The role of an internal medicine specialist in the health care system: going back to the past?

Abstract

1074 doctors. It may be good for the doctors but it is definitely not good for the patients. The obser‐ vations coming from the cardiological examina‐ tions are not positive. What is disturbing is not only the lack of basic knowledge in the area of in‐ ternal diseases but also the more frequent lack of knowledge about cardiology outside the field in which the person taking the exam works. We hear excuses like “I work in a hemodynamics laborato‐ ry and that is why my knowledge of echocardiog‐ raphy is limited.” Such a narrow specialty has its pros. Performing numerous procedures the ma‐ jority of doctors (but not all) achieves true mas‐ tery in their field. On the other hand, with this approach we provide treatment for example for coronary arteries instead of for a coronary heart disease, and certainly not for a patient suffer‐ ing from a coronary heart disease. This is a dan‐ gerous tendency, especially that we come in con‐ tact with older and older patients suffering from multiple diseases. If we stick to the cardiocentric approach, we can make mistakes. A doctor who does not have sufficient knowledge either does not see the problem or prefers not to see it if he does not know the solution for it. That is why the system of consultations is developing. But here we come across another problem, in order to ask for a consultation one has to notice the prob‐ lem and describe it. And how should one do this without knowing the significance of wheezes over the lung fields or what the symptoms of fluid in the peritoneal cavity are or what the erysipelas looks like? Specialist consultations, whose value cannot be questioned in some situations, must not be treated as a fundamental method of diag‐ nostics and treatment. Such a method prolongs the diagnosis time, is certainly inconvenient for the patient, especially if it happens in an outpa‐ tient clinic and the patient has to move between different places where the consultations are pro‐ vided and in the end this is an expensive course of action. What is more is that such a situation very often leads to polypharmacy and the associated I have no doubts that an internal medicine doc‐ tor should be a key figure in the health care sys‐ tem. One ‐degree specialties that have been imple‐ mented for the last few years have led to the very fast but at the same time very narrow training of FORUM FOR INTERNAL MEDICINE