What does an internist do in the outpatient setting?

An essential element of any health care system is access to high quality primary care. Internists who work in the outpatient setting typically provide:

• evaluation of adult patients with any undiagnosed sign, symptom or health concern
• comprehensive care for patients with multiple chronic conditions
• health maintenance recommendations

One of the main goals of the outpatient clerkship is for all students to continue to develop the skills necessary to provide these critical elements of outpatient care.

Evaluation of adult patients with any undiagnosed sign, symptom or health concern

To do this effectively, one must:

• recognize the classic (and atypical) presentations of common diseases
• recognize early signs and symptoms of serious disease (the “red flags”)
• distinguish between self-limited illnesses and problems requiring further medical intervention
• perform time-efficient histories and physicals
• make diagnoses at the quick pace required in most outpatient settings
• initiate therapy that is evidence based
• understand appropriate way to monitor response to therapy

Comprehensive care for patients with multiple chronic conditions

Internists have a thorough, in-depth understanding of the chronic diseases so prevalent in our society. They are masters at managing all aspects of the evaluation and management of these maladies. They are acutely aware of how treatment for one disease often affects a patient’s other illnesses. They take into account the personal and financial costs of evaluation and treatment and they consider the psychosocial impact on the patient, the family, and society.

Health maintenance recommendations

The spectrum of preventable conditions is broad and includes various cancers, coronary artery disease, osteoporosis, emphysema, and HIV. The scientific literature on the effectiveness of putative prevention modalities is abundant and, often, conflicting. To meet the public's expectations for clear, authoritative guidance on disease prevention, physicians must be well-informed, skilled in critical appraisal of the literature, and skilled at negotiating treatment plans with patients who may have distinct preferences and values. Disease prevention is a major intellectual and humanistic challenge for modern internists. It is an area of medicine that must be a major focus of an outpatient curriculum.