ENG235 fall2020 u7 internal ped VOC

UNIT – VOCABULARY & READING (2 hours) ENGLISH IN MEDICINE – GENERAL PRACTITIONER Y2 INTERNAL MEDICINE & PEDIATRICS Presenter: Nguyen Hoang Quynh Mai Editor: Nguyen Hoang Quynh Mai Email: 1004quynhmai@gmail.com OVERVIEW DEFINITION Doctors in general internal medicine are trained to manage patients presenting with a wide range of acute and long term medical conditions and symptoms Pediatrics is the area of medicine that manages medical conditions affecting infants, children and young people 1 OVERVIEW WHAT DO YOU KNOW ABOUT: INTERNAL MEDICINE? PEDIATRICS? OVERVIEW MAKE A COMPARISON INTERNAL MEDICINE SAME DIFFERENT - PEDIATRICS - OVERVIEW NATURE OF THE WORK Doctors working in general internal medicine (GIM) have particular expertise in diagnostic reasoning, managing uncertainty, dