Internal Medicine Doctor – About Diabetes

According to new research from the Archives of Internal Medicine, doctor and patient alike will want to watch the growth of diabetes. By the year 2025, there could be as many as 380 million people affected by complications of type 2 diabetes. Because this epidemic is becoming so widespread, it is in everyone’s best interest to understand as much as possible about the disease, including how it is contracted and what you can do to control it.

Both type 1 and type 2 diabetes are disorders of the body’s natural insulin production. When a person has type 1 diabetes, the body produces very little insulin, or sometimes none at all. This kind of diabetes is often hereditary and often shows up in children. Type 2 diabetes is sometimes called “the preventable diabetes”. Even so, it is becoming increasingly common due to diets high in sugar, calories, along with lifestyles that do not incorporate much physical activity. When a person has type 2, their cells do not respond to insulin production. Though it has long been referred to as “adult-onset diabetes”, more and more children are becoming susceptible to the condition. More and more soft drink consumption, sugary cereals, larger portions, and decreased exercise have all been blamed for this rise.

There are a number of risk factors that any internal medicine doctor will tell you are warning signs of being susceptible to type 2 diabetes. These include being over the age of 45 along with being more than 20 percent overweight, also defined as having a BMI of 27 or more. Having immediate family members with the condition is also a risk factor. Certain ethnicities, such as African Americans, Alaska Natives, and American Indians are at higher risk for the disease.

Type 2 diabetes, as any internal medicine doctor can tell you, is one of the few diseases that can be almost entirely eliminated by changes in a person’s diet and lifestyle. Even losing a small amount of weight can have a drastic impact on the condition and the symptoms. A study in the New England Journal of Medicine showed that the participants who made lifestyle changes such as getting more exercise and cleaning up their diets were able to reduce their risk of contracting diabetes by 58 percent.

If you or someone you know is pre-diabetic or is suffering from symptoms related to diabetes, it is important to see an internal medicine doctor as soon as possible. Get some blood work done and find out your status. The physician will be able to give you all the information you need when it comes to controlling the condition.

How to Study for and Pass the Internal Medicine Boards

As the ABIM internal medicine certification exam approached, we received a large number of emails from our subscribers asking for suggestions on the best way to study for the boards. The truth is there is no one path to success though there are certainly ways to increase your likelihood of passing. Regardless of whether you are preparing for board certification or trying to achieve maintenance of certification (MOC), the best tried and true overall method is to “study early and study often.” Below we lay out possible strategies and tactics (in no particular order) for passing the ABIM board exam:

1. Know the basics of the internal medicine board exam

This is obvious but a lot of people simply don’t review this prior to starting their exam preparation and instead rely on their ABIM study source of choice to provide the information.

  • Review the ABIM exam blueprint and understand the topics covered on the exam
  • A large percentage (33%) of the exam is comprised of Cardiovascular Disease, Gastroenterology, and Pulmonary Disease
  • Over 75 percent are based on patient presentations – most take place in an outpatient or emergency department; others are primarily in inpatient settings such as the intensive care unit or a nursing home.
  • While it’s not a big part of the exam, be prepared and expect to interpret some pictorial information such as electrocardiograms, radiographs, and photomicrographs (e.g., blood films, Gram stains, urine sediments).

2. Use the in-training exam as a starting gauge

If you are a resident, the Internal Medicine in-training exam is a good starting point to see where you stand. It’s simply that – a barometer of where you stand. It will give you an idea where you may be weak and where you may be pretty strong. It will also give you an idea of how you compare with your peers. Don’t alter your ABIM study plan simply based on it but it does give you an early metric of the areas you need to focus on.

3. Get a study guide to prepare for the ABIM exam

It’s important to have a good study guide that is tailored for the exam. Some of the more popular and effective guides we’ve come across are the MedStudy Internal Medicine Board Review books and Harrison’s Principles of Internal Medicine Board Review.

4. Join a study group

Study groups, if utilized properly, are particularly effective because they allow you to learn from your colleagues and other exam takers. Oftentimes, people will form study groups with their colleagues (ideally limited to 3-4 people) at their residency program. Tactics to use in ABIM study groups may include:

  • Focus on a new internal medicine category by week. For example, focus one week on cardiology and the next on pulmonary care. The exam can be broken into a dozen or so categories (see the ABIM exam blueprint). The majority of the subspecialty questions on the Internal Medicine board exam will focus on cardiology, gastroenterology, and pulmonary care. However, do not neglect the other areas as the ABIM wants to ensure that internists have a broad base of medical knowledge.
  • Test each other with internal medicine questions you have written yourself. We are firm believers in the philosophy that the best way to learn is to teach. If you help others learn, your knowledge of medical concepts will be greatly strengthened.

