Friday, April 30, 2010

Death of Traditional Internal Medicine

Interesting post by an internal medicine physician on the death of the traditional internist. In the old days, internists would take care of their patients both as outpatients (in clinic) and as inpatients (in the hospital).

Dr. Knope argues that this practice is essentially dead and I think he's right. In today's healthcare world, care is extremely fragmented. A typical internist sees 20-30 patients in clinic daily and seeing patients in the hospital is often impractical.

Moreover, access to one's internist is not always simple - patients can often wait a month or more for minor problems and thus visit urgent care centers or "minute clinics." The patient could be prescribed medications or interventions at these visits that get lost in follow up with the internist or when he or she gets hospitalized.

Dr. Knope chose to opt out of the mess by opening a "concierge" practice, where a few wealthy patients pay him to be at their beck and call for all problems, whether in the clinic or the hospital. This, however, is not a practical solution to the problem, which he admits.

I think the primary care specialties have recognized this problem and thus argued for the establishment of a "medical home" model, which would at least centralize all of the patient's medical information and allow for more efficient coordination of care. The ACP has done a lot of advocacy on this issue and I believe important measures supporting this process were passed with the new health care reform law.

I don't think the traditional internist will survive, except in rural areas or niche practices like concierge medicine, but the hope is that the new breed of internist will better utilize technology and performance improvement measures to deliver holistic care that results in better health for patients and society.

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