Better Health: Smart Health Commentary Better Health (TM): smart health commentary

Article Comments (3)

Family Practice, Internal Medicine, and General Practice: What’s The Difference?

I get mail, this from a healthy 20-something reader who’s just moved to a new city:

What’s the difference between doctors listed as Family Practice, Internal Medicine, and General Practice?  Also, what are some things I should consider (that I might not already be considering) when finding a primary care physician?

That’s a bit of a loaded question, not because of any bias of mine (perish the thought!) but because each of those terms is used in different ways, by different people, at different times, for different purposes. So here’s the rundown on each of them in turn.

Family Practice

What it’s supposed to mean: Designates a physician who has completed a three-year postgraduate training program in Family Medicine, trained to provide primary care to patients of all ages, presenting with conditions of any organ system, including care of acute conditions and ongoing management of chronic diseases.

What doctors hope people think it means: Some doctors think having themselves listed as “Family Practice” is good marketing. This irks me. (Trust me: an irked dinosaur is not a pretty sight. You wouldn’t like me when I’m irked.)

What it really means: As long as you check for Board certification, pretty much what it’s supposed to mean. (And remember: no news is NOT good news. No mention at all means no certification. Just like no mention of any marital status on a dating website means “Married”.) Otherwise it means someone trying to horn in on what I do because they think the term is inclusive.

Internal Medicine

What it’s supposed to mean: Indicates that a physician has completed a three-year postgraduate training program in General Internal Medicine. Bear in mind that the vast majority of graduates of those programs goes on to further specialty fellowship training. Precious few of them actually go out at that point and hang up a shingle, opening their doors to a practice specializing in the care of patients with multiple complex diseases.

What doctors hope people think it means: In this new day and age of enhanced prestige marketing appeal of primary care, plenty of specialists with sagging revenues and appointment slots to spare believe that a listing under “Internal Medicine” will lure more patients. They have no problem with this double-dipping, but I do.

What it really means: Technically, it could indicate someone who couldn’t get accepted into any fellowship program. Most likely it’s a specialist trying to get listed twice in the directory. As a practical matter for a generally healthy adult, it’s a perfectly acceptable option for a primary care physician.

General Practice

What it’s supposed to mean: In the olden days, physicians hung out a General Practice shingle after one year of internship. Specialists were the only ones who went on for more advanced residency training. After everyone started doing residencies, it was osteopathic physicians who used the term General Practice, while MDs went on to fine-tune the training and certification that became Family Medicine (which now welcomes osteopathic graduates).

What it really means: Either an older MD who only did a one-year internship, or a younger DO who did a three-year residency. By now, though, even this is a little dated, so I’m surprised that there are physicians listed at General Practice. What it really means is that you need to carefully explore training and certification.

What else to look for:

Given that the reader failed to specify what he was already considering in terms of his physician search (presumably such vital indicators as Board certification, convenience of office hours, and courtesy of staff, among other things) the main thing I would do is provide reassurance that it is okay to go with one’s gut. Pick a doctor you like. More importantly, don’t be afraid to STOP going to a doctor you decide you do not like. Trust me; the doctor is not going to care. There are plenty of other patients out there.

Think in terms of finding a doctor who “gets” you. Someone you’d feel comfortable going to when you’re uncomfortable. Someone you can trust. That’s really the bottom line, whatever section of the directory they’re listed in.

*This blog post was originally published at Musings of a Dinosaur*


You may also like these posts

Read comments »


3 Responses to “Family Practice, Internal Medicine, and General Practice: What’s The Difference?”

  1. Noemi Velez says:

    This was helpful to rule out general doctors but I still need a little more under standing. Would you say that both family practice and internal practice are trained to provide care to patient presenting with conditions of any organ system including care of acute conditions?
    My husband will be 44 tomorrow. Four more years than he expected. Most males, inculding father,unlces, and cousins, have died by age 40. He seems like he has a number of problems experiencing pains in different areas. Some numbness in his fingers and chronic pain in arms and back due to an injury in 1998.
    Around 2003 he had a spinalcird stimulator. I need to find the best doctor for him before its too late. Death comes quickly in his family. Its like oqne day they are fine then three months later they died of heart disease. He has been seeing a cardiology and everything seems ok but at home he gets these massive head aches as if his blood presure is high.

  2. Dr. Barry Silberg says:

    An internist used to be called a “diagnostician”. General practice doctors would refer complex problems to these specialists. The problem is, many doctors don’t know what they don’t know. If a problem is not getting better, it is best to find another doctor. Being friendly does not always equate with competence.

  3. Walt Smith says:

    Of the three types of Doctors you spoke of . Which would be the best selection for seniors?

Return to article »

Latest Interviews

How To Make Inpatient Medical Practice Fun Again: Try Locum Tenens Work

It s no secret that most physicians are unhappy with the way things are going in healthcare. Surveys report high levels of job dissatisfaction burn out and even suicide. In fact some believe that up to a third of the US physician work force is planning to leave the profession…

Read more »

Caring For Winter Olympians In Sochi: An Interview With Team USA’s Chief Medical Officer Dr. Gloria Beim

I am a huge fan of the winter Olympics partly because I grew up in Canada where most kids can ski and skate before they can run and partly because I used to participate in Downhill ski racing. Now that I m a rehab physician with a reconstructed knee I…

Read more »

See all interviews »

Latest Cartoon

Richmond, VA – In an effort to simplify inpatient medical billing, one area hospitalist group has determined that “altered mental status” (ICD-9 780.97) is the most efficient code for use in any patient work up.