We recognize that joining a study group is often not feasible – especially for those no longer in residency programs where everyone is preparing the boards. Fortunately, we live in a digital age where being part of a study group is much easier. You can connect with colleagues through Skype, Google hangout or a number of other channels. One of our favorite approaches is to remain informed and learn through the power of social media – in particular Twitter. In a previous post, we highlighted excellent Twitter handles to follow for ABIM exam review as you prepare for certification. If Twitter is not your cup of tea, you can also connect with colleagues through the Knowmedge ABIM community on Google+. Regardless of what approach you decide, studying alongside others preparing for the same exam is a great motivational tool for success.

5. Get a question bank that fits your personal needs

What is the value of an Internal Medicine question bank? This is a discussion near and dear to our heart, of course. Question banks have become a popular tool because they bring together a lot of material in a question format and help create a test taking environment. There are a lot of question banks to choose from – so what should you look for in an ABIM qbank?

  • High quality ABIM-style questions in a format similar to the exam: The exam is mostly filled with clinical vignettes and has straightforward questions as well. At a minimum, your ABIM exam question bank should have both of these types of questions. Quantity is important – but the quality of the questions and explanations is much more important.
  • Detailed explanations that review why the incorrect choices were wrong: A question bank that does not provide you detailed explanations is probably not worth the money and time spent. As you review questions, you will inevitably get some wrong – your choice of ABIM question bank should detail why your choice is incorrect and the reasoning behind the correct choice.
  • Ability to track your personal performance: Your choice of ABIM qbank should be able to tell you your performance overall and by category. Most – not all – question banks provide you a dashboard broken down by category. The Knowmedge question bank has gone an additional step to break the categories into subcategories as seen on the ABIM exam blueprint. This allows you to review your strengths and weaknesses at a granular level. Knowing you are weak at cardiovascular disease is great – knowing you are weak at arrhythmia questions is more valuable.
  • Add-ons – Notes, Lab values, Highlighting: Depending on how you study, these may be valuable features.

ABIM exam questions straight talk:

  • No question bank – not MKSAP, not Knowmedge, not any – knows what will be on the actual ABIM exam. Based on the ABIM Blueprint, you can make assumptions on what are the most high-yield areas to study. The point of a question bank is not to give you the exact questions that will be on the exam – it is to hopefully teach you concepts you may see on the exam and how to reason through what you don’t know immediately.
  • High-quality ABIM exam review questions can be found in many places – question banks are not the only place. There are study guides, books, and even free sources. So don’t simply base your decision on question bank on the questions. In addition to the quality of the questions, what truly differentiates one ABIM exam question bank from another is whether it will truly help you build a broad base of knowledge and help you retain information for the exam. If you are not comfortable reading a bunch of text – it won’t matter how great the questions are. If you are not an audio-visual learner, the Medstudy or Knowmedge videos won’t do anything for you (As clarity, the Knowmedge qbank contains text and audio-visual explanations for this exact reason). If you are an “old-fashioned” learner that prefers printouts – USMLEWorld is definitely not for you – those who have used them are well aware their software will block you from taking print screens or copying of their content. In short… don’t follow the herd – each one of us learns differently and you need to pick the best method for you.

6. Consider whether a review course is right for you

There are pros and cons to taking a review course for your ABIM exam prep. The pros are that it gives you a serious dose of review in a short period of time. It gets you focused if you weren’t focused and some courses are absolutely excellent – we know some internists are ardent supporters of some of the professors that teach these courses. The three most popular independent courses we are aware of are:

  • Awesome Review by Dr. Habeeb Rahman – The best known and most popular independent course. Dr. Rahman has a very unique style of teaching and accompanies his lectures with his own videos. During this six day course (Sunday – Friday), Dr. Rahman provides students his own set of notes and questions to practice.
  • iMedicineReview by Dr. Shahid Babar – This three day course (Friday, Saturday, Sunday) course comes with a set of 1,500 review questions.
  • Unique Course by Dr. Satish Dhalla – A six day course (Monday – Friday) taught by one of the Top Internists in the Nation as selected by U.S. News

The cons of a review course are that they are expensive (Often over $1,000 plus hotel stay) and can be inconvenient to travel to and from. Regardless of whether you attend a review course or not, it cannot replace the pre and post-course study time that is needed. It is complementary to study time and does not replace it.

