Why I Love General Internal Medicine ?

When it comes to choosing a specialty, most medical students fall
into 1 of 3 categories: 1) those who know exactly what they want to do;
2) those who have a sense of what they want to do but aren't sure; and
3) those who have no clue what they want to do, either because they
haven't yet found something they like or because they like multiple
specialties.

As a medical student, I fell into the latter camp, for the latter
reason. A few years later, I'm an outpatient general internist, which
means that I'm a primary care physician for adults, and I couldn't be
happier. Here are some reasons why.



Variety Is the Spice of Life


Show me a career where the same thing happens
day-in and day-out and I'll show you a bored human being. As a
physician, I want to see a variety of patients -- men and women, young
and old, rich and poor, and so on -- and I want to treat a mix of
medical conditions.

As an outpatient general internist, I see all kinds of people for
acute and chronic problems involving anything from their head to their
toes. Each day is an adventure. Any medical concern that doesn't make
the person first go to the emergency department is fair game.

Now, I'm not saying that every patient I see is different from the
last, with a new and fascinating illness. I see plenty of people with
colds, painful backs, and other run-of-the-mill concerns.

And, sometimes being able to see "everything" can feel overwhelming.
Frankly, I don't always know what to do for every patient who walks
through my door, although I usually know where to start, or whom to ask
for help.

Still, I find the patient mix intriguing. On any given day, I may
treat someone with a sinus infection in 1 room, and diagnose someone
else with a rectal mass in the next. Not every kind of physician gets to
do that.



Continuity and Coordination of Care Are Key


While I enjoy working with a variety of
patients, I also enjoy getting to know my patients over time. I wouldn't
be satisfied practicing in a specialty where I see a particular patient
only once or twice, until the problem resolves, and never again.

One of the things I love about being an outpatient general internist
is the continuity. As a primary care physician, I'm expected to be the
expert on my patients -- both their medical problems and who they are as
people -- and I generally know them better than any other physician
involved in their care.

It's a huge responsibility, and it comes with a price. Getting to
know a patient and coordinating care takes time, from requesting outside
records to reviewing them and communicating with consultants. Time is
the one thing that most doctors will tell you they lack.

That said, during my career as a general internist I'll get to work
with some patients for 20, 30, or even 40 years or more. Furthermore, I
learn from my communications with consultants, which helps me stay on
top of the latest developments in multiple specialties. And that, my
friend, is priceless.



Practicing Prevention


Finally, as an outpatient general internist I
get to see patients every day in their own clothes, going about their
lives, feeling well.

Certainly, a large part of primary care is helping sick people feel
better. But an equally significant part is focused on preventing
disasters by diagnosing and treating conditions -- or simply by
counseling patients -- before their conditions mushroom into something
major.

Unfortunately, when it comes to reimbursement, our healthcare system
hasn't yet fully realized the value of preventive care. For example, the
cardiologist who stents a clogged artery is paid far more than the
general internist who prevents an artery from becoming clogged in the
first place, by addressing the patient's hyperlipidemia, hypertension,
and diabetes.

I'd like to think that 1 day preventive care will be reimbursed as
much as procedures. In the meantime, I derive great satisfaction from
knowing that I not only put out fires, but that I also prevent them from
starting. As a primary care physician, I stand by my patients in both
sickness and in health.

In conclusion, choosing which field of medicine to pursue can be
daunting, especially if -- like I did as a medical student -- you find
yourself drawn to several different specialties. My parting advice: Ask
yourself what you want out of a career in medicine. Talk to
practitioners you admire and respect. And, for the variety, for the
continuity and coordination of care, as well as for the preventive care,
I hope you'll consider a career in outpatient general internal
medicine.
Adam B. Possner, MD

Medscape Med Students © 2011 WebMD, LLC