Internal medicine in academic centres: what future?

sThe rapid increase in medical knowledge and the introduction of new diagno stic and therapeutic techniques has also led to increasing specialisation i n the field of internal medicine. For this reason controversy has arisen, p articularly in university centres, about the importance and role of "genera l" internal medicine compared to the medical specialties. In this paper the most important tasks of internal medicine in patient care, in graduate and postgraduate training and in clinical research are analysed. The prime tas k of internal medicine is comprehensive care for the increasing number of e lderly patients with multiple co-existing diseases. In this respect general ists cannot be adequately replaced by specialists. Mutual critical co-opera tion between internists and specialists also reduces the risk of overuse of medical technology and leads to a corresponding reduction in hospital cost s. In medical schools internists have a major task in teaching bedside clin ical examination and a general approach in the diagnosis and treatment of t he most relevant medical disorders, while specialised knowledge becomes mor e important during the postgraduate training period. Hospital-based interna l medicine remains an essential basis for clinical training not only for ge neral internists and family physicians but also for all medical sub-special ties. In continuous medical education internists have the task of synthesis ing and transmitting new knowledge from the various special fields, includi ng their application in a non-selected broad patient population. Also in cl inical research several tasks remain for internists, such as clinical epide miology, cost-benefit analysis and critical evidence-based assessment of di agnostic and therapeutic methods. Discontinuance or drastic reduction of in ternal medicine in university centres would not be justified and could lead to a negative balance between general internists and specialists, with neg ative consequences for health care, as experienced in the USA. Instead of f ragmentation and rivalry for positions and resources, better co-ordination and co-operation between internists and specialists is needed in university centres, if possible in integrated medical departments.