Internal Medicine

Internal Medicine Physician (Internist)

The internal medicine physician, or internist, applies scientific knowledge and clinical expertise to diagnose, treat, and provide compassionate care to adult patients ranging from health to complex illnesses. 

In addition, they have special training in diagnosing puzzling medical problems, in caring for patients with chronic illnesses, and in caring for patients with more than one condition. 

They also specialize in health promotion and disease prevention. Doctors of internal medicine are also known as internists, general internists, and interns in residency. 

Although internists may provide primary care, they are neither family doctors nor general practitioners, whose specialties include surgery, obstetrics, and pediatrics. Internal medicine physicians routinely treat conditions such as heart disease, hypertension, diabetes, obesity, and chronic lung disease. In some cases, internists consult with doctors in other specialties, or they may be asked by another specialist to consult on a patient.

Internists must complete a residency in internal medicine, which generally lasts three years after graduating from a four-year medical school. Upon completion of general internal medicine residency training, a physician may begin practicing internal medicine, or an internist may choose to specialize in a particular area of internal medicine, such as cardiology or infectious diseases. The fellowship training requires two to three years of additional training.

General internists usually provide care in an ambulatory setting (office or outpatient), and follow their patients in a hospital environment (inpatient setting). 

Hospitalists are internists who care for patients only in hospitals. Upon completion of basic internal medicine training, many internists enter practice. General internists practice general internal medicine and are commonly known as “internists”. They are well equipped to treat a broad and comprehensive range of illnesses that affect adults and are recognized as experts in diagnosis, in treating chronic illness, and in promoting health.

 They are not restricted to one type of medical issue or organ system. A general internist is equipped to handle any problem, no matter how common or rare, or how simple or complex it may be. A physician with special training can solve puzzling diagnostic problems and can handle serious chronic illnesses and situations where several different illnesses may occur simultaneously.

A general internist can practice in many different settings. Because of their training, they are uniquely qualified to practice primary care and follow patients for the duration of their adult lives and establish long and rewarding personal relationships with them. Internists may act as primary care physicians, but they are not general practitioners, or family physicians, whose training includes pediatrics, obstetrics, and surgery, which is why most hospitalists in the US are general internists. Other general internists combine these facets of care and provide both outpatient and inpatient care. 

General internists may also practice in unique settings, such as rehabilitation centers and long-term care facilities. Internists can “subspecialize” in a more focused area of internal medicine by completing additional training.  Subspecialty training (often called a “fellowship”) usually requires an additional one to three years in addition to the basic three year internal medicine residency. 

In spite of the fact that doctors with additional training in a particular area of internal medicine are often referred to by their subspecialty focus (for example, cardiologists), all share the same basic internal medicine training and are referred to as internists as well. An internist receives a broad and deep training to subspecialize in a particular medical area, which enables them to manage complex medical problems and in many cases perform advanced clinical procedures.

FACP stands for Fellow of the American College of Physicians (ACP), the largest society of internists in the world. Doctors who are Fellows of ACP are dedicated to continuing education in medical practice, teaching, or research.  An honorary fellowship is given to individuals who have made a significant contribution to the practice of medicine. ACP fellowship is a mark of distinction. 

In addition to teaching, hospital appointments, public service, continuing medical education, publishing scientific articles, and advanced training, your doctor has made special efforts to be a better doctor. At the end of the day, it means that your doctor is committed to providing high-quality health care. 

Internal Medicine Doctor vs. Family Medicine Doctor

People often want to know the difference between an internal medicine doctor and a family medicine doctor when choosing a primary care physician. 

They both specialize in a variety of medical fields. They both treat adults and children (in some cases). 

What’s the difference? And more importantly, which type of doctor is best for you? 

Internal Medicine Doctors

Internists, also known as internal medicine doctors, treat primarily adults. 

For internists to see children, they must have dual training in both internal medicine and pediatrics.

Internal medicine doctors diagnose, treat, and prevent diseases in adults. 

They are trained to treat a wide variety of health conditions as well as to counsel patients on prevention and wellness.

Before practicing internal medicine, interns must complete a three-year residency, and some go on to further training in a subspecialty, such as neurology, endocrinology, oncology, psychiatry, dermatology, cardiology, geriatrics or rheumatology.

Family Medicine Doctors

Family medicine physicians treat patients of all ages – from infants to the elderly. 

They practice four areas of medicine:

  • pediatrics
  • adolescent medicine
  • adult medicine
  • geriatrics

Family medicine doctors usually treat the same patients throughout their lives, and in many cases, they treat multiple generations of the same family at the same time.

Following medical school, doctors must also complete a three-year residency program to practice family medicine. 

A residency in family medicine includes training in pediatrics, gynecology, urology, internal medicine, psychiatry, radiology, ophthalmology, emergency medicine, surgery and obstetrics.

As they treat a wide range of ages and conditions, they must be able to diagnose and treat a wide range of diseases and conditions.

