Medical Family Therapy in Internal Medicine

Abstract

Whether a puzzling diagnostic dilemma or multiple severe chronic illnesses, Internal Medicine providers are trained to manage both simple and complex medical conditions. Internists are equipped to handle the broad and comprehensive spectrum of illnesses that affect adults and are experts in diagnosis, treatment of chronic illness, and health promotion and disease prevention. They are not limited to one type of medical problem or organ system. This includes care across the continuum of outpatient (community-based) to inpatient (hospital) facilities, with particular attention paid to times of transition when risk for adverse outcomes from chronic medical conditions increases. Nearly one-fifth of Medicare patients discharged from a hospital have an acute medical problem within the subsequent 30 days that necessitates another hospitalization, and the majority of the time, it is for a different medical condition than the original hospitalization (Jencks, Williams, & Coleman, 2009). The transition from hospital to home is a high-risk time for most patients but particularly for patients who are elderly or those with more chronic medical conditions. Internists, by nature of their training in balancing multiple medical conditions in adults, are well-equipped to provide care to patients at any inpatient or outpatient site.

Additional Resources

Literature

Galanti, G. (2014). Caring for patients from different cultures. Philadelphia, PA: University of Pennsylvania Press.

McDaniel, S. H., Campbell, T. L., Hepworth, J., & Lorenz, A. (2005). Family-oriented primary care. New York, NY. Springer.

Miller, W. R. & Rollnick, S. (2013). Motivational interviewing: Helping people change (3rd ed.). New York, NY: Guilford Press.

Oyama, O., & Burg, M. A. (2016). The behavioral health specialist in primary care: Skills for integrated practice. New York, NY: Springer.

Peek, C. & National Integration Academy Council. (2013). Lexicon for behavioral health and primary care integration: Concepts and definitions developed by expert consensus. (AHRQ Publication No.13-IP001-EF). Retrieved from http://integrationacademy.ahrq.gov/sites/default/files/Lexicon.pdf

Rollnick, S., Miller, W. R., & Butler, C. C. (2008). Motivational interviewing in health care: Helping patients change behavior. New York, NY: Guilford Press.

Measures/Instruments

Alcohol Use Disorders Identification Test (AUDIT). http://www.talkingalcohol.com/files/pdfs/WHO_audit.pdf

Drug Abuse Screening Test (DAST-7). https://www.drugabuse.gov/sites/default/files/files/DAST-10.pdf

Generalized Anxiety Disorder 7-Item Scale (GAD-7). http://www.integration.samhsa.gov/clinical-practice/GAD708.19.08Cartwright.pdf

Patient Health Questionnaire-9 (PHQ-9). http://www.phqscreeners.com/

Organizations/Associations

American College of Physicians. https://www.acponline.org/

Collaborative Family Healthcare Association. http://www.cfha.net/

Society of General Internal Medicine. http://www.sgim.org/

Glossary of Important Terms for Care in Internal Medicine

Acute

An acute complaint occurs for less than 2 weeks (e.g., cough or cold symptoms ); acute visits are typically for a new, quickly arising problem that cannot wait until the next scheduled visit.

Adherence

The extent to which medications and healthcare regimens prescribed by healthcar e providers are followed by patients. For example, providers ask patients to adhere to taking medications , following diet plans, and increasing exercise.

Attending physician

A physician who has completed all medical training and serves as the provider of record. Attending physicians supervise residents and medical students; they are ultimately responsible for the patient care residents and medical students provide.

Chronic

A complaint occurring for 3–4 weeks or more. This may be a disease that patients still have, thought it may be managed with medication (e.g., hypertension ), or may be a complaint that has persisted over time (e.g., cough for 2 months); chronic visits are typically for management of ongoing medical conditions.

Differential diagnosis

A short list of possible diagnoses. As internists are working through potential diagnoses to consider, they may discuss the differential diagnosis for a patient. This can occur during an H&P or with a new problem presented by a patient. This term is generally used while diagnostic labs or studies are still pending.

History and Physical (H&P)

Evaluation that is completed by medical doctors, including internists , and serves as the complete evaluation of a patient, including the patient’s story of events and physical exam findings.

Progress/Encounter note

Typical documentation done by a member of the care team after the patient visit, highlighting which issues were discussed, physical exam or lab findings, and assessment and care plan moving forward.

Resident physician

A physician who has completed an undergraduate college degree and 4 years of medical school and is essentially in an apprenticeship position. They work semi-independently, depending on skill level. An attending physician either directly observes, is available to join, or is available via telephone to provide supervision and instruction. Internal medicine residency is 3 years.

Vital signs

Physical exam/data that include temperature, heart rate, respiratory rate, and blood pressure. At times, other objective measures may be added, including weight or pulse oximetry (measure of oxygen level in the blood).