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Internal medicine focuses on so-called systemic diseases. These are rare diseases most often linked to immune disorders which simultaneously affect several organs or systems. In which cases should you consult an internist? What happens during a consultation ? Update with Professor Pascal Sève, head of the Internal Medicine Department at the Croix-Rousse hospital in Lyon and secretary general of the French National Society of Internal Medicine (SNFMI).
Internal medicine: what is an internist and what is his role?
Internal medicine is a medical specialty that understands the patient as a whole. “Internal medicine is mainly practiced in hospitals or clinics. Originally, the term internal medicine was created in Central Europe at the end of the 19th century to contrast dermatology (external medicine) with medicine based on understanding physiopathological processes affecting the patient’s interior”immediately asks Professor Pascal Sève.
Unlike other medical specialties, the internist does not treat just one organ. He has skills and expertise in all medical specialties such as cardiology, pulmonology, endocrinology, neurology, gastroenterology, rheumatology, etc. The internist can make the diagnosis of a general disease affecting several organs, with symptoms considered unexplained, causing medical wandering. In the event of a systemic illness, he offers appropriate treatment within his expertise. Today, in Europe, internists have a dual mission:
- Unscheduled hospitalization for frequent situations: these are the polypathological patients who are referred to the services, most often, by emergency doctors or general practitioners;
- A consultation exercise in a day hospital: an expert activity on rare diseases, often linked to an immunological mechanism, but not only that. These can also be, for example, genetic diseases or rare metabolic diseases. The expertise activity can also be carried out for so-called difficult diagnoses.
How does an internal medicine consultation work?
The internal medicine consultation is based on patient interview. “The internist will ask the patient questions about his medical and surgical history, his lifestyle, whether he has taken medications, whether he suffers from allergies… Then, he will trace his medical history in order to determine when the disease started, with what symptoms, which joints are affected, etc.”, explains the secretary general of the French National Society of Internal Medicine.
The interrogation is completed by a complete physical exam. The internist will then analyze the results of the additional examinations and make diagnostic hypotheses. In the event of a confirmed diagnosis, treatment may be implemented.
What are the risks during a consultation with an internist?
A consultation in internal medicine presents no risk. It is very rare for the internist to perform invasive procedures in consultation, even if he or she is authorized to do them.. “He can perform punctures at the marrow level and samples from the salivary glands, skin biopsies, pleural punctures, etc. But, most often, these additional examinations are carried out later, during hospitalization. “reassures our expert.
When to consult an internist?
Two situations justify a consultation in internal medicine:
- In the event of a rare disease affecting several organs: the general practitioner or organ specialist refers to the internist with a diagnosis. For example, lupus is a non-organ specific autoimmune disease that can affect the skin, joints, kidneys, heart, nervous system and blood cells. Instead of having a specialist for each organ, the patient has just one. Let us also cite, as examples, systemic vasculitis, and sarcoidosis, diseases which can affect the lungs, eyes, skin, joints, kidney, heart, ENT sphere, nervous system, etc.
- In case of complex diagnosis or complications: With training in infectious diseases and cardiology, the internist can manage treatment complications. It is he who intervenes to make the complex diagnoses. The internist is then the doctor of last resortthe one we consult when organ specialists have failed to establish a diagnosis. “In the presence of symptoms that affect several systems (joint pain, skin rashes, fever, disturbance of liver function, inflammation in the blood, etc.), the internal medicine specialist will then study all the pieces of the puzzle and try to determine which disease causes all the symptoms”, informs Professor Pascal Sève. Sometimes it also happens that certain patients have the juxtaposition of more frequent diseases, that is to say, for example, a disease which affects the joints and another which affects the skin.
How to become an internist?
Thirteen years of study are usually required to become an internist.
At the end of the first 6 years of medicine after the baccalaureate, training is based on 5 years of internship then 2 years in a hospital environment during which internists will acquire multiple skills.
The DES (Specialized Studies Diploma) in internal medicine and clinical immunology includes 4 internships in internal medicine, 1 internship in infectious diseases, 1 internship in intensive care and 4 free internships. It is during these years of training exclusively in the hospital that internal medicine interns will acquire skills in other medical specialties. “Due to this long and plural training with a global approach, the internal medicine training model is the one that best prepares for global patient care, on a medical, psychological and social level”argues the specialist.
Prepare your visit to a clinical immunology and internal medicine department, hospital or university hospital
To properly prepare your visit in the event of an outpatient consultation, it is essential to come with all the documents that you have at your disposal: consultation reports, biological analyses, imaging, endoscopy, etc. A letter from the attending physician is necessary.