Spectator Posted March 23, 2012 Report Share Posted March 23, 2012 So, I'm interested in internal medicine and likely General Internal. I'm curious though: where do their patients come from? Are most of their patients follow-ups they've collected from time on CTU? You'd think that cardiology pts are referred to cardiologists, resp to respirologists, etc. etc. Which patients end up at the General internist? How do they get there? Pretty basic question, but I'm confused. Link to comment Share on other sites More sharing options...
NLengr Posted March 23, 2012 Report Share Posted March 23, 2012 Lots of them handle most issues in more rural areas. CHF, DM, CO etc. if they get really complex they might send them on to subspecialties If needed. Link to comment Share on other sites More sharing options...
japlanet Posted March 23, 2012 Report Share Posted March 23, 2012 Many hospitals now have some version of "rapid GIM" clinics where patients can be referred from the ER to a general internist and be seen within 48 hours - for urgent but not emergent issues which are more complex than the scope of a GP. Many GPs will refer to GIM for management of more complex topics which would technically fall in the GP's scope but that the GP may not feel comfortable managing. Of course many GIM docs develop areas of special interest and get referrals for a certain sort of issue (i.e. renal fx, diabetes, obesity) without having subspeciality training. Link to comment Share on other sites More sharing options...
ellorie Posted March 23, 2012 Report Share Posted March 23, 2012 But what about referral to GIM vs. subspecialist? If a family doctor has a patient with a heart problem, how do they decide whether to refer to GIM or cardiology? What qualifies as a case that is managed by an IM doc versus a subspecialist? Link to comment Share on other sites More sharing options...
markov79 Posted March 23, 2012 Report Share Posted March 23, 2012 i've heard that whether or not a GIM hands a patient off to a subspec is kind of like whether or not a GP hands a patient off to a GIM? is there any truth to that? (ie. outside of comfort/knowledge zone, more complex, specialized issues, etc) Link to comment Share on other sites More sharing options...
lostintime Posted March 23, 2012 Report Share Posted March 23, 2012 It's when people have multiple co-morbidities involving multiple internal organs....and GIM can consolidate those issues and look at it more holistically. That's the theory anyway. Link to comment Share on other sites More sharing options...
thebouque Posted March 23, 2012 Report Share Posted March 23, 2012 Who refers to GIM? (not talking about the hospitalist side of the job) Rural areas: they cover subspecialties. Academic centers: very few referrals for multisystemic diseases (small% of their actual practice), referrals from family doctors, and of course PREOPS PREOPS PREOPS PREOPS PREOPS GIM subspecialties: obstetrical medicine, vascular medicine Bottom line: lots of preoperative assessments Link to comment Share on other sites More sharing options...
apache Posted March 30, 2012 Report Share Posted March 30, 2012 you see a lot of im consults in er and with hospitalized patients with multiple co-morbities. you might see the occasional one if you're on inpatient psych (which i think you're interested in, correct me if i'm wrong) at the teaching hospital. But what about referral to GIM vs. subspecialist? If a family doctor has a patient with a heart problem, how do they decide whether to refer to GIM or cardiology? What qualifies as a case that is managed by an IM doc versus a subspecialist? Link to comment Share on other sites More sharing options...
apache Posted March 30, 2012 Report Share Posted March 30, 2012 You could be seen by both, heart problems have the potential to cause kidney problems, vascular problems and almost every other organ system you can think off. you even get psych consults to certain subspecialties because lithium is messing with patient with bipolar tendencies kidneys and they'd like her stabilized on a different medication, same with metabolism of anti-psychotics etc. there's so much to know in medicine than generalism (as in im) is a specialty in itself. But what about referral to GIM vs. subspecialist? If a family doctor has a patient with a heart problem, how do they decide whether to refer to GIM or cardiology? What qualifies as a case that is managed by an IM doc versus a subspecialist? Link to comment Share on other sites More sharing options...
thebouque Posted March 30, 2012 Report Share Posted March 30, 2012 If a pt comes in with a heart problem usually only cardio will be asked unless they don't hospitalize patients (then GIM or family will hospitalize with cardio as a consultant). Cardiology can deal with a lot of multisystemic comorbidities, they don't necessarily need GIM for their renal comorbidities (and if they did need someone they'd ask for nephro directly). Internal medicine subspecialists never ask GIM just to ''take care of potential multisystemic comorbidities''. As far as inpatients are concerned, GIM consultations depends on how the system works. If in your hospital, pts are hospitalized by family medicine, then GIM might be asked as consultants (just like any specialty). If GIM are the primary hospitalists (which is the case in most academic centers), then they'll hospitalize the patients and subspecialties or other specialties will be asked as consultants as needed. Keep in mind that even though multisystemic/weird/internists' diseases seem fascinating, they're by no mean the bread and butter of GIM. Link to comment Share on other sites More sharing options...
leviathan Posted April 3, 2012 Report Share Posted April 3, 2012 If a pt comes in with a heart problem usually only cardio will be asked unless they don't hospitalize patients (then GIM or family will hospitalize with cardio as a consultant). Cardiology can deal with a lot of multisystemic comorbidities, they don't necessarily need GIM for their renal comorbidities (and if they did need someone they'd ask for nephro directly). Internal medicine subspecialists never ask GIM just to ''take care of potential multisystemic comorbidities''. As far as inpatients are concerned, GIM consultations depends on how the system works. If in your hospital, pts are hospitalized by family medicine, then GIM might be asked as consultants (just like any specialty). If GIM are the primary hospitalists (which is the case in most academic centers), then they'll hospitalize the patients and subspecialties or other specialties will be asked as consultants as needed. Keep in mind that even though multisystemic/weird/internists' diseases seem fascinating, they're by no mean the bread and butter of GIM. It depends what it's for. Heart problems that are bread and butter IM stuff goes to GIM. Heart problems like a STEMI go to cardiology. Link to comment Share on other sites More sharing options...
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