Currently in medical care in the United States, there are four main primary care specialties: family medicine, internal medicine, pediatrics, and geriatrics. Internal medicine is primary care for adults, pediatrics is primary care for children and infants, and geriatrics is primary care for seniors. Family medicine, the broadest specialty, is primary care for all ages.
A family medicine physician is a medical ‘home base’ for patients. They treat all ages, all sexes, all organs, and all diseases. They can see every member of the family, from birth through old age. This allows family medicine doctors to develop long-term relationships with their patients and to understand how their patients’ role in the family affects their health. They can provide check-ups, immunizations, screening services, gynecological exams and obstetric care, routine health care, and health counseling. When more specialized care is needed, a family medicine doctor can refer their patients to appropriate specialists. They can become educators and advocates for their patients in the sometimes overwhelming health care system.
As health care changes in this country, family medicine is a growing specialty for families and individuals who are seeking more personalized health care and a more personal relationship with their physician.
A specialist in general internal medicine is often referred to as an “internist.” While internal medicine physicians also provide comprehensive care, they should not be confused with general practitioners or family medicine practitioners, both of which may provide pregnancy care, deliver babies, and treat children. An internal medicine doctor specializes only in the health care of adults.
With internal medicine, there is never an illness too big or too small. These physicians have exceptionally broad-based training, and they can care for patients in any condition -- from healthy to dealing with serious medical issues. Because their scope is so wide, internal medicine physicians can provide an excellent picture of overall health.
One of the unusual aspects of internal medicine is that physicians in this field often treat their patients for a very long time -- sometimes for life. They manage preventive care when their patients are well, and they become advocates and consultants when complex medical issues arise. Because internal medicine physicians tend to treat patients over a long period of time, they are an ideal choice to manage chronic illnesses.
There are a huge number of subspecialties within internal medicine, for example: cardiology (which deals with problems of the heart and blood vessels), nephrology (which deals with diseases of the kidneys), and hospice medicine (which tends to the special needs of patients at the end of life). General internal medicine is considered a subspecialty itself and refers to internists without another specific focus. General internists provide total, primary care for the whole body of adult patients, in sickness or in health.
Neurology is the study of the brain and nervous system, including the spinal cord and nerves. Disorders of the nervous system can affect many parts of the body, and a neurological exam must be quite thorough. A neurologist examining a new patient will check for any issues with:
motor skills (the way your brain and muscles work together)
sensory skills (sight, hearing, taste, touch and smell)
coordination and balance
changes in mood or behavior
A neurologist can order different kinds of tests to check the function of the brain and nerves. These tests may include a head CT scan (a type of 3-dimensional x-ray), an electroencephalogram (which measures the electrical impulses inside the brain), an MRI (a detailed image of the brain or spinal cord), or electromyography (which uses electricity to test nerve function). The results of the exam and the tests help neurologists diagnose and form treatment plans for disorders like multiple sclerosis, tremors, stroke, and migraine headaches.
Some neurological problems, such as certain brain tumors, may require surgical treatment. Since neurologists do not perform surgery, they will refer patients who need operations to a surgical subspecialist, such as a neurosurgeon. Beyond surgery, a neurologist might recommend any of the following treatments:
medication (such as interferon for MS or topiramate for migraines)
laser therapy (class IV laser treatment is sometimes used to alleviate peripheral neuropathy pain)
physical therapy (stretches and exercises can increase balance and range of motion, helping patients to move more easily and with less pain)
Therapies such as these can improve quality of life for patients dealing with neurological disorders. Neurologists help their patients sense and interact with the world at their very best.
Geriatrics is the subspecialty of internal medicine that provides primary care to older adults. Physical health tends to decline with age, and geriatricians work to manage such age-related concerns as chronic illness, frailty, multiple medications, and declining mental health to keep seniors as active and independent as possible.
Some of the most common concerns seen by a geriatrician include:
Mobility issues, including the need for canes and walkers, as well as preventing falls
Osteoporosis, a weakening of the bones, which affects as many as a quarter of all men and half of all women over fifty
Loss of hearing or vision
Incontinence, or the inability to control one’s bladder
Memory loss, including dementia and Alzheimer’s disease
A geriatrician may also provide their patients with comprehensive care that includes checking on their social health. Seniors are at increased risk for poverty, loneliness, abuse, and injuries in the home. As part of their health care, a geriatrician may inquire about family support, living conditions, or the ability of a patient to perform daily self-care tasks.
In some cases, a geriatrician may serve as an advisor to other physicians on a specific case or condition. However, most of the time geriatrics is a primary care specialty, and geriatricians provide routine health care to the older patients they work with.
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