INTRODUCTION OF THE INTERNAL MEDICINE （内科学总论） Baoyuan Chen. MD.FCCP.

1. INTRODUCTION OF THE INTERNAL MEDICINE （内科学总论） Baoyuan Chen. MD.FCCP. Division of Respiratory Medicine Department of Internal Medicine Tianjin General Hospital, Tianjin Medical University

2. Major points: ● About INTERNAL MEDICINE ●Progress ofINTERNAL MEDICINE ● What is the Physician’s mean? ● Evidence based Medicine, EBM ● How to learn the INTERNAL MEDICINE?

3. ● About INTERNAL MEDICINE

4. The history of the medicine Original concept of Medicine: ●Medicine: all of the clinical medical events. ●Internal medicine means treatment without operation, or without using a knife. ●External medicine means treatment with surgical procedure or operation related medicine.

5. Classification of MEDICINE： ①Basic medicine ②Preventive medicine ③Preclinical medicine ④Clinical medicine ⑤Sport medicine Clinical medicine (major) ①Internal medicine ②Surgery ③Pediatrics ④Gynecology and obstetrics

6. Medicine is not only a science, but a profession that involved medical science as well as personal, humanistic, and professional attributes. The delivery of medicine depends on science and the scientific method. cecil’s Internal medicine

7. Internal medicine : is a course or a medical specialty of studying internal structure within human body, and diagnosis and treatment of disease. It is the basis of all other clinical courses, and the key course to connected closely with others. The textbook of internal medicine for Chinese medical student

8. THE INTERNAL MEDICINE WITH FOLLOWING SUBJECTS： ◆ CARDIOVASCULAR DISEASE（CARDIOVASOLOGY） Coronary heart disease/cardiac arrhythmia /endocarditis/Rheumatic heart disease ◆ GASTROINTESTINAL DISEASE（GASTROENTEROLOGY） Liver disease/Hepatic tumors/Pancreatitis Gastric ulcer

9. ◆ BLOOD DISEASE（HEMATOLOGY） Anemia/Acute or chronic Leukemia/Hodgkin’s lymphomas(lymphoma) ◆ ENDOCRINE DISEASE（ENDOCRINOLOGY） Hyper(hypo)thyroidism/Diabetes mellitus /Metabolic bone disease

10. ◆ KIDNEY DISEASE（NEPHROLOGY） Glomerulonephritis/Urine tract infection Renal failue ◆ RHEUMATIC DISEASE Rheumatic arthritis/Systemic erythema lupus/ Systemic vasculitis

11. ◆ RESPIRATORY DISEASE（PULMONOLOGY） Upper Respiratory tract infection Pneumonia Bronchitis(acute or chronic) Asthma Lung cancer Pulmonary tuberculosis Chronic obstructive pulmonary disease Pulmonary interstitial fibrosis Respiratory failure and ARDS Sleep apnea syndrome Pulmonary thromboembolism

13. H1N1 Severe Pneumonia 2009.11.18 2009.11.14 2009.11.25 2009.12.10

15. ●Progress of INTERNAL MEDICINE

16. Medicine has advanced to an outstanding degree in the past half century. • The advances have come at the most fundamental levels of science. • The understanding of disease processes depends on levels of the fundamental scientific knowledge.

17. The Milestonesin medical history last 50 years: ①Breakthroughs in infectious diseases, ② The regulation of blood pressure, ③ Fundamental immunology, fundamental genetics, ④ Metabolic regulation by hormones, that provide the tools to help understanding of human disease(clinical medicine) .

18. Several findings of the Fundamental science, ①an understanding of how proteins are synthesized and express their various physical properties, ② why and how it influences organ function, ③ the importance of protein-protein interaction in transmitting messages across cell membranes to the nucleus of cells.

19. ④how messages transfer from the outside to the inside of cells, ⑤ how hormones influence cell action, ⑥ how cells respond to external stimuli and are regulated in their response.

20. ●Evidence based Medicine

21. As the physician for the twenty-first century must understand advances in fundamental biology, a similar understanding is needed of the fundamentals of clinical study design which applies to diagnostic and therapeutic interventions.

22. The physician has the responsibility: as an expert who helps create standards, measures of outcome, clinical guidelines, and mechanisms to ensure high-quality, cost-effective care.

23. The evidence based medicine(EBM) is a newly rising science of clinical medical domain，is the guide of decision making in modern medical therapeutics. The evidence based medicinedemanded clinical practice, specially in therapeutic decision and practice based on scientific evidence, asking doctor to take patient’slong term effect and prognosismarker as the primary end point。

24. The randomized control trial, with thousands of patients at multiple institutions, as the preferred method for measuring the benefits and uses of diagnostic or therapeutic interventions. A multicentre, multinational, prospective, randomized, double blind study to compare the effectiveness of medicine A to medicine B.

25. As studies progress from those that demonstrate biologic effect and toxicity(safety), and finally to those that assess true clinical benefit. The measuring outcome have also improved from subjective impressions of physicians, to reliable and valid measures of morbidity, quality of life, functional status, and other patient outcomes.

26. Any medicine/method/strategy must following: ●safety and efficacy ●effect on medical outcomes, ●patient satisfaction, ●cost-effectiveness.

27. ●What is the Physician mean?

