Stevens R
Ann Intern Med. 1986 Oct;105(4):592-602. doi: 10.7326/0003-4819-105-4-592.
The content, role, and purpose of internal medicine, organized as an American specialty 100 years ago, have been marked by ambivalence from the beginning. Nevertheless, molded to a large extent by external events, including the strategic and symbolic importance of surgery in American medicine, the rise of university medical schools, development of other specialties, and, more recently, the demand for primary care and the incentives built into reimbursement schemes and organized health care systems, internal medicine has become a powerful entity in American medicine. Its role in the future is likely to be more influential than in the past, both in policy and substantive areas. Continuing tensions in internal medicine include uncertainties about the relation between generalism and specialism, primary care and subspecialties, and internal medicine and general medicine.
100年前作为一门美国专业学科组建起来的内科医学，其内容、作用和目的从一开始就充满矛盾。然而，在很大程度上受到外部事件的塑造，包括外科手术在美国医学中的战略和象征意义、大学医学院的兴起、其他专科的发展，以及最近对初级保健的需求和报销计划及有组织的医疗保健系统中内置的激励措施，内科医学已成为美国医学中的一股强大力量。它在未来的作用在政策和实质领域可能比过去更具影响力。内科医学中持续存在的紧张关系包括通科与专科、初级保健与亚专科，以及内科医学与普通医学之间关系的不确定性。
