Jumat, Oktober 26, 2007

internist force

Internist
Diagnoses diseases and renders nonsurgical care, providing consultation in complex cases.

Duties and Responsibilities

Internists diagnose and treat diseases - preparing and reviewing case histories and clinical records. They also perform and direct diagnostic procedures, including x-ray examinations and clinical laboratory tests, interpret test results and evaluate examination findings, and prescribe such treatment for internal diseases as drugs, physical therapy and dietary regimens.

The Internist manages internal medicine services - formulating procedures for pediatric services, scheduling the use of internal medicine clinics and diagnostic facilities, and assigning nurses and medical technicians. Other responsibilities include advising on the types and quantity of supplies and equipment, coordinating internal medicine services with other medical activities, and instructing interns and residents in procedures and methods of internal medicine.

Civilian Opportunities

Internal Medicine Doctor

Duties and Responsibilities

Internal medicine doctors provide care mainly for adults who may have problems associated with the body's organs. In the civilian medical community, physicians' duties and responsibilities depend upon where they decide to work. They may work in managed care, private practice or academic medicine. In managed care, a health plan pays a fixed monthly fee per member to a physician and the physician agrees to provide specific services to the health plan member.

from http://www.afrotc.com/careers/jobsearch/category/medicine/44MX.htm
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internist-I

Internist-I

From Wikipedia, the free encycloped

INTERNIST-I was a broad-based computer-assisted diagnostic tool developed in the early 1970s at the University of Pittsburgh as an educational experiment. The system was designed to capture the expertise of just one man, Jack D. Myers, MD, chairman of internal medicine in the University of Pittsburgh School of Medicine. The Division of Research Resources and the National Library of Medicine funded INTERNIST-I. Other major collaborators on the project included Randolph A. Miller, Harry E. Pople, and Victor Yu.

Contents

Development of INTERNIST-I

For ten years, INTERNIST-I was the centerpiece of a Pittsburgh course entitled “The Logic of Problem-Solving in Clinical Diagnosis.” In consultation with faculty experts, much responsibility for data entry and updating of the system fell to the fourth-year medical students enrolled in the course. These students encoded the findings of standard clinicopathological reports. By 1982, the INTERNIST-I project represented fifteen person-years of work, and by some reports covered 70-80% of all the possible diagnoses in internal medicine.

Data input into the system by operators included signs and symptoms, laboratory results, and other items of patient history. The principal investigators on INTERNIST-I did not follow other medical expert systems designers in adopting Bayesian statistical models or pattern recognition. This was because, as Myers explained, “The method used by physicians to arrive at diagnoses requires complex information processing which bears little resemblance to the statistical manipulations of most computer-based systems.” INTERNIST-I instead used a powerful ranking algorithm to reach diagnoses in the domain of internal medicine. The heuristic rules that drove INTERNIST-I relied on a partitioning algorithm to create problems areas, and exclusion functions to eliminate diagnostic possibilities.

These rules, in turn, produce a list of ranked diagnoses based on disease profiles existing in the system’s memory. When the system was unable to make a determination of diagnosis it asked questions or offered recommendations for further tests or observations to clear up the mystery. INTERNIST-I worked best when only a single disease was expressed in the patient, but handled complex cases where more than one disease was present poorly. This was because the system exclusively relied on hierarchical or taxonomic decision-tree logic, which linked each disease profile to only one “parent” disease class.

Use of INTERNIST-I

By the late 1970s, INTERNIST-I was in experimental use as a consultant program and educational “quizmaster” at Presbyterian-University Hospital in Pittsburgh. INTERNIST-I’s designers hoped that the system could one day become useful in remote environments—rural areas, outer space, and foreign military bases, for instance—where experts were in short supply or unavailable. Still, physicians and paramedics wanting to use INTERNIST-I found the training period lengthy and the interface unwieldy. An average consultation with INTERNIST-I required about thirty to ninety minutes, too long for most clinics. To meet this challenge, researchers at nearby Carnegie-Mellon University wrote a program called ZOG that allowed those unfamiliar with the system to master it more rapidly. INTERNIST-I never moved beyond its original status as a research tool. In one instance, for example, a failed attempt to extract “synthetic” case studies of “artificial patients” from the system’s knowledge base in the mid-1970s overtly demonstrated its “shallowness” in practice.

INTERNIST-I/QMR

In the first version of INTERNIST-I (completed in 1974) the computer program “treated the physician as unable to solve a diagnostic problem,” or as a “passive observer” who merely performed data entry. Miller and his collaborators came to see this function as a liability in the 1980s, referring to INTERNIST-I derisively as an example of the outmoded “Greek Oracle” model for medical expert systems. In the mid-1980s INTERNIST-I was succeeded by a powerful microcomputer-based consultant developed at the University of Pittsburgh called Quick Medical Reference (QMR). QMR, meant to rectify the technical and philosophical deficiencies of INTERNIST-I, still remained dependent on many of the same algorithms developed for INTERNIST-I, and the systems are often referred to together as INTERNIST-I/QMR. The main competitors to INTERNIST-I included CASNET, MYCIN, and PIP.

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internist

Internist
by the editors of Consumer Guide

Internists deal with the diagnosis and treatment of diseases of adults, except for those conditions that require management by a surgeon or an obstetrician. Like the family practitioner, the internist is trained to handle a wide range of illnesses; in fact, many people select an internist as their family doctor.

