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General internal medicine at the crossroads of prosperity and despair: caring for patients with chronic diseases in an aging society.

Abstract：

:During the past quarter century, general internal medicine has emerged as a vital discipline. In the realm of patient care, it is the integrating discipline par excellence. Ironically, as general internists face the challenge of integrating advances of dizzying speed and complexity, and as their clinical practice becomes increasingly effective, it has become much more difficult for them to earn a living. General internists find themselves at the crossroads of prosperity and despair. Although general medicine research leads the research agenda in many departments of medicine, it is particularly vulnerable. The necessary multidisciplinary "programmatic" infrastructure is expensive, and results often take many years to obtain, particularly in the study of chronic disease. The educational environment in many institutions is particularly difficult for general medicine, both because the current emphasis on technical skills obscures patients' and learners' real needs and because complex patients on general medicine services are now so ill and their turnover so rapid. General internal medicine and geriatrics are synergistic, especially in today's marketplace. A focus on geriatric medicine could help general medicine continue to flourish. General internists are ideally suited to the integrated care of elderly patients with multiple problems, research opportunities are enormous in the geriatric population, and the teaching of geriatrics requires a high level of generalist skills. Problems that plague current generalist practice have unique significance to older patients. Organizations that represent general internists would do well to join forces with many other advocacy groups, especially those representing the interests of elderly patients and geriatric medicine.

journal_name

Ann Intern Med

journal_title

Annals of internal medicine

authors

Larson EB

doi

10.7326/0003-4819-134-10-200105150-00013

subject

Has Abstract

pub_date

2001-05-15 00:00:00

pages

997-1000

issue

eissn

0003-4819

issn

1539-3704

pii

200105150-00013

journal_volume

134

pub_type

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General internal medicine at the crossroads of prosperity and despair: caring for patients with chronic diseases in an aging society.