7. Review our suggested ABIM test taking strategies

The ABIM exam questions are not intended to trick you – they are intended to challenge your knowledge and ability to bring together your understanding of many different concepts and topics. Below are some of the tactics you can use as you are practicing questions and/or taking the actual ABIM exam:

  1. For clinical vignettes, read the question (last line) first and then go back and read the scenario. This way you’ll know what to look for as you are reading the scenario.
  2. Try to answer the question even before seeing the answer choices.
  3. Pay attention for keywords that can clue you in on an etiology or physical exam.
  4. Watch for key demographic information – Geography, ethnicity, gender, age, occupation.
  5. The ABIM test is not intended to be tricky but we are all human so we miss keywords sometimes – such as “least likely” – pay attention to these.
  6. If you are challenged by a longer clinical vignette, note the key items and develop your own scenario – this may trigger an answer.
  7. Most internists we’ve spoken with say time is generally not an issue – but be aware that it is a timed exam and that you have approximately two minutes per question.

We cannot stress enough the mantra “study early and study often.” The exam is challenging but it can be conquered with diligence and proper preparation.

8. Understand and be prepared for ABIM test day

  • Be prepared and confident. No matter how you have chosen to study, on test day – confidence is critical!
  • Get a good night’s rest – last minute cramming and staying up late is only going to stress you out more.
  • Get there early – don’t risk getting caught in traffic. It’s much better to be a little early than be aggravated in traffic.
  • Take an extra layer of clothing. The last thing you want to do is be uncomfortable and cold because someone decided to turn on the air conditioner too high.
  • Test day is long! Be mentally prepared for it. From registration to the optional survey at the end, the day will be 8-10 hours long (depending on whether you are certifying for the first time or taking the maintenance of certification exam).
  • Keep some power snacks with you to take during break time.
  • Review the ABIM exam day schedule so you know exactly what to expect.

That’s a basic overview of how to study for and pass the ABIM board exam. As mentioned, there is no secret sauce or method to this – you simply need to have a broad base of knowledge. There is no substitute for studying early and studying often! If you are preparing for the ABIM Boards, we wish you well – we’re here to help so let us know if you have any questions! Happy studying!

Internal Medicine – Experts Serving Different Roles

Internal medicine experts serve many different roles within the medical field by examining and diagnosing problems affecting multiple areas of the body. It may sound simple, but this field is incredibly complex.

Internal Medicine may sound simple, but this field is incredibly complex, leading to medical professionals in this field being refereed to as “the doctor’s doctor”. A doctor who focuses on internal medicine, often refereed to as a internist, is unlike most other doctors. Rather than concerning themselves with one particular area of the body, internists are usually dedicated to the study and diagnoses of problems of the whole body. Their area of focus are diseases and disorders that afflict multiple parts of the body, often in seemingly unrelated systems of the body. Given the complex nature of the area of their study, these internists are often called on to serve many roles in the medical field.

The primary role of an internist is to aid and consult in the diagnoses and treatment plan for diseases or injuries affecting multiple areas of the body or whose cause and scope are unclear. Like a medical detective, they will take available evidence given to them through testing or consultation with the referring doctor and eliminate possible causes for the illness. After helping to diagnose the problem, internists will work with specialists and general physicians to create a treatment plan that will across multiple areas of the body, treating the patient as a whole rather than a collection of different systems.

Doctors of internal medicine are also especially adept at dealing with patients suffering from multiple illnesses or disorders at the same time. Given their knowledge and focus on the whole body, these doctors are able to fully understand how these unrelated problems may affect each other, and how any potential treatments may adversely or positively affect the other illnesses and problems. They can use this whole body knowledge to advise specialists in these particular areas, overseeing the whole patient’s well being.

Furthermore, these internal experts take a great deal of pride in their ability to work directly with patients in the care and treatment of their medical problems. Using their knowledge of the whole body, they can create a generalized plan for patients to deal with potential medical issues.

If you find yourself with medical problems beyond the scope of a specialist, consider scheduling an appointment with an internal medicine expert. Internists are uniquely qualified to address an array of medical issues that no other doctor can. He or she is prepared to treat you in ways that another doctor cannot.