“When you enter a hospital, you’re bound to have some kind of mental status change,” said Dr. Fishbinder, co-partner of Area Hospitalists, PLLC. “Whether it’s confusion about where your room is located in relationship to the visitor’s parking structure, frustration with being woken up every hour or two to check your vital signs, or just plain old fatigue from being sick, you are not thinking as clearly as before you were admitted. And that’s all the justification we need to order anything from drug and toxin screens, to blood cultures, brain MRIs, tagged red blood cell nuclear scans, or cardiac Holter monitoring. There really is no limit to what we can pursue with our tests.”

Common causes of mental status changes in the elderly include medicine-induced cognitive side effects, disorientation due to disruption in daily routines, age-related memory impairment, and urinary tract infections.

“The urinalysis is not a very exciting medical test,” stated Dr. Fishbinder. “It doesn’t matter that it’s cheap, fast, and most likely to provide an explanation for strange behavior in hospitalized patients. It’s really not as elegant as the testing involved in a chronic anemia or metabolic encephalopathy work up. I keep it in my back pocket in case all other tests are negative, including brain MRIs and PET scans.”

Nursing staff at Richmond Medical Hospital report that efforts to inform hospitalists about foul smelling urine have generally fallen on deaf ears. “I have tried to tell the hospitalists about cloudy or bloody urine that I see in patients who are undergoing extensive work ups for mental status changes,” reports nurse Sandy Anderson. “But they insist that ‘all urine smells bad’ and it’s really more of a red herring.”

Another nurse reports that delay in diagnosing urinary tract infections (while patients are scheduled for brain MRIs, nuclear scans, and biopsies) can lead to worsening symptoms which accelerate and expand testing. “Some of my patients are transferred to the ICU during the altered mental status work up,” states nurse Anita Misra. “The doctors seem to be very excited about the additional technology available to them in the intensive care setting. Between the central line placement, arterial blood gasses, and vast array of IV fluid and medication options, urosepsis is really an excellent entré into a whole new level of care.”

“As far as medicine-induced mental status changes are concerned,” added Dr. Fishbinder, “We’ve never seen a single case in the past 10 years. Today’s patients are incredibly resilient and can tolerate mixes of opioids, anti-depressants, anti-histamines, and benzodiazepines without any difficulty. We know this because most patients have been prescribed these cocktails and have been taking them for years.”

Patient family members have expressed gratitude for Dr. Fishbinder’s diagnostic process, and report that they are very pleased that he is doing everything in his power to “get to the bottom” of why their loved one isn’t as sharp as they used to be.

“I thought my mom was acting strange ever since she started taking stronger pain medicine for her arthritis,” says Nelly Hurtong, the daughter of one of Dr. Fishbinder’s inpatients. “But now I see that there are deeper reasons for her ‘altered mental status’ thanks to the brain MRI that showed some mild generalized atrophy.”

Hospital administrators praise Dr. Fishbinder as one of their top physicians. “He will do whatever it takes to figure out the true cause of patients’ cognitive impairments.” Says CEO, Daniel Griffiths. “And not only is that good medicine, it is great for our Press Ganey scores and our bottom line.”

As for the nursing staff, Griffiths offered a less glowing review. “It’s unfortunate that our nurses seem preoccupied with urine testing and medication reconciliation. I think it might be time for us to mandate further training to help them appreciate more of the medical nuances inherent in quality patient care.”

Dr. Fishbinder is in the process of creating a half-day seminar on ‘altered mental status in the inpatient setting,’ offering CME credits to physicians who enroll. Richmond Medical Hospital intends to sponsor Dr. Fishbinder’s course, and franchise it to other hospitals in the state, and ultimately nationally.

***

Click here for a musical take on over-testing.

See all cartoons »

Latest Book Reviews

The Spirit Of The Place: Samuel Shem’s New Book May Depress You

When I was in medical school I read Samuel Shem s House Of God as a right of passage. At the time I found it to be a cynical yet eerily accurate portrayal of the underbelly of academic medicine. I gained comfort from its gallows humor and it made me…

Read more »

Eat To Save Your Life: Another Half-True Diet Book

I am hesitant to review diet books because they are so often a tangled mess of fact and fiction. Teasing out their truth from falsehood is about as exhausting as delousing a long-haired elementary school student. However after being approached by the authors’ PR agency with the promise of a…

Read more »

Unaccountable: A Book About The Underbelly Of Hospital Care

I met Dr. Marty Makary over lunch at Founding Farmers restaurant in DC about three years ago. We had an animated conversation about hospital safety the potential contribution of checklists to reducing medical errors and his upcoming book about the need for more transparency in the healthcare system. Marty was…

Read more »

See all book reviews »

Commented - Most Popular Articles

Sorry. No data so far.