Making a difference by choosing internal medicine

As long as I can remember, I have wanted to be a doctor. But in retrospect, I never fully understood what that meant until I grew older and wiser.

For me, and I suspect for many of us, the desire to become a physician was born out of an innate need to help others and solve problems. Before entering medical school, I wanted to become a cardiothoracic surgeon, probably influenced by television portrayals of these specialists as well respected and by the prestige and fame I thought such a career would bestow. But my experiences with patients throughout my training taught me that my calling was for the more cognitive and less procedural aspects of medicine. I saw internal medicine as the foundation for everything that is needed to be a physician.

Internal medicine has evolved over the years, but it is the common thread that runs through all the specialties. Our professional identity stems from how we perceive ourselves, how others perceive us, and where our future lies. The beauty of internal medicine is our ability to define ourselves and explore any aspect of practice that we choose.

The internal medicine specialist sees disease differently than other specialists. From the macroscopic view to the minuscule details, it is that comprehensive approach to all aspects of the patient that allows success in this complex field.

We are more than just master diagnosticians who can collect disparate pieces of information and put together a complex puzzle of symptoms, lab findings, and data points. We are well equipped to treat a wide range of problems and follow patients longitudinally across the entire aspect of their conditions.

More important, we are the patient's medical home. Many of us have treated our patients for decades and share their joys and sorrows. We have taken care of generations, from grandparents to grandchildren. It is truly rewarding when long-established patients bring in their children so that you can be their doctor, too. We should see ourselves as not only patients' primary point of contact—for many, their first experience with the health care system—but as their advocate, place of solace, healer, and guide through their health care journey.

The challenge comes in how we are perceived by others. In this ever-changing health care system, the internal medicine specialist is not always seen as the team leader or the captain of the ship. Frequently, subspecialists will refer patients to other subspecialists and not include the internal medicine specialist in treatment decisions. Many will see the internal medicine specialist as the last resort to deal with the paperwork, refills, or administrative burdens that they do not want to handle. Even patients may have an unfair and distorted view of our role, seeing us just for wellness checks and common colds. Insurance companies see us as gatekeepers or as throughput components of the health care system.

Yet many others see our true worth. Many patients will look to us for guidance. Patients will often ask if I agree with a subspecialist's recommendations and if they should take a medication or receive a treatment that a subspecialist prescribed them. These patients tell their subspecialists that they will not do anything without the approval of their primary care physician. Some insurance companies will partner with the internal medicine specialist to improve value and quality of care. This benefits all by both reducing the burden of disease and lowering unnecessary costs to the health care system. Finally, there are subspecialists who truly understand the value of a physician who provides comprehensive care, who understands all the nuances of the practice of internal medicine.

As we define our professional identity, there is a dichotomy both in how we are perceived and how others perceive us. What do we have to do moving forward? The foundation of internal medicine must start in medical schools and continue up through residency programs. Mentorship is the key to encouraging many to enter this rewarding field. The culture needs to shift regarding how we are perceived by our colleagues, and we must also constantly advocate for ourselves, as we know our own value and worth.

This mentorship and culture change must happen throughout all levels of medical education, including attending physicians and preceptors. A medical student should never be told that they are “too smart” to choose internal medicine. This goes beyond medical schools and residencies to the very halls of Congress, as our elected leaders need to fully understand the value that we bring to the health care system.

Internal medicine physicians extend life, reduce hospitalizations, and decrease cost burdens. It is easy for someone to declare that the cardiothoracic surgeon performing emergency bypass surgery on a heart attack patient has saved the patient's life, while the internal medicine specialist who diligently counsels a patient, evaluates and manages their health, and modifies their lifestyle with recommendations that prevent a heart attack for decades is overlooked. The saving of that life was done not with a flourish, but with a steady and quiet resolve that denotes the true value of internal medicine.

We continue to face many challenges from both internal and external sources, and our future often seems murky and unclear. That said, maintaining the simple goals of providing quality care and enjoying and embracing the value of internal medicine will give us fulfillment in our careers. While there are many incredible opportunities throughout the medical profession, I chose the road less traveled, and that has made all the difference.