[Internal medicine in Italy and Europe: current realities and prospects]

The crisis of internal medicine may be viewed as a crisis of the image of the internist himself. If, however, we look to the future, this image has the potential to be viewed in a significantly improved light, provided the internist modifies his role and position within the health service structure and maintains his characteristic broad-minded approach to medical problems. He may play his essential role in patient management by utilizing his capacity to "fit together" diagnostic options, advice from specialists, and therapeutic choices--in short by acting as "case manager" and offering expert support to both individual patients and to the overall organizational setup of the clinical structure. Another important task of the internist is to train students and oversee continuing education of the medical community. The position of clinical and patient manager is particularly relevant to future health care scenarios that will be characterized by economic constraints, the need for new organizational models, populations on the move, and the necessity to involve patients directly in health-related decision making and to respect their opinions. To meet this challenge, the future internist must enhance his global approach to medical problems with specific training in management in order to offer multi-sector expert support to the health care structure.