When the Spanish Society of Internal Medicine turns 70, the internists of the five provinces of Castilla-La Mancha define their work
70 years ago, doctors Carlos Jiménez Díaz, Gregory Maranon, Teófilo Hernando, Juan Andreu Urra and Manuel Bermejillo founded the Spanish Society of Internal Medicine. Their counterparts in Albacete, Toledo, Guadalajara, Cuenca and Ciudad Real now analyze the importance of a specialty that has been the mother of all. Together with their ‘brothers’, general practitioners, internists are “MEDICINE with capital letters”.
Internal, MEDICINE with capital letters
Internal Medicine has been MEDICINE, with capital letters, since ancient times. Surgery was practiced by other professionals for many centuries and was considered a trade of inferior category. All this changed in the 19th century as healing techniques, materials and scientific knowledge improved.
From then on, Surgery began a spectacular development and Internal Medicine remained as the part that grouped all the diseases that do not have surgical treatment.
Great doctors, such as Gregorio Marañón or Carlos Jiménez Díaz, developed their profession in this environment and created the first medical society in Spain. Subsequently, the continuous improvements in the knowledge of diseases and the improvements in diagnosis and treatment techniques have caused the development of “medical specialties” from the second half of the 20th century, which were breaking off from the common trunk of the Internal Medicine.
All medical specialties start from Internal
Thus, intensive care physicians were internists dedicated to the care of severe and unstable patients; gastroenterologists were internists who performed endoscopy and focused their activity on digestive diseases, etc.
Over time, the specialties were developed and filled with content independently to the point that they work in autonomous sections or departments, in many cases independent of each other. In addition, its mission is easily identifiable by the population, which has been progressively demanding its attention due to its specialized dedication to a well-defined area of medicine.
Today, the role of these professionals has been revitalized and the versatility of the internist makes him a very valuable piece in the health system. This explains why in many countries around us a period of core training in Internal Medicine is included for several years, before starting training in a specialty.
Turned 70 years oldSpanish Internal Medicine maintains its social structure, has adapted to important changes, has been able to maintain its core role in the health system and it could be anticipated that it has a promising future.
Internal Medicine: key in the diagnosis of difficult cases
Due to their training, Internal Medicine specialists are highly valued in the study of difficult-to-diagnose cases. It is a fundamentally hospital specialty, which is responsible for about 25% of discharges given in the hospital. It is, therefore, key in the organization and operation of a hospital.
Within the strengths of Internal Medicine, the great versatility of its specialists and their ability to adapt to new diseases stand out, which has been demonstrated both in the AIDS pandemic of the 1980s, and now in the current one due to COVID-19. Internists have been the first to face the pandemic and are bearing the brunt of their care.
Domain of clinical history
It uses, fundamentally, mastery of the clinical history technique as a basis for diagnosis. However, it is up to date and uses new technologies (ultrasound, magnetic resonance imaging, CT, among others) as complementary tools always requested on the foundations of a good clinical history. Internal Medicine has already incorporated ultrasound at the bedside as the fifth pillar of physical examination.
In Toledo, in addition to conventional hospitalization, the service has developed new forms of hospitalization such as the Short Stay Unit/Rapid Diagnosis Unit (UCE/UDR) or the Shared Care Medical Unit (UMAC).
From autoimmune diseases to HIV
At the University Hospital of Toledo, the service has promoted and expanded monographic consultations such as that of autoimmune diseases, the complex chronic patient consultation (UCAPI), that of the HIV patient, the post-COVID consultation and the lipid consultation. It is also intended to unify in a single consultation the attention to rare and minority diseases and to put into practice a solid project of attention to thromboembolic disease. From the specialty, collaboration with Primary Care with the development of various projects is considered a priority.
Teaching, another strength
Teaching is a strength of Internal Medicine. In the Toledo service, not only its 15 resident doctors (3 each year) receive training, but also numerous medical specialists in training from all medical specialties, in order to acquire knowledge and skills in medical pathology before dedicating themselves exclusively to their specialty . For the same reason, the service contributes to the teaching of medical students. In the last 4 years, the collaboration with the Faculty of Medicine of the UCLM has allowed the sixth-year students of the Faculty of Medicine of Albacete to rotate through our service, to have a general vision of the patient and not fragmented by devices and systems. .
Lastly, the Internal Medicine service promotes clinical research and the completion of doctoral theses through its main lines of research.
“The internist is trained to treat multiple pathologies and coordinate the best patient care”
Internal Medicine is a specialty in which scientific knowledge and clinical experience are applied to diagnose and treat adults with a wide range of health problems and illnesses.
Internists are trained in the management of patients who have undifferentiated or multisystem disease processes. They serve both inpatients and outpatients and can play an important role in teaching and research. In fact, Internal Medicine and Family Medicine are often confused as equivalent.
However, internists work mainly in hospitals, being essential in regional or proximity ones. The internist is trained to treat multiple pathologies and coordinate, referring to a higher level hospital, when the patient needs it.
From the hand of the rest of the companions
In our hospital, collaboration with services such as Traumatology, General Surgery, Neurosurgery or Angiology and Vascular Surgery allows a better surgical result because the comorbidities of the patient who must undergo surgery, such as anemia, diabetes, heart failure, etc., are taken care of from the first day.
The success of a surgery or intervention can be a failure if complications such as infection or pulmonary embolism are not detected or treated in time.
“Together with our brothers, the GPs, we are the ones closest to the patient”
“Heal little, improve a lot and always take care”
In this photo, incomplete due to the absence of several of the medical and nursing professionals, two of the characteristics of the internist are observed: temperance and at the same time restlessness, two of the values that allow us to be able to think of the patient in its totality, both in the physical and organic part as well as in the social part to achieve the well-being that the patient deserves. As the classics used to say, “cure little, improve a lot and always take care”.
We have long been considered the pillar of Medicine and they are partly right. Along with our brothers, the GPs, we are the ones who are closest to the patient in all their circumstances and we are the ones they reach with the most familiarity.
Internal Medicine is the common trunk of all other specialties
Internal Medicine is the common trunk from which the different medical specialties have been developed. When, over the last century, scientific knowledge has been accumulating and diagnostic techniques have been developed for each organ or system, increasingly sophisticated and complex, “organ or system specific” medical specialties have been developed.
Multisystemic diseases, therefore, are also a field of the internist.
Another key role of the internist is the management of the increasingly frequent polypathological patients, with various vital organs affected by different diseases.
Also as an interconsultant in surgical patients for pre and postoperative management, etc.
And finally, we must not forget that the majority of frequent diseases of any organ or system are within the reach of the internist with the same capacity as “organ” specialists: pneumonia, COPD, heart failure, diabetes…