Evolution of general internal medicine in Canada

Dr Panju, professionally you have experienced ups and downs of general internal medicine and likely seen its role changing, both in the hospital care and in the outpatient care. Could you share with us your Canadian experience of the evolution of general internal medicine?

Akbar Panju: I would be very happy to do so. As you know, I am a general internist practicing at McMaster University in Canada. I will take you back in history a bit.

Sir William Osler was a general internist. At that time [19th century] a general internist, or what you call a physician, did all kinds of subspecialties of medicine together. Then, there was an era about 30 to 40 years ago, when subspecialized disciplines came into being, when people became a cardiologist, a gastroenterologist, and [took on] different specialties. I see now over the last 10 to 20 years there has been a major renaissance, a revival, of general internal medicine, where a physician trained in general internal medicine with the different disciplines of internal medicine is able to look after patients with multiple complex problems. These days patients do not have one illness. As patients live longer, they have multiple conditions, for example, they might have a heart disease, diabetes, arthritis, gastrointestinal problems. I think we need trained physicians, like general internists, who can provide complete care to these complex internal medicine patients. The need for a general internist specializing in multiple different areas for those complex medical patients has come, and I think the society needs this kind of individuals. That is the reason that the general internal medicine concept, particularly in Canada, is now prevalent and it is becoming more and more important.

Our treatments are changing. We have got evidence-based guidelines, so an internist who practices evidence-based medicine in different disciplines can be a very effective clinician to look after complex medical patients in the hospital and in the outpatient setting. In my opinion the future of general internal medicine—and we can talk about the future in a second [see Future of general internal medicine]. I think that internal medicine has gone from downsloping but now is on the rise. It is very interesting. More and more of our trainees in Canada are choosing to be a specialist in general internal medicine. In other words, general internal medicine has now become a specialty. It has just become the same specialty as cardiology, because you need certain skill sets to look after complex medical patients.

I am very happy to be a general internist. I have seen it through over the last 40 years that I have been in practice. I have seen it downslope and now it is an exciting moment for generalism. I think Sir William Osler, if he had to find out now, would be very happy to know that the concept of general internal medicine is back at the forefront.