[Internal medicine today--and tomorrow?]

Internal medicine has recently undergone major changes, which have created--among others--4 feelings of alienation among physicians: first, the internist--initially an observer of clinical signs, and later laboratory-assisted--has now become operator-assisted with modern technology in imaging and other technologies assisting him by giving him not the essence, but the interpretation of the gathered information; second, the dialogue between basic biomedical research and the bedside clinician has been interrupted by the creation of a new language in molecular genetics, to which he has no access any more; third, modern biotechnology is rapidly creating an unlimited number of new biological therapeutic modalities, giving the internist too many therapeutic options which he can no longer master. Fourth, the formerly direct, bipolar relationship between patient and physician has been extended to a triangular relationship between patient, physician and an institution (hospital administration, public health authority, health insurance). In order to solve these problems, internal medicine has several options. First, maintaining the dialogue in research across subspecialties by creating a group of full time clinical investigators, with training in basic molecular and cellular biology, who can be the interface between modern molecular genetics and clinical internal medicine; and second, developing new clinical investigators to evaluate our diagnostic and therapeutic strategies with a logical and scientific methodology: patient care analysis, health care research, medical outcome evaluation and quality assessment are all disciplines which will link the various fields of internal medicine into a tight network. To do this, the Swiss Society of Internal Medicine has to modify its structures, to become a scientific and a professional organization, cognizant of the evolution of medicine within the European scene.