How does it all work?

[chemist12]

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Am I right in thinking that Internal Medicine doctors work in the general wards?

Do general wards even exist nowadays? Or are Hospitals just made up of different specialist units?

When a patient is admitted to hospital, is it likely he will be taken care of by a doctor of internal medicine?

Finally, do patient get a specific doctor assigned to them during there stay at a hospital? Or do they just see whichever doctor happens to be around at that time.

If anyone has time, could you explain more about how an internal medicine department is run. I assume most of the patients come from the ER/ICU.

Thank you.

 

[Phyozo]

Am I right in thinking that Internal Medicine doctors work in the general wards?

Do general wards even exist nowadays? Or are Hospitals just made up of different specialist units?

When a patient is admitted to hospital, is it likely he will be taken care of by a doctor of internal medicine?

Finally, do patient get a specific doctor assigned to them during there stay at a hospital? Or do they just see whichever doctor happens to be around at that time.

If anyone has time, could you explain more about how an internal medicine department is run. I assume most of the patients come from the ER/ICU.

Thank you.

This varies widely depending on the admission diagnosis and the hospital you go to. In general, there is a general medicine ward where people are admitted. Depending on the level of nursing care they need, they could also be admitted to the DOU or ICU. Most hospitals have a general medicine ward consisting of hospitalist service and/or teaching service (where the residents in an academic hospital work). Patients on admission are assigned a primary team who does an initial intake, but this team can change depending on the hospital/ward rotation schedule. Internists generally take care of the general medicine wards, step down unit, and ICU. Some hospitals have specialized services which take particular types of patients (ex cardiology service for ACS, liver service for transplant/ESLD/failure/GIB). In other hospitals, all these patients are admitted to medicine under the appropriate level of care and then those specialties follow as consult services.

Basically, it all depends.

 

[chemist12]

I didn't realise ICU was part of Internal Medicine. I thought it was its own speciality.

Is Intensive care a subspecialty of Internal Medicine? If it is, are unspecialised Internal Medicine doctors able to work in the ICU as backup?

Do cardiac/derm/respiratory/Gynocological patients ever end up in the general medical wards? From my understanding, many hospitals have specialised care units for these patients...

What sort of patients are most likely to end up in the general medical ward?

What sort of patients are least likely to end up in the general medicial ward?

Thanks in advance

 

[Phyozo]

I didn't realise ICU was part of Internal Medicine. I thought it was its own speciality.

Is Intensive care a subspecialty of Internal Medicine? If it is, are unspecialised Internal Medicine doctors able to work in the ICU as backup?

Do cardiac/derm/respiratory/Gynocological patients ever end up in the general medical wards? From my understanding, many hospitals have specialised care units for these patients...

What sort of patients are most likely to end up in the general medical ward?

What sort of patients are least likely to end up in the general medicial ward?

Thanks in advance

Your answers to these questions are very varied from hospital to hospital. The ICU is a service, not a specialty. Pulm/Critical care docs can work the ICUs, but so do some hospitalists with consultation from Pulm/CC. For example, in many open ICUs, hospitalists will follow their patient and coordinate care with the pulm/cc team. Some hospitals have a cardiology service which will take STEMI or heart failure patients without a general medicine team ever seeing them. Others will admit all their STEMI/heart failure to general medicine and cardiology follows as a consult service.

I don't know your background, but I'm going to assume no more advanced than the first couple years of med school (or premed perhaps?). In any case, all these questions are answered appropriately once you get ward experience.

 

[chemist12]

Haha, I'm flattered that you think I could even make it past the first year in medical school. I am not a medical student (or premed). I am a layman (with some knowledge of neuro-anatomy).

However, I am fascinated with how hospitals work. I am also interested in what doctors learn while they are in medical school.

I assume "hospitalist" is another term for a doctor of internal medicine.

So pulmonary doctors are important in some ICUs? I would have thought someone in the ICU would be more at risk of cardiac and neurological problems.

