- 1. Internal Medicine in Europe Daniel SERENI EUROPEAN
FEDERATION OF INTERNAL MEDICINE Brussels 5 May 2007
2. Internal Medicine in Europe
- 30 000 to 40 000 Internists
- Diversity of Internal Medicine in Europe
- Challenges to Internal Medicine
- Need for Internal Medicine in Europe
3. How Long Is Training In Internal Medicine?
- 6 years: Netherlands, Finland, Czech Rep.
- 7 years: Denmark, Slovakia, Germany, Malta.
4. Countries With Mandatory CommonTrunk For Sub-specialists.How
Long?
- Exists in ALL COUNTRIES EXCEPT: Spain, Italy, France
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- 2:Greece, Slovakia, Slovenia, UK, Malta.
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- 3 :Belgium, Switzerland, Finland, Czech Rep,
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- 5 :Sweden, Turkey, Poland
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- Recommended in Estonia and Israel
5.
- Greece, Spain, Netherlands, Latvia, Switzerland, Sweden,
Finland, Poland, Czech Rep, Estonia, Slovakia, UK Portugal and
Israel
- Italy, France, Belgium, Denmark, Turkey, Slovenia, Germany,
Malta
Countries Where Teaching Diagnostic Techniques forInternists are
Defined 6. Percentage of Internists Working In Hospitals
- Over 80% of Internists in most countries work primarily in
hospitals
7. Medicine In Europe Is Characterised By Diversity
- Healthcare systems may be
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- state driven : UK, NL, Sweden
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- state and private : Fr, It, Sp, Germany, CH, Pl
- % of GNP spent for healthcare varies from
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- Clear messages to the public
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- caring for the whole patient
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- Longer training than family physiciansorGPs
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- Annals of Internal medicine
16. Internal Medicine in Europe
- Diversity of Internal Medicine in Europe
- Challenges to Internal Medicine
- Need for Internal Medicine in Europe
17.
- dismantling of IM departments in hospitals
- fashion and glamour: young doctors decreasinglyattracted to
IM
- Weakness of identity as a scientific discipline
- Will of indepen den c yof former derivate specialities:
cardiology
Threats on Internal Medicine 18. Who threatens Internal
Medicine?
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- there is only one pie to share
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- Tend to focus on GPs for out - practice and on
medico-technologic-subspecialties in hospitals
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- what is new is more attractive
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- They have a poor knowledge of whatinternal medicine
andinternists are.
19.
- Do the broad scope of Internal Medicine and the variety of its
practices mean that Internists can take care of all patients?
- With or without a sub-specialisation ?
Need for adefinition of IM adapted to local situation 20.
Medical practice
- General medicine / family medicine
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- Frequent hea l th problems
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- Use of specific medical technology
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- Narrow fields of pr a ctice
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- Rare and systemic disease s
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- Integrated care , associatedmorbidities
21. Practice of Internal Medicine in France, a survey in
2002
- About half have a subspecialty: infectious diseases,
gastro-enterology, diabetes, geriatrics, nephrology, vascular disea
s es, etc
- Most frequent diagnosisforinpatients
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- Infections17% , vasculardiseaes 10% , h ea matologic disord er
s8.5% , cancers 8% , systemicdiseases 7.5% , gastro-enterology7% ,
cardiology6%
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- Mostly referred by GPs or other specialists
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- Asking for diagnostic or therapeutic advise
22. Diversity of competence and knowledge Level of excellence
subspecialists GPs internal medicine internal medicine 23. Internal
Medicine in Europe
- Diversity of Internal Medicine in Europe
- Challenges to Internal Medicine
- Need for Internal Medicine in Europe
24.
- to obtain cost effectiveness political debates
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- ethical and professional Issue
Health care is a challenging political issue 25.
- undifferentiated situations
- general and systemic diseases
- the internist has received a long and adequate training
enabling him/her to take care of such patients
Internal medicine as an answer to the needs of the patients 26.
Role of Internists in Medical Training
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- All major general text books refer to InternalM e dicine
27. New fields for Internists
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- Links with emergency care
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- Care of inpatients ( 85% of them are internists)
- Internists in the Emergency Room
- Emergence of new sub-specialties
28. Internists And Research
- Mainly at University Hospitals
- Oriented towardsparticular fields of I.M.
- Difficulties related to: time, money and support
- Content:clinical epidemiology, clinical pharmacology, clinical
assays, multicentre studies,basic patho-physiology, audit of
clinical management, vascular diseases, vasculitis, systemic
diseases, diabetes and metabolism, geriatrics, etc..
- Need for a europan clinical research network in IM
29. Internal Medicine in Europe: Strengths
- Historical role in patients care
- Most internists hospital-based
- Remains the basis of student training
- ProvidesCommon Trunkfor sub-speciality training in most
countries
- Training programme for IM fairly uniform
- Internists opinion leaders
30. 31. Lobbying for Internal Medicine
- Internal Medicine is adapted to the present situation because
of its capacity to solve complex and combined medical problems
.
- In hospitals, Internists and Internal Medicine Departments or
Services are indispensable for the care of a number of patients who
do not require specialised medical technology
- A majority of patients and primarily the elderly need an
integrated care : in complex situations, Internists are the only
doctors dedicated to the task.
- Internists can deliver a cost effective medical care thanks
totheir ability to develop standards and guideline with an holistic
point of view and to integrate quality of care assessment in a wide
range of clinical situations.
32. Lobbying for Internal Medicine
- Training ofStudents must remain based on a common trunk in
Internal Medicine
- Residents should get a minimum training in IM medicine before
subspecialisation
- In a health care system based on GPsgate keepers, Internists
are necessary as consultants and responsible for coordination of
patients care
- Internists in other countries may be in charge of primary
care
- Whatever the organisation of the primary care, Hospitals need
Internal Medicine Departments or Services
- Internal Medicine is an Indispensable Specialty