Because general internal medicine practitioners are highly skilled in solving often-perplexing diagnostic problems and treating severe chronic illnesses, they frequently find themselves caring for patients facing both local and systemic diseases simultaneously. Internists are specially trained to deal with whatever medical condition a patient presents, no matter how complex or rare, and they often do so from a patient’s late teen years through old age.
What are some examples of the various local and systemic illnesses that doctors of internal medicine see on a daily basis?
Localized diseases defined
A localized disease is an infectious or neoplastic (benign or malignant tumor) process that originates in– and is confined to–one area of the body or organ system. Examples include:
• An ear infection
• A boil on the hand
• An abscess on the leg
• A localized cancer that has not extended beyond the margins of the organ involved
Systemic diseases defined
A systemic illness is one that affects the entire body, rather than a single organ or body part. Many organs and tissues might be involved in the complex disease process. Some of the most commonly treated systemic disorders internists handle include:
Influenza – In severe cases, an internist may prescribe an antiviral medication, such as Tamiflu or Relenza, to shorten the illness and prevent serious complications.
Diabetes mellitus – Internists help patients monitor blood glucose levels and manage their diet and exercise programs. If needed, oral medications may be prescribed, or insulin used via injections or pump.
Hypertension – High blood pressure is often effectively treated with lifestyle changes, but medications may be used to control the condition.
High cholesterol – More than 102 million American adults have unhealthy cholesterol levels, and over 35 million of these individuals have cholesterol levels high enough to put them at risk for heart disease, the number one killer of men and women in the United States. Internists help patients manage high cholesterol with lifestyle changes and statin medicines if required.
Chronic fatigue syndrome – This complicated disorder with an unknown cause manifests as extreme fatigue that does not improve with rest. Rather than depend on a single test to diagnose CFS, internists must perform a variety of medical tests to rule out other similar illnesses. Treatment usually focuses on symptom relief through lifestyle changes and sometimes medications.
Lupus – At least 1.5 million Americans have this chronic autoimmune disease that can damage the brain, joints, skin and/or internal organs. Lupus can be very challenging for an internist to diagnose and treat because the symptoms often mirror those of other illnesses and often last for years. Doctors treat lupus with various medications, including corticosteroids and immunosuppressants, as well as complementary supplements such as fish oil, DHEA and vitamin D.
When local becomes systemic
Internists often treat illnesses that begin as local and progress to systemic diseases. For example, a case of pneumonia might begin in one or both lungs and then spread throughout the body in a potentially life-threatening condition called sepsis. The microbe responsible for the pneumonia enters the bloodstream or lymphatic system and is carried to other parts of the body. What was once a localized disease has now become a systemic, or disseminated, disease.
A cancer that metastasizes from a localized region into other organs, the blood or the bones is a systemic disease that is treated by an oncologist – an internist who has pursued additional training to specialize in the care of cancer patients.