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The Editors welcome submissions for possible publication in the Letters section. Authors of letters should:
•Include no more than 300 words of text, three authors, and five references
•Type with double-spacing
•Send three copies of the letter, an authors' form signed by all authors, and a cover letter describing any conflicts of interest related to the contents of the letter.
Letters commenting on an Annals article will be considered if they are received within 6 weeks of the time the article was published. Only some of the letters received can be published. Published letters are edited and may be shortened; tables and figures are included only selectively. Authors will be notified that the letter has been received. If the letter is selected for publication, the author will be notified about 3 weeks before the publication date. Unpublished letters cannot be returned.
Annals welcomes electronically submitted letters.
IN RESPONSE:
Dr. Volpintesta reinforces the contention that the practice of internal medicine has become essentially the same as that of family practice in many, but certainly not all, groups. The plea for a single primary care specialty has been suggested by others, with the appropriate role for general internists that of consultative physician-scientists (1). However, the argument that general internists are not always differentiated in their ability to manage complex medical problems is no reason that such a differentiation is not desirable. Both disciplines need to better define their practice responsibilities when they work as a group. I agree that many patients do not understand a difference in training or competencies between an internist and family physician. The designation of an internist has always been ambiguous in its meaning, and the term adult specialist has recently been suggested as a substitute (2).
Dr. Ginsberg's plea for a more equitable reimbursement for internists given their care of the sickest and most time-intensive patients is well taken. However, I believe it would be difficult in the present cost environment to see any difference enacted.
Dr. DiPiero agrees that how we provide care to our sickest patients is the benchmark for high-quality care. Unfortunately, accurate measurements for the management of complicated, multisystem disease are not yet available, and accredited bodies have not included such measurements in their surveys. It is true that a major part of primary care involves nurturing patients with trivial symptoms or minor acute illnesses. Clearly, an internist must be able to communicate effectively with these patients, but this need not be accomplished at the expense of skills that have traditionally defined our discipline.
With the present homogenization of residency review requirements for internal medicine and family practice, a legitimate question is whether the competencies in the care of adults is truly different. It would be of interest for the American Boards of Internal Medicine and Family Medicine to give each other's graduates the qualifying examination. I believe that graduates of internal medicine programs would demonstrate psychosocial skills similar to those of their family medicine counterparts but that a significant difference would exist in the knowledge of disease management.
James P. Nolan, MD
State University of New York at Buffalo; Buffalo, NY 14215
The Editors welcome submissions for possible publication in the Letters section. Authors of letters should:
•Include no more than 300 words of text, three authors, and five references
•Type with double-spacing
•Send three copies of the letter, an authors' form signed by all authors, and a cover letter describing any conflicts of interest related to the contents of the letter.
Letters commenting on an Annals article will be considered if they are received within 6 weeks of the time the article was published. Only some of the letters received can be published. Published letters are edited and may be shortened; tables and figures are included only selectively. Authors will be notified that the letter has been received. If the letter is selected for publication, the author will be notified about 3 weeks before the publication date. Unpublished letters cannot be returned.
Annals welcomes electronically submitted letters.
- Copyright ©2004 by the American College of Physicians