Reliving the Remedy – History of Internal Medicine

Mastering Medicine
From infant to senior care, society is able to prosper with the current developments of internal medicine dating all the way back to the 19th century. In 1885, the Association of American Physicians (AAP), founded by dominating physicians along the east coast, collaborated with sister organization, American Society for Clinical Investigation (ASCI). The ASCI was founded in 1909 by Dr. Samuel Metzer with the purpose to explore and investigate clinical research for further development in academic medicine. Dr. William Osler, president of the AAP, borrowed the term internal medicine from its German origins.

“The time has come when able young men should be encouraged to devote themselves to internal medicine as a specialty. Content to labor and wait during the first 10 or 15 years of professional life, with pathology as the solid basis of development, such men will pass to the wards through the laboratories thoroughly equipped to study the many problems of internal medicine… ” – Dr. William Osler

This medicine in particular is the science of the laboratory and experimental method, to determine the primary origins of the symptoms and causes of an illness or disease. The AAP and ASCI conducted annual combined meetings to further progress in clinical research of this particular treatment. Due to the promotion of the partnership of the two, academic associations popularized throughout the country. In 1915 the American College of Physicians (ACP) developed in effort to promote the devotion of inspired peoples toward internal medicine research, training and treatment.

Collaboration to Celebration
A physician specializes in the application of clinical expertise and scientific knowledge to treat any illness from then, adult to senior care. The academic system developed an arrangement for those studying, to complete seven years of med school and post grad training for the successful result in diagnosis and treatment stages of internal medicine. Eventually advancing in the field, the ACP established the Annals of Clinical Medicine in 1927, being the most influential journal with devotional findings and studies towards the future of medicine that impacts patients from the inside, out.

“It is much more important to know what sort of a patient has a disease than what sort of a disease a patient has.”- Dr. William Osler

Hope for Heroes
The First World War claimed the lives of over 45,000 soldiers due to the spread of diseases like acute pulmonary disease, with little medical assistance. After the progression of internal medicine however, the development of treatments such as penicillin and sulfonamides helped save a majority soldiers with accumulating illnesses and disease during World War Two. In 1936 after the historically celebrated journal publication, the ACP partnered with the American Medical Association to form the ABI, the American Board of Internal Medicine. This combination produced a more definite title with the explicit criteria for a specialist of internal medicine.

Beyond this point in history evolved internal medicine through the collaboration of multiple American medical associations. The knowledge of physiology, pathology, biology, biochemistry and many other sciences contributed by leading physicians and researchers, inclined the outcome of advances in the medical field. The medicine of today is a tremendous result of science and medicine together. Medical leaders of science during the late 19th century paved the path for a nearly endless scope of possibilities for technological advances in the practice; and now, the flower can blossom.

Internal Medicine for Your Health

You likely already have a primary care physician. Sometimes things come up with our health though that necessitates a doctor that specializes in other areas as well. If you find that you are in need of a doctor from internal medicine then you should start by talking to your present doctor about a referral. You might just get automatically referred, but it is better if you can have some say in which doctor you get.

As you begin your search for a physician, take the time to do some research to see who is available. You may be able to find specialists online along with reviews of how people have liked them. You have to be careful believing every review. If you hear the same problem over and over it could be a warning sign depending of course on what the problem is.

The areas that should probably be most important to you are their knowledge, care, and experience. It is important to have a doctor who is knowledgeable in their specialty and even a little bit outside of their specialty. Sometimes specialists could have the tendency to be in a world of their own and not know how to integrate other issues and the specialists for them into the picture.

It is also important that you have an internal medicine doctor who truly cares about you as a patient. Some specialists do not specialize in people at all. It is important to have a doctor who knows how to connect with people and show sympathy and empathy as they deal with you.

Experience is another important area of consideration. You will want to make sure that the internal medicine doctor and any doctor for that matter are experienced in their field. You can find this out by looking up doctors on their clinic’s page. Many times they will have a picture of a doctor along with their education and past clinical experience.

Once you have had the chance to look into a few areas about prospective doctors, you should have enough information to choose one and get a referral from your primary care physician. Once you begin going to a specific doctor, make sure you are getting the treatment and service you expected. If you feel like your internal medicine specialist is not the right fit for your circumstances then look again at the ones you had researched before and find another one that had fit your standards.

You live in a free country, and although insurance can seem to dictate at times where you go to the doctor, you do have a choice to some degree. When you are not well, you need every opportunity you can get to become well again.