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Internal medicine

(internalmedicine)





Internal medicine is concerned with the diagnosis and treatment of internal diseases, that is, those thataffect internal organs or the body as a whole. A physician who practices internalmedicine is, in the United States , an internist.

It is hard to define the boundaries between internal medicine and several other specialisms. In fact, in somecountries all non-surgical specialisms are grouped conveniently with "internal medicine".

In the USA , there is some overlap between internal medicine and primary care (or family medicine), which is often practiced byinternists.

In the UK , the specialism is still referred to as generalmedicine (although the combination general (internal) medicine can be found increasingly), and itspractitioners are physicians or hospital physicians as distinct from surgeons .

History

The field on internal medicine came into existence mainly on the European continent. Until the late 18th century , medicine had been a thoroughlyunscientific profession, ignorant of physiology and uninterested inexperimental findings. Most medicine that was being practiced was based on the four humors and the writings of Galen and Hippocrates . There was very little interplay between "internal medicine" and surgery , which was being practiced by non- doctors .

A number of changes occurred at the end of the Enlightenment thatwould change the face of medicine . Perhaps the most vital one was the invention ofthe stethoscope by René-Théophile-Hyacinthe Laennec ( 1781 - 1826 ) around 1816 [1] . Although doctors had listenedto breath sounds before, by putting their ear to the chest of the patient, it became much more comfortable to do so with the stethoscope .

The "internal method" was developed almost completely in the Salpêtrière hospital in Paris , where a large number of very influentialdoctors practiced the art of diagnosis and prognosis (although they seemed to be much less interested in curing that patient). The method was based on arigorous history and physical examination (this was before Rudolf Virchow 's Pathology and WilhelmRöntgen 's X-rays ). Amongst diseases that were originally described by Salpêtrière doctors are Multiple Sclerosis and Haemochromatosis .

The "internal method" was later perfected by Sir William Osler and is practiced to this day.

Principles

The main tools of the doctor are the medical history and the physical examination , but this holds particularly true for internal medicine. Subtle descriptions ofdisease (e.g. cyclic shallow and deep breathing, as in Kussmaul's respiration) or physical signs (e.g. clubbing in many internal diseases) are important tools in guiding the diagnostic process. In the medicalhistory, the "Review of Systems" serves to pick up symptoms of disease that a patient might not normally have mentioned, and thephysical examination typically follows a structured fashion.

At this stage, a doctor is generally able to generate a differential diagnosis , or a list of possible diagnoses that can explain the constellation of signs and symptoms . Occam's razor dictates that, when possible, all symptoms should bepresumed to be manifestations of the same disease process, but often multiple problems are identified.

In order to "narrow down" the differential diagnosis, blood tests and medical imaging are used. They can also serve screening purposes,e.g. to identify anemia in patients with unrelated complaints. Commonly performedscreening tests, especially in older patients, are an X-rays of the chest, a full blood count , basic electrolytes , renal function and blood urea nitrogen .

At this stage, the physician will often have already arrived at a diagnosis, or maximally a list of a few items. Specifictests for the presumed disease are often required, such as a biopsy for cancer , microbiologicalculture etc.

Treatment

Medicine is mainly focused on the art of diagnosis and treatment with medication , but many subspecialties administer non-surgical treatment:


Health science - Medicine

Anesthesiology - Dermatology - Emergency Medicine - General practice - Intensive care medicine - Internal medicine- Neurology - Obstetrics  &  Gynecology - Pediatrics - Public Health  &  Occupational Medicine - Psychiatry - Radiology - Surgery

Branches of Internal medicine

Cardiology - Endocrinology - Gastroenterology - Hematology - Infectious diseases - Nephrology - Oncology - Pulmonology - Rheumatology

Branches of Surgery

General surgery - Cardiothoracic surgery - Neurosurgery - Ophthalmology - Orthopedic surgery - Otolaryngology  (ENT) - Plastic surgery - Podiatric surgery - Urology - Vascular surgery

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