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Saturday, February 11, 2023

Is the internist as the "doctor's doctor" no longer existence?

 In the days when I trained as an internist and for another 20 years or so after that medical folks talked about the doctor's doctor. This referred to an internist known for his meticulous history taking skills and performing a very complete physical exam that would at least sometimes find something others has missed, He (and it was not always a he) was the physician to whom other doctors would refer to when they or their family member had a serious or mysterious medical condition or maybe just for reassurance. 

However, as time went on the monetary compensation of the internists shrunk to a point (where for example they make only slightly more than a CRNA) and there was no time to take the time the oldtimey internist took because they could not afford to.Less compensation per patient lead to more patients per hour needed to be seen.

Recently I learned of an encounter a relative living in France had with his internist.At least there is one internist in France who seems much like that idealized internist that my fellow internal medicine residents and I hoped we could become.

My relative had been the victim of a missed acute appendicitis and was now several weeks post  percutaneous drainage of several abscesses secondary to a ruptured appendix and was awaiting a follow up appendectomy 

The internist took very detailed history and examined him and agreed with the need for follow up appendectomy and gave him the names and backgrounds of several surgeons.

Senior internists in France earn about $21200 per year only slightly less than US general internists but graduate from medical school without significant debt and have low malpractice premiums and are largely free of the major hassles of insurance approval for testing.Perhaps their practice styles allow them more time to be more like the stylized internist model of the past in the U.S.Alternately perhaps my relative's internist was an aberration.  


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