Moving Us Closer To Osler
A Miller Coulson Academy of Clinical Excellence Initiative

General Internal Medicine: An Opportunity to Engage Holistically

The author having fun ice skating with colleagues at Patterson Park, Baltimore, Maryland.


General internal medicine focuses on the importance of knowing and treating the whole patient. The entire patient, in their biopsychosocial context, must always be considered to provide high-quality, patient-centered care.

As a bright-eyed pre-medical student, I yearned for a career in medicine. I aspired to be the type of physician who had longitudinal relationships with patients. A doctor who patients could count on to assist them through health challenges, alleviate their suffering and worry, and promote their overall well-being.  A true partner through life’s victories and challenges.


Why I chose a general internal medicine (GIM)

As I went through medical school, I loved getting to know my adult patients and their families. I loved the spirit of medical education; both the guidance I received from my teachers and being able to educate others in the clinical environment and the classroom.


At the same time, I witnessed the imperfections of our current medical system: the inequities with access, the disparities in health outcomes, and the need for better care options for many common conditions such as addiction. Along with being a champion for my individual patients, I wanted to assist and advocate for the advancement of health access and quality at a population-level. As these many interests bubbled up in my medical student mind, I was excited to find a medical specialty that was the perfect fit for me: general internal medicine or GIM.


GIM is a specialty that prepares practitioners with the knowledge and skills to confidently promote the well-being and manage the health of all adult patients – from patients with no known comorbidities to patients with significant medical complexity. GIM training provides the opportunity to serve as a primary physician in both the outpatient and inpatient clinical environments as an outpatient primary care doctor, a hospitalist, or a combination of both.  Clinically, we are well-equipped to address acute and chronic medical issues, but also assist our patients with the prevention of disease. The opportunity to educate and partner with a patient on a weight loss plan, smoking cessation, or risk mitigation for disease through lifestyle or pharmacologic risk reduction strategies (such as pre-exposure prophylaxis (PrEP) in patients with high-risk sexual behaviors or buprenorphine in patients with opioid use disorder) is tremendously fulfilling.


A holistic approach

GIM focuses on the entire patient in the biopsychosocial context, so general internists are well-positioned to lead, study, and advocate for the betterment of health of all adult patients in many different ways beyond direct patient care. General internists are involved in research to improve healthcare access, quality, and value, to decrease health disparities and enhance health equity, and to promote the well-being of patients and their communities.


General internists are leaders in healthcare innovation through health policy work, development of innovative care delivery models, or the design of new ways to provide evidenced-based, patient-centered care. With their holistic and foundational knowledge of medicine, general internists have a sizable presence in medical education and guiding the paths of future physicians and health professionals. The possibilities for a career in GIM are exponential and allow practitioners to evolve in their career as their interests and passions change over a lifetime.


I never have the same week twice

During a work week, I have the great fortune to be the primary care physician for tremendous patients who place their trust in me. I am there to care for their acute medical concerns, manage chronic diseases, counsel on health promotion, and share in the beautiful tapestry of their lives. I see my patients in outpatient clinic and communicate with them by phone or electronic messaging regularly.


I also have the opportunity to teach internal medicine residents and medical students in outpatient clinic and on the inpatient wards.  The opportunity to directly work with learners in the clinical environment, assist with the development of their medical skills, and witness the strong relationships they develop with their patients is an absolute joy. I also teach didactic sessions on various topics, whether it is an interactive small group session on high value care for residents and students on the hospital wards, a lecture on the evidence behind hypertension management goals and therapies for interns, or a reflective session on recent challenges in patient care with my primary care internal medicine residents.


As an associate program director in our medicine residency program, I am able to have frequent mentorship meetings with residents to discuss their professional development, ensure their goals and wellness are being addressed, and assist on their scholarship projects to advance the medical field. I serve on health system and professional society committees to promote and advocate for improved health care for patients and educational resources for future physicians and health professionals. I dedicate time each week to pursue projects that study or enhance current medical education and primary care practice. I am able to disseminate this work through talks and workshops at regional and national meetings, peer-reviewed literature, and other media.


Outside of work, I have the ability to spend quality time with my family and friends. I play with my son constructing imaginary cities out of building blocks and watch the latest binge-worthy series on Netflix with my wife and a bowl of popcorn.


GIM offers an important lesson for all health providers: the importance of knowing and treating the whole patient. It is important to not narrow our focus on one symptom, one abnormal result, or even one disease – the entire patient, in their biopsychosocial context, must always be considered and appreciated to provide high-quality, patient-centered care.


GIM offers the flexibility and balance that allows me to pursue all of my passions and pursuits. Of course, there are trials and difficult times in any job – GIM is no exception, although we continue to advocate and are fortunate to see great improvements in our field.


But every evening, I lay down knowing how blessed I am to do a job that I love that makes a difference in the world. I am proud to be GIM.


Publication of this article coincides with the beginning of #ProudToBeGIM Week. ProudToBeGIM is a national campaign to educate medical students and residents about career opportunities in general internal medicine and is co-sponsored by the Society of General Internal Medicine and the American College of Physicians.  To learn more about general internal medicine and the campaign, please visit ProudToBeGIM.org