Fournier A M
University of Miami School of Medicine, Department of Family Medicine, Miami Beach, Florida 33139, USA.
Am J Med. 1998 Mar;104(3):259-63. doi: 10.1016/s0002-9343(97)00347-1.
Internal medicine is confronting a conflict between its generalist and specialty roles, coupled with a conflict between the needs of academic internal medicine in contrast to those of private practice. The historical origins of these conflicts are explored. To resolve these conflicts, internal medicine must rediscover the common ground shared by the general internist and specialist, academician and practitioner. This common ground is best found in the role of internist as physician-scientist. In the future, specialists and general internists will need to emphasize their roles as consultants. In the process, internal medicine will become smaller and more "academic." The benefits of this role for internal medicine should be rapidly demonstrated through outcomes based research in order to win over skeptical payors, peers, and the public at large.
内科医学正面临着通科与专科角色之间的冲突，以及学术性内科医学需求与私人执业需求之间的冲突。本文探讨了这些冲突的历史根源。为解决这些冲突，内科医学必须重新发现普通内科医生与专科医生、院士与从业者之间的共同基础。这个共同基础最能在作为医师科学家的内科医生角色中找到。未来，专科医生和普通内科医生将需要强调他们作为顾问的角色。在此过程中，内科医学规模将变小且更具“学术性”。内科医学这一角色的益处应通过基于结果的研究迅速得到证明，以便赢得持怀疑态度的支付方、同行以及广大公众的认可。