By adding fellowship training to their practice, many family medicine physicians also specialize in obstetrics, sports medicine, and palliative care.


Venipuncture (“Blood Draw”)

In the bloodstream, the plasma contains substances such as glucose, electrolytes, proteins, and water. 

When blood is allowed to clot in a test tube, serum is the liquid that remains.

The blood carries oxygen, nutrients, waste products, and other materials through the body. 

It helps regulate body temperature, fluid balance, and acid-base balance.

Blood is usually drawn from a vein on the inside of the elbow or the back of the hand.

In infants and young children, a sharp instrument called a lancet may be used to puncture the skin and cause it to bleed. 

Blood is collected on a slide or test strip. If bleeding occurs, a bandage may be placed over the area.

Depending on the type of blood test you will have, you will need to prepare differently. Some tests do not require special preparation.

In some cases, your health care provider will let you know if you need to stop taking any medicines before this test or if you need to fast. 

Be sure to consult your provider before stopping or changing your medicines.

When the needle is inserted, you may experience a slight sting or pain. 

After the blood is drawn, you may experience some throbbing at the site.

Veins (venipuncture) are used to draw blood, usually from the inside of the elbow or the back of the hand. 

An airtight vial or syringe is used to collect the blood after the needle is inserted into a vein. Each test requires its own preparation.

Arterial Puncture To Analyze Blood Gasses

Blood from any part of the circulatory system (artery, vein, or capillary) can be used for a blood gas analysis. 

An arterial blood gas (ABG) measures blood taken from an artery. 

This test measures the partial pressure of oxygen (PaO2) and carbon dioxide (PaCO2) in a patient’s blood. 

PaO2 provides oxygenation status information, while PaCO2 provides respiratory status information (chronic or acute respiratory failure). 

Hyperventilation (rapid or deep breathing), hypoventilation (slow or shallow breathing), and acid-base status affect PaCO2. 

ABG analysis is the standard for assessing oxygenation and ventilation in the absence of invasive methods such as pulse oximetry or end-tidal carbon dioxide monitoring.

In most acid-base balance analyzers, pH and PaCO2 are directly measured. 

The serum bicarbonate is calculated from the Hasselbach equation; this measurement will likely be called “total CO2”. 

The difference will therefore be about 1.2 mmol/L. 

The ABG may however show a larger difference than the measured value, especially in critically ill patients.

Depending on the study, machine, or calibration used, the calculation may either be accurate or inaccurate and must be interpreted appropriately according to your institutional standards.

Clinical settings other than emergency medicine, intensive care, anesthesiology, and pulmonology may also require arterial blood gas testing. 

ABGs are used to screen for many diseases, including acute respiratory distress syndrome (ARDS), severe sepsis, septic shock, hypovolemic shock, diabetic ketoacidosis, renal tubular acidosis, acute respiratory failure, heart failure, cardiac arrest, asthma, and inborn errors of metabolism.

Multiple pathological conditions can be diagnosed by measuring the ABG, pH, partial pressures, and comparing it to the measured serum bicarbonate in a sick patient. 

Alveolar-arterial oxygen gradients are useful indicators of lung gas exchange, which can be abnormal in patients with ventilation-perfusion mismatches.

An arterial blood gas sample requires whole blood. An arterial puncture or indwelling arterial catheter is used for specimen collection. 

Before drawing an ABG from either upper extremity, a modified Allen test must be performed to ensure adequate collateral flow. 

You can also use pulse oximetry or duplex ultrasound. Radial arteries are commonly used because they are superficial and easily palpable over the radial styloid process. 

The femoral artery is the next most commonly used site. A unilateral upper extremity is chosen for the procedure. 

The patient is asked to clench his raised fist for 30 seconds while flexing his selected upper extremity at the elbow. 

In order to obstruct blood flow, pressure is applied over the ulnar and radial arteries. 

Untie the raised fist after five seconds. A pale, white or blanched palm will appear. 

Pressure is then released from the ulnar artery while the radial artery is kept compressed. 

The palm returns to its original color after 10 to 15 seconds, indicating adequate Ulnar collateral blood flow. 

The radial artery should not be punctured if the palm does not return to its actual color. 

By maintaining the radial artery pressure and releasing the ulnar artery pressure, the collateral blood flow is assessed.

Endotracheal Intubation

A tube is inserted through the mouth or nose into the windpipe (trachea) during endotracheal intubation. 

This is usually done via the mouth in emergency situations.

You will be given medicine to make inserting the tube easier and more comfortable whether you are awake (conscious) or asleep (unconscious). A sedative may be given as well.

In order to view the vocal cords and the upper part of the windpipe, a tube is then inserted into the windpipe and past the vocal cords to just above the spot where the trachea branches into the lungs if the procedure is done to assist with breathing. 

To assist breathing, the tube can then be connected to a mechanical ventilator.

