Trusting internal medicine in hard times

Lenti, Marco Vincenzo

doi:10.1007/s11739-014-1046-y

Cited by 3 publications

(2 citation statements)

References 9 publications

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“…Secondly, it has proved capable of adapting in relation to the various clinical settings and to the changing burden of disease. Finally, internal medicine has deemed humanism as an essential part of clinical practice [7]. Hence, this crisis may represent a great opportunity to rethink the healthcare system in a more rational and patient-centred way.…”

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confidence: 99%

Carving out a place for internal medicine during COVID‐19 epidemic in Italy

Lenti

Sabatino

2020

J Intern Med

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confidence: 99%

Carving out a place for internal medicine during COVID‐19 epidemic in Italy

Lenti

Sabatino

2020

J Intern Med

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“…In internal medicine, patients are more "diagnostically undifferentiated" than in other specialties and, as a consequence, the diagnostic process is susceptible to a higher failure rate [8], largely due to inconsistencies in this reasoning process [9,10]. Conversely, particularly in internal medicine, characterised by an extremely large body of factual evidence, using a correct diagnostic methodology allows compensation for inevitable case-specific weaknesses [11].…”

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confidence: 99%

Diagnostic reasoning in internal medicine: a practical reappraisal

2020

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The practice of clinical medicine needs to be a very flexible discipline which can adapt promptly to continuously changing surrounding events. Despite the huge advances and progress made in recent decades, clinical reasoning to achieve an accurate diagnosis still seems to be the most appropriate and distinctive feature of clinical medicine. This is particularly evident in internal medicine where diagnostic boundaries are often blurred. Making a diagnosis is a multi-stage process which requires proper data collection, the formulation of an illness script and testing of the diagnostic hypothesis. To make sense of a number of variables, physicians may follow an analytical or an intuitive approach to clinical reasoning, depending on their personal experience and level of professionalism. Intuitive thinking is more typical of experienced physicians, but is not devoid of shortcomings. Particularly, the high risk of biases must be counteracted by de-biasing techniques, which require constant critical thinking. In this review, we discuss critically the current knowledge regarding diagnostic reasoning from an internal medicine perspective.

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Multimorbidity and polypharmacy in the elderly: lessons from REPOSI

2014

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The dramatic demographic changes that are occurring in the third millennium are modifying the mission of generalist professionals such as primary care physicians and internists. Multiple chronic diseases and the related prescription of multiple medications are becoming typical problems and present many challenges. Unfortunately, the available evidence regarding the efficacy of medications has been generated by clinical trials involving patients completely different from those currently admitted to internal medicine: much younger, affected by a single disease and managed in a highly controlled research environment. Because only registries can provide information on drug effectiveness in real-life conditions, REPOSI started in 2008 with the goal of acquiring data on elderly people acutely admitted to medical or geriatric hospital wards in Italy. The main goals of the registry were to evaluate drug prescription appropriateness, the relationship between multimorbidity/polypharmacy and such cogent outcomes as hospital mortality and re-hospitalization, and the identification of disease clusters that most often concomitantly occur in the elderly. The findings of 3-yearly REPOSI runs (2008, 2010, 2012) suggest the following pertinent tasks for the internist in order to optimally handle their elderly patients: the management of multiple medications, the need to become acquainted with geriatric multidimensional tools, the promotion and implementation of a multidisciplinary team approach to patient health and care and the corresponding involvement of patients and their relatives and caregivers. There is also a need for more research, tailored to the peculiar features of the multimorbid elderly patient

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Trusting internal medicine in hard times

Cited by 3 publications

References 9 publications

Carving out a place for internal medicine during COVID‐19 epidemic in Italy

Carving out a place for internal medicine during COVID‐19 epidemic in Italy

Diagnostic reasoning in internal medicine: a practical reappraisal

Multimorbidity and polypharmacy in the elderly: lessons from REPOSI

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