An internal medicine specialist, or an internist, is an expert in adult medicine equipped to handle complicated, multisystem diseases, often involving multiple organ systems at once. They can act as primary care physicians, coordinating care across specialties like cardiology, endocrinology or infectious diseases, and addressing the intricate interactions between conditions. For that reason, they are often referred to as ‘doctor’s doctors’.
Dr Rakesh Gupta holds an MD in internal medicine from the Medical University of Rohtak. He is the chairman of Sarvodaya Healthcare, Faridabad. He is a life member and fellow of the Indian Academy of Clinical Medicine, and a life member of the Research Society for the Study of Diabetes in India. He enjoys walking, hiking and listening to old Hindi songs.
Understanding internal medicine
A specialty that deals with prevention, diagnosis and treatment of all kinds of diseases. Internists coordinate with other specialists when specialised skills are necessary with a directive diagnosis in mind. What makes internal medicine unique is its scope and depth in adult medicine.
Different from primary care physicians?
Primary care physicians diagnose and manage acute and common symptoms, and seasonal spikes. In addition, they take care of needs of family members of different ages, and are thus also called family physicians. While internists can handle primary care issues, they are also trained to handle more complicated issues that require intense management of body functions and rigorous follow-up. They are more equipped and skilled in handling severe morbidity and high-risk cases. Their knowledge in all specialties is constantly updated as they keep treating all kinds of problems.
Dr Rakesh Gupta
Core competencies of an internist
Being very observant, keeping eyes on any signs of an abnormal nature from the moment one meets the patient. Once a thorough inspection is made with the eyes, an internist’s ears should do more than his tongue. He should ask precise questions pertaining to diagnosis and listen to everything the patient has to say. Based on a detailed and thorough history, an internist approaches a patient for careful examination. Our teachers highlighted the importance of knowledge: the eyes see what the mind knows; hence, only a well-read physician can identify clinical signs on the body. Lastly, a practised, analytical mind can comprehend all points from history, examination and evidence from diagnostics to make the right diagnosis.
Self confidence
An internist needs to be self-confident as many times, reports, attendants and even his own staff may not stand by his side. Then, gut feeling steps in.
How do I know if I need a specialist or an internist?
The recent emergence of super-specialty in India has brought about a change in the mindset of the privileged urban population. They decide to see a specialist in case they feel symptoms in specific areas of the body. This they do to expect a shorter course of investigation and treatment, thus saving both time and money. However, it is always advisable to initially go to a broader specialist.
A specialist should only be consulted when you have a specific diagnosis and are referred by a physician.
In rural areas, with fewer doctors, people still consider physicians as their primary doctors and are still not well versed with the role of a specialist.
Treating a patient with a complex medical history
A detailed history helps the doctor understand the subliminal existence of chronic disease―silent triggers like infection, trauma or stress and the development of complications because of imbalance in body functions due to chronic malfunctioning. In such a situation, an internist usually adopts a holistic approach. He begins by understanding the individual's and the family's medical history, patient's routine/lifestyle, understanding the current condition the person is suffering from and then looking at the best possible treatment option. The goal is to develop and adopt a plan that helps address the condition in a systematic manner and understanding whether there is any interaction/relation between other diseases the patient might be suffering from.
Mental health issues that come with long-drawn illnesses
Recently, a lot of mental diseases have become more prominent due to poor lifestyle choices like improper diet, sleep, exercise and consistent stress at work, worsened by a lack of social circle, poor relations in family and self-doubt due to social media.
Thus, a lot of internists accept their role as a therapist for these populations.
The role of preventive care
Preventive care is an important part of the practice of internal medicine. This includes disease prevention, especially for sensitive populations like senior citizens, people suffering from chronic lung, heart and kidney diseases, blood disorders and those on immune-suppressors. Early detection of communicable, lifestyle and genetic disorders is also a part of the internist’s job to help in controlling the disease, curbing development of complications and reducing disabilities. Preventive care enhances quality of life, reduces health care costs and ensures sustainable health care.
Preventive strategies for Indian population
These range from daily to annual activities. As described by European research, Indians belong to the thin-fat kind of body type. This means we have extremities and visceral deposition of fat in our body, leading to clogging of major organ vessels before the fat is visible on the surface.
A diet consisting of a balance of proteins, carbs and fat and proportionate distribution of minerals, vitamins and roughage is important.
Healthy output of the stored energy in form of regular play, exercise or even mild walk suffices. Stress is constant, so you need to learn how to manage it with practice and determination.
Balancing recommendations with a patient’s preferences
The internist adopts a patient-centric approach wherein the focus is on understanding the patients’ concern, their physical and mental requirements along with their cultural, social and economic contexts. For instance, many individuals are apprehensive about eating food items that clash with their cultural preferences. Consequently, the internists work towards creating a plan that would respect the patient’s preferences while also address and fulfil the bodily requirements.
Diagnostic tests or imaging techniques used most regularly
★ Blood tests
★ Urine tests
★ Electrocardiogram
★ Pulmonary function tests
★ X-rays
★ Ultrasound
★ CT scan
★ Magnetic resonance imaging
How technology has changed the field
Patient care, diagnostics and treatment processes are witnessing significant enhancement. For instance, tele-health has enabled better and accessible consultations even in remote areas. Electronic health records have enabled and improved documentation and streamlining of patient data, and the integration of AI assists in diagnostics and better analytical outcomes. Further, various devices today provide real-time medical updates and personalised data.