The internist is specifically trained to deal with chronic (long-term) illnesses, such as diabetes and high blood pressure, and acute (short-term) diseases, such as infections. In addition, an internist has both the range and the depth to diagnose illnesses that might escape detection by a specialist if they lie outside his or her special field.

After graduating from medical school, an internist completes one year of internship, followed by two years of residency in internal medicine. Internal medicine is also the basis for many other specialties, such as cardiology, endocrinology, gastroenterology, hematology, and nephrology. That is why these branches are often referred to as subspecialties, and the doctors who practice them as subspecialists.

In order to become a subspecialist, an internist must complete at least two years of additional training, which is referred to as a fellowship, in his or her chosen subspecialty before becoming eligible for subspecialty board certification.

from ; http://health.howstuffworks.com/define-internist.htm

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internal medicine

Internal medicine

From Wikipedia, the free encyclopedia

Internal medicine is the branch and specialty of medicine concerning the diagnosis and nonsurgical treatment of diseases in adults, especially of internal organs. Doctors of internal medicine, also called "internists", are required to have included in their medical schooling and postgraduate training at least three years dedicated to learning how to prevent, diagnose, and treat diseases that affect adults. Internists are sometimes referred to as the "doctor's doctor," because they are often called upon to act as consultants to other physicians to help solve puzzling diagnostic problems. While the name "internal medicine" may lead one to believe that internists only treat "internal" problems, this is not the case. Doctors of internal medicine treat the whole person, not just internal organs. According to the American Medical Association, specialists of internal medicine earn between $175,000 to $350,000 per year.

Contents

Definition of an Internist

Internists hold either an allopathic (MD,MBBS,MBChB,etc) or osteopathic (DO) degree. They are not to be confused with "Medical Interns," who are physicians in their first year of residency training. Although Internists may act as primary care physicians, they are not "family physicians," "family practitioners," or "general practitioners" (whose training in certain countries includes the medical care of children, and may include surgery, obstetrics and pediatrics). General Internists practice medicine from a primary care perspective but they can treat and manage many ailments and are usually the most adept at treating a broad range of diseases affecting adults.

Internal Medicine sub-specialists may also practice general internal medicine, but can focus their practice on their particular subspecialty like cardiology or pulmonology after completing a fellowship. (Additional training of 2-3 years)

In the USA, adult primary care is usually provided by either family practice or general internal medicine physicians. The primary care of adolescents is provided by family practice, internists and pediatricians. The primary care of children and infants is provided by Family Practice or Pediatricians. Thus, there is overlap.

Caring for the whole patient

Internists are trained to solve puzzling diagnostic problems and handle severe chronic illnesses and situations where several different illnesses may strike at the same time. They also bring to patients an understanding of preventative medicine, men's and women's health, substance abuse, mental health, as well as effective treatment of common problems of the eyes, ears, skin, nervous system and reproductive organs. Most older adults in the United States see an internist as their primary physician.

Subspecialties of internal medicine

Internists can choose to focus their practice on general internal medicine, or may take additional training to "subspecialize" in one of 13 areas of internal medicine, generally organized by organ system. Cardiologists, for example, are doctors of internal medicine who subspecialize in diseases of the heart. The training an internist receives to subspecialize in a particular medical area is both broad and deep. Subspecialty training (often called a "fellowship") usually requires an additional one to three years beyond the standard three year general internal medicine residency. (Residencies come after a student has graduated from medical school.)

In the United States, there are two organizations responsible for certification of subspecialists within the field, the American Board of Internal Medicine, and the American Osteopathic Board of Internal Medicine.

The following are the subspecialties recognized by the American Board of Internal Medicine[1].

The ABIM also recognizes additional qualifications in the following areas

Internists may also specialize in allergy and immunology. The American Board of Allergy, Asthma, and Immunology is a conjoint board between internal medicine and pediatrics.

The American College of Osteopathic Internists recognizes the following subspecialties.[2]

Principles of diagnosis

The main tools of the doctors are the medical history and the physical examination, but this holds particularly true for internal medicine. Subtle descriptions of disease (e.g. cyclic shallow and deep breathing, as in Cheyne-Stokes's respiration, or persistently deep breathing as in Kussmaul's) or physical signs (e.g. clubbing in many internal diseases) are important tools in guiding the diagnostic process. In the medical history, the "Review of Systems" serves to pick up symptoms of disease that a patient might not normally have mentioned, and the physical examination typically follows a structured fashion.

At this stage, a doctor is generally able to generate a differential diagnosis, or a list of possible diagnoses that can explain the constellation of signs and symptoms. Occam's razor dictates that, when possible, all symptoms should be presumed to be manifestations of the same disease process, but often multiple problems are identified.

In order to "narrow down" the differential diagnosis, blood tests and medical imaging are used. They can also serve screening purposes, e.g. to identify anemia in patients with unrelated complaints. Commonly performed screening tests, especially in older patients, are an X-ray of the chest, a full blood count, basic electrolytes, renal function and blood urea nitrogen.

At this stage, the physician will often have already arrived at a diagnosis, or maximally a list of a few items. Specific tests for the presumed disease are often required, such as a biopsy for cancer, microbiological culture etc.

Treatment

Medicine is mainly focused on the art of diagnosis and treatment with medication, but many subspecialties administer surgical treatment:

Pulmonology: Bronchoscopy


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