When a patient presents with dermatological or gynocological problems, could they ever be seen by a purely internal medicine physician?

The reason I ask this is, I have Harrison's Principles of Internal Medicine 18th Edition, In the first part it has several chapters regarding women's health, neoplasm during pregnancy, and medical disorders during pregnancy. After that, it seems the subject isn't addressed again. With so little info on women, it seems that a internal medicine physician would have to rely on gynocological consults, but then why include any chapters on women? There is no mention of pediatrics (or derm).

Thanks for answering my questions. They have been very helpful. Do you want to become an Internal Medicine Physician?

 

[Phyozo]

Haha, I'm flattered that you think I could even make it past the first year in medical school. I am not a medical student (or premed). I am a layman (with some knowledge of neuro-anatomy).

However, I am fascinated with how hospitals work. I am also interested in what doctors learn while they are in medical school.

I assume "hospitalist" is another term for a doctor of internal medicine.

So pulmonary doctors are important in some ICUs? I would have thought someone in the ICU would be more at risk of cardiac and neurological problems.

When a patient presents with dermatological or gynocological problems, could they ever be seen by a purely internal medicine physician?

The reason I ask this is, I have Harrison's Principles of Internal Medicine 18th Edition, In the first part it has several chapters regarding women's health, neoplasm during pregnancy, and medical disorders during pregnancy. After that, it seems the subject isn't addressed again. With so little info on women, it seems that a internal medicine physician would have to rely on gynocological consults, but then why include any chapters on women? There is no mention of pediatrics (or derm).

Thanks for answering my questions. They have been very helpful. Do you want to become an Internal Medicine Physician?

Yes a hospitalist is usually an internist (though can be from family med or emergency med) who only sees inpatients. This is in contrast to generalists who are your run-of-the-mill primary care docs that had in the past been required to round on their hospitalized patients...now it's separated between inpatient and oupatient care. Pulm/CC docs specialize in critical care medicine which involve maintinence of vents/lines. Those patients ARE at higher risk for other medical problems, but the appropriate patients will get consults from other specialists to help them out. Gyn and Derm are their own specialties and likely your primary care doc will send you to see those specialists if you have problems in that area. There are certain types of gyn and derm problems (UTI, acne, eczema) which are simple and don't require specialists to treat...but you'll get referred to those specialists whenever the primary doc feels uncomfortable or the problem begins to fall outside his scope of practice. Harrison's is a thick internal medicine book which tries to encompass the breadth of what internists ought to know...which is why it's lacking in certain areas like gyn and derm...internists don't need to know everything about those fields (and other specialties)...just enough to know when it's appropriate to refer. The exact boundary between fields is unclear and each doc has their own levels of comfort for treating various problems.

 

[coffeebeanjenn]

Chemist12, when I first read your question I thought that you must be writing a novel or screenplay.

 

[chemist12]

Chemist12, when I first read your question I thought that you must be writing a novel or screenplay.

Yea, I can see why you might think that.

I study, and am interested in, Medicinal Chemistry.

As I've studied Medicinal Chemistry, I have become more and more familier with Medical science in general. Which eventually made me interested in the "hospital system".

I'm really struggling to understand how IM, FM, and EP differ... (particularly IM and FM).

I know that FM includes pediatrics and obstetrics.

Originally I thought that FMPs have a general background in all non serious diseases. IM would be a generalist for serious diseases that require hospitalisation.

However, people who end up on the hospital wards for serious illnesses are still going to have minor/chronic illnesses as well (eg depression, acne, CFS, hypertension). I assume pregnant women would also be found on the general wards for some illnesses (eg infectious diseases unrelated to pregnancy). Although I understand now, the IMP would call a Gyn/Ob consult.

This means the IM specialists basically has to know about the treatments for these illnesses (SSRI, Tetracyclines, retinol, Beta blockers etc etc).

Does there really need to be a specialisation? Family medicine could be made into a subspecialty of IM - subspecialise in pediatrics and you've got an FM! Or is that oversimplified?