28. Professionalism in internal medicine included those attributes and behaviors that serve to maintain the interest of the patient above one's own self-interest. ●A commitment to the highest standards of excellence in the practice of medicine and in the generation and dissemination of medical knowledge. ●A commitmentto the attitudes and behaviors that sustain the interests and benefit of patients. ●A commitment to be responsive to the health needs of society professionalism with accountability, excellence, duty, honor, and respect for others.

29. Becoming a physician has meaning far beyond completing medical school and residency. • It is the entry to a way of life, the learned professions are really career which cannot separate their lives. • There are no part-time professionals, a physician can also be a good spouse, a good parent, and a good citizen of the community.

30. Physicians must be trained as scientists ●to understand and apply the thinking patterns of the scientific method, ● to develop an inquiring mind, ● to know how to design experiments and obtain data, ● to learn how to analyze those data, ●to use knowledge to ask questions and provide truthful answers. ●will learning the new, correcting the old.

31. The patient-physician interaction process requires: ①a history taking and physical examination, ②ordering of diagnostic tests, ③ integration of clinical findings with the test results, ④ understanding of the risks and benefits of the courses of action, ⑤ consultation with the patient and family to develop future plans. ⑥new information,new techniques,and new technology can be brought into the process. ⑦ physicians can call on the evidence-based medicine to guide the process so that patient’s benefit is maximized.

32. The patients are likely to ask the questions: ①Does my physician really care me? ②Does what happens to me matter to the physician? ③ Does my doctor show sensitivity and compassion more than technical ability? *Patients deserve compassion and understanding.

33. THE PHYSICIAN As a caregiver They want their physicians to be interested in them as individuals who seek advice, as well as relief from pain, disease, and suffering. They want to sense that they can safely share their deepest thoughts and their most heartfelt confidences with their physicians. They want to value their physician asa trusted friend.

34. "You give but little when you give of your property--it is when you give of yourself that you truly give". The physician must be willing to meet the patient's needs and also willing to undertake a long-term commitment to the patient's care. Sometimes we may find once again that our patients are the best teachers, because they may teach us how to become a physician who the patient need really.

35. When a patient sees a doctor, the patient is seeking help—to recover or maintain health. The physician's task is to work for the patient's health. The doctor does so by trying to attenuate disease, by relieving discomfort, by assisting the patient with any disability, and by maximizing contentment.

36. ●HOW TO LEARN THE INTERNAL MEDICINE

37. ▲STUDY WITH BASIC MEDICAL THEORY ▲ PRACTICE WITH THEORY （1）CLINICAL SKILL TRAINING （2）COMBINE PRACTICE WITH THEORY （3）THINKING ANG COMPREHENSION ▲ HOW TO MAKE CLINIC DECISION

38. Q and A ◆Learn how to rise questions ◆ Than learn how to answer patient’s questions and questions ( yourself)

39. Three key questions in this sequence. ①Should I get a test to improve my assessment of diagnosis or prognosis? ② Which test is the best test? ③Which therapeutic strategy is most appropriate for this patient?

40. Where do you learn from ◆Learn from the textbook ◆ Learn from your teachers ◆ Learn from your classmates ◆ Learn from your patients

41. The key sections of Internal Medicine ◆Definition Etiology Pathophysiology Pathology ◆ Diagnosis and differential diagnosis Clinical manifestation Laboratory tests ◆ Treatment (principle )

42. For becoming a physician what should you learn? ◆How to make a good interview with your patients and family? ◆How to collect medical history ◆How to take the physical examination ◆How to order a laboratory test ◆How to analysis the clinical data ◆How to make a diagnosis ◆How to choice a treatment strategy

43. The interaction of a doctor and patient during the interview is a marvelous mixture of art and science. The art is the interaction of two unique human beings; the science is the interaction of the biologic and behavioral bases of medicine. Each physician must develop an interviewing technique that is comfortable and true to his or her own personality. Interview style also necessarily varies according to the particular patient.

44. A successful doctor-patient interview requires a great deal of synthesis and judgment . The physician must be thinking of many elements: ①the diagnostic possibilities, ② the prognosis, ③ how and what to communicate to the patient, ④ how to help the patient feel as comfortable as possible, ⑤ which laboratory tests and therapy to choose, ⑥ how to explain them clearly to the patient.

45. History of the present illness For each major symptom, what, where, when, how course, what makes the symptom better or worse, questions to narrow diagnostic possibilities.

46. In most clinical meet the patient presents basic questions to the doctor: ◆ Am I sick? ◆ What is causing my illness? ◆ Will it go away? Will it kill me? ◆ Can you make me well? Better? ◆ Can you help me stay well?

47. Daily clinical work : • making a diagnosis, • determining prognosis, • carrying out treatment, • promoting health, • preventing disease.

48. The modern medicine has shifted attention toward the laboratory, even today most of the diagnosis is accomplished through history taking and physical examination, which narrow the diagnostic possibilities before laboratory testing is used.

49. The great diagnosticians will be the ones who also have the greatest access to the newest and most comprehensive therapies. ”comprehensive care” means being able to care for individuals in the best way with the greatest depth of knowledge.

50. PROGNOSIS It is important to tell the patient the diagnosis and discuss what to expect from the clinical course of the condition. For many patients, the prognosis of the illness is their greatest concern.