Since the procedure is usually performed in an emergency situation, there are no steps you can take to prepare.

The hospital will monitor your breathing and blood oxygen levels. If necessary, oxygen may be administered. 

Your doctor may give you medicine if you are awake to reduce your anxiety or discomfort.

Flexible Sigmoidoscopy

Sigmoidoscopy (sig-moi-DOS-kuh-pee) is an examination that evaluates the lower part of the colon. 

In a flexible sigmoidoscopy exam, a thin, flexible tube (sigmoidoscope) is inserted into the rectum.

Doctors can look inside the rectum, the sigmoid colon, and most of the descending colon with a tiny video camera at the tip of the tube – just under the last two feet (about 50 centimeters) of the large intestine. 

During a flexible sigmoidoscopy exam, tissue samples (biopsies) can be taken through the scope.

Flexible sigmoidoscopy cannot show the entire colon to the doctor. 

Therefore, flexible sigmoidoscopy alone cannot detect cancer or small clusters of cells that could lead to cancer (polyps) farther into the colon.

While sigmoidoscopy is one option for colon cancer screening, there are other options that allow your doctor to view your entire colon, such as colonoscopy. 

Discuss your options with your doctor.

The preparation for sigmoidoscopy and the test itself may take less time than colonoscopy, hence sigmoidoscopy may occasionally be preferred over colonoscopy. 

In addition, no anesthetic is usually required. The risk of direct harm such as a tear in the colon or rectum wall (perforation) is lower with sigmoidoscopy than with colonoscopy.

Intravenous (IV) Line Insertion

The peripheral intravenous catheter (PIVC) is the most commonly used intravenous device in hospitalized patients. 

Most commonly, they are used for therapeutic purposes, such as administering medications, fluids, and/or blood products, and taking blood samples.

An intravenous line, catheter, or cannula is an indwelling single-lumen plastic conduit that allows fluids, medications, and other therapies to be injected directly into a peripheral vein. 

In acute healthcare settings, peripheral lines are the most commonly placed invasive procedure, with more than 1 billion lines being used each year. 

It presents strategies for placing peripheral IV lines using anatomical, landmark-based techniques and emphasizes the role of the interprofessional team in placing and caring for IV lines while minimizing complications.


Nasogastric (NG) Tube Placement

In addition to providing nutritional support, nasogastric tubes are often used to treat intestinal obstructions. 

However, they are beneficial for any patient population who needs nutritional support or gastric decompression. 

The purpose of this activity is to review the indications for the placement of nasogastric tubes and to describe the relevant anatomy, technique, equipment, and potential complications of the procedure. 

It emphasizes the importance of the interprofessional team in the use of NG tubes.

Nasogastric tubes, as their name suggests, are tubes that pass through the nares and pass through the posterior oropharynx, down the esophagus, and into the stomach. 

Nasogastric tubes are typically used to decompress the stomach in cases of intestinal obstruction or ileus, but they can also be used to administer nutrition or medication to patients who cannot take oral nutrients. 

Tubes are available in a variety of types, each designed specifically for its intended use.

Urinary Catheters Placement

In all hospitals, bladder catheterization is a common procedure. The procedure can be done externally, urethrally, or suprapubically. 

A common complication is urinary tract infection, which is the most common hospital-acquired infection. 

This activity describes in detail the practical aspects of urethral catheterization, which is the most commonly used method worldwide, as well as the role of an interprofessional healthcare team in improving care for patients who undergo urethral catheterization.

Diagnostic and therapeutic purposes are both served by urinary bladder catheterization. 

The urinary catheter can either be intermittent (short-term) or indwelling (long-term) depending on the dwell time.

Internal Medicine Frequently Asked Questions

Internists apply their knowledge and expertise to diagnose, treat, and provide compassionate care to adults across the spectrum of health to complex illnesses. 

They are also involved in health promotion and disease prevention.

In addition to allergy and immunology, cardiology, endocrinology, hematology, gastroenterology, nephrology, oncology, pulmonology, and rheumatology are all subspecialties of internal medicine.

Internal medicine doctors provide vaccinations, nutritional counseling, wellness checkups, and screenings for common health problems. 

They also perform preoperative evaluations.

Venipuncture is a routine procedure typically performed to obtain blood samples for diagnostic purposes. 

It is used to monitor various blood components.

Phlebotomy is the process of drawing blood from a vein, usually in the arm, with the help of a needle. 

It’s also called a blood draw or venipuncture, and it can be used to diagnose a lot of medical conditions. 

The blood is usually sent to a laboratory for testing.

Most often, it is used for laboratory testing. 

A vein (venipuncture) is used to draw blood, usually from the inside of the elbow or the back of the hand. 

Blood is collected in an airtight vial or syringe after a needle is inserted into a vein. The preparation may vary depending on the test.

The three most popular methods of collecting blood are arterial sampling, venipuncture sampling, and fingerstick sampling.