November ACP-ASIM Observer, page 1.) The Board is developing a patient-peer assessment protocol that requires 10 peers and 25 patients to take part in a telephone survey they assure me is confidential.

Physicians in small rural hospitals like me do not have 10 other peer physicians who we can enroll. I am the only gastroenterologist in my community. I cannot ask noninternists or nonsubspecialists to assess me because they are not peers.

My greater concern is how we protect confidentiality. My risk manager says that releasing the names of 25 patients for an automated telephone survey might abrogate the physician-patient relationship. The Board has not proven how it will protect patients' privacy or adhere to federal guidelines. Without significant protection built into the system, any promise of confidentiality is worthless. I fully expect that any information gleaned from this procedure could appear on the front page of my local newspaper.

Irving S. Gottfried, FACP Farmville, Va.

Medicare HMOs

It is time for physicians to proclaim what the public already knows: for-profit HMOs have generally been a failure. ("The trouble with Medicare HMOs," December ACP-ASIM Observer, page 1.) The public despises their intrusion into the doctor-patient relationship and the loss of free choice of physician and hospital. As the article points out, the General Accounting Office told Congress that Medicare HMOs have been overpaid by Medicare. These health plans are so inherently wasteful that they have either raised premiums, reduced services or fled the Medicare+Choice program altogether.

HMOs cannot control costs because they squander 25% to 30% of premiums on administration, advertising, executive salaries and profit. Meanwhile, popular and efficient Medicare, with all of its problems, has a total overhead of only 2% to 3%. ACP-ASIM should insist that additional tax dollars for Medicare be used to increase provider compensation and expand the program. If Medicare were expanded to cover everyone, the huge savings from a universal risk pool and vastly simplified administration could fund a prescription drug benefit for everyone.

Bailing out private Medicare HMOs would be corporate welfare and a giant step in the wrong direction.

James S. Bernstein, FACP
Rockville Centre, N.Y.


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