Internal medicine: bring adult health problems into one clinical picture
Internal medicine concerns the assessment and care of adults with medical conditions, including problems involving several body systems. The task is often to connect findings rather than treat each result as a separate disease. A clear account starts with the person’s main difficulty and the evidence available.
A problem list should help reasoning rather than replace it
Adult patients can have both old and new medical conditions simultaneously. They also could experience symptoms, existing diagnoses, laboratory results (new) and side effects due to medication. Each category should continue to be treated separately. Symptoms do not automatically equal a diagnosis, and lab results may or may not provide a reason for the symptoms. By organizing this information, you can determine whether there is a relationship between some of these problems, and if those problems must still be evaluated individually.
For an imaginary adult case, use separate categories to differentiate the data you have gathered from the data you suspect. Also, include the time frame prior to developing a unified theory. While a coherent theory can be very attractive, the theory should not force unrelated information to fit a singular cause. An effective summary should show where the uncertainty lies and what type of further evidence is necessary to support the proposed theory.
Connections matter when several conditions coexist
Body systems have connections. A dysfunction in one body system can lead to difficulties in assessing other body systems. Treatments have effects outside of their original intended targets. Therefore, when evaluating an adult with multiple conditions, it is helpful to look at all the body systems involved. This does not imply that there is a single cause for all of an adult's conditions or that every possible investigation is warranted.
Describe a functional relationship between two body systems that have been previously studied, such as circulatory and renal body systems. Provide examples of how the two body systems relate without implying that they explain the adult case. Next, distinguish a functional relationship between the two body systems from evidence that shows how they explain the adult case. Taking this step prevents general knowledge about relationships between body systems from being mistakenly identified as evidence that demonstrates why an adult case developed.
Treatment burden belongs beside possible benefit
Many adults living with multiple chronic conditions are faced with multiple medications, numerous visits to healthcare providers, and a multitude of responsibilities for self-management. As such, these individuals often experience great difficulty managing their care. Considerations of potential benefits and risks of treatment options, drug-drug interactions and what aspects of their lives are most meaningful to the patient should be considered during decision-making processes regarding internal medicine. Without examining the cumulative effect of applying separate condition plans for adults with multiple chronic conditions, decisions made by the care team can create unrealistic expectations for an adult's ability to effectively manage their total care plan.
To prepare for examination, compare the intent of each portion of a fictional treatment plan to the effort required to implement each portion. Determine any overlap among components of the treatment plan and determine what questions requiring evaluation were left unanswered. Do not make assumptions about an adult's prescribed medication regimen independently of any supporting documentation. Responsible clinicians or pharmacists must examine the entire clinical scenario, including any necessary monitoring, when modifying an adult's treatment regimen.
The next decision should follow from the question that remains
Clear communication is essential in internal medicine since it can be practiced by numerous specialties and locations. The transfer of responsibility for an adult's medical care should clearly outline the present medical problems, relevant diagnostic results, treatment currently being administered and pending action items. Results from evaluations require interpretation, as well as a plan for follow-up evaluation. Simply having results available is fundamentally different than providing evidence that supports an adult's comprehension of their significance or who will take subsequent action based upon those results.
Complete an educational case study by identifying the major remaining uncertainty, describing the next logical step, and outlining how future progress will be assessed. Relate future outcomes to symptoms or daily functioning in addition to measurable results. The model presented herein describes one method of organizing data; however, it establishes neither the etiology nor urgency of an actual illness. New or worsening concerns need appropriate clinical advice, and urgent help should not be delayed for a routine review.
Check your understanding
A short quiz, with an explanation after each answer.
Is a symptom automatically a diagnosis?
Return to the section you found hardest and explain its example without looking at the page. Check the explanation, then repeat the quiz later. Being able to describe the reasoning is more useful than remembering the position of a correct answer.