Letters

Future of Internal Medicine

Thank you for excellent coverage of Internal Medicine Symposium held at AKUH highlighting future in of Internal Medicine in health care.

I consider myself a kaleidoscope for internal medicine from mid 60s to present. HOPE hospital Sanford which I considered a modal for Pakistan on returning back to Pakistan; It became third medical school of university of Manchester. There were four consultants each with special interest in neurology, cardiology, pulmonology and Endocrinology. This model still holds good for district hospitals in Pakistan.
The society of internal medicine of USA also considered internists to have one year specialty training. The president of American College of Gynecologist and Obstetricians advocated extra training in internal medicine as one third of women consulted obstetrician for medical problems.

The situation in Pakistan is different as they reduced training in medicine from three years to two years. CPSP authorities are requested to restore three years training in Internal Medicine for subspecialties. Specialties are needed but general internists should remain primary physician for the patients to integrate various treatment patients with multi comorbidities.

The circumstances that led to the specialists and the decline of generalists have been detailed before, but they’re worth summarizing. First, medicine has become more complex. Whereas it’s estimated that the doubling time of medical knowledge in 1950 was 50 years. It’s now considered a truism that the totality of medical knowledge doubles every 73 days. If that prospect isn’t intimating enough, consider that every year, 5600 medical journals publish some 800,000 papers. Before 1980 it was golden age of internal medicine for trainees look forward to master clinicians as role model.

Financial advantaged and prestige of subspecialties led to lesser number of graduates are entering in internal Medicine. We need confident generalist because of increasing numbers of patients with multiple co-morbidities. A study in the Archives of Internal Medicine found that, from 1999 to 2009, the number of visits resulting in physicians’ referrals increased 159 percent, from 41 million to 105 million. Among Medicare patients, the referral rate increased by more than 350 percent. Specialist visits now constitute more than half of all outpatient visits in the USA. And for 40 percent of older adults, the physicians they see most often is a specialist.

We need them more for our district hospitals and medical colleges. Because internists or Master Clinicians are physicians who make lifelong commitments to caring for patients and educating young and future physicians. As role models, they consistently demonstrate the physician behaviors now identified as essential, including psychosocial awareness, respect for health care economics, patient-centered paradigms, and excellence in clinical sciences.
Describing my own experience of 60 Years of practicing on Internal Medicine to young graduates; I have enjoyed the career as general internists as the best sub-specialty for holistic care of the patients with intellectual satisfaction making a clinical diagnosis. It can still give you a decent living and sense of personal satisfaction and achievement for destiny chose you to become a physicians as in the preface of the first addition of Harrison’s Textbook of Internal medicine.

“No greater opportunity, responsibility, or obligation can fall to the lot of a human being than to become a physician. In the care of the suffering, (the physician) needs technical skill, scientific knowledge, and human understanding. Tact, sympathy, - Harrison’s Principles of Internal Medicine, 1950”.

Prof. Ejaz Ahmad Vohra
Karachi, Pakistan.