Internal medicine in Spain

Patients who are seen by internists seldom have a single, well-defined nosological entity. More often they are elderly patients with marginal pluripathology who have associated chronic or terminal illness with their attendant social problems. Nowadays, the majority of patients with the most prevalent diseases fit this profile. Sometimes, in large hospitals, the Department of Internal Medicine has little opportunity to manage specific or defined entities without the 'competition' of other subspecialist colleagues. Until a consensus is reached on the types and severity of conditions that can be cared for by internal medicine and on the criteria that must be fulfilled to justify subspecialist care, this inefficient distribution of patients is bound to continue. Internal medicine does not need to be replaced by some newly designed body of specialists; rather, internists should be able to develop expert skills in some defined areas of internal medicine. The principal challenge facing Spanish internal medicine at the present time is retaining the confidence of both their medical colleagues and the public at large that the specialty's traditional, wide-based, multidisciplinary approach to care is still the best and most efficient way to look after the majority of patients in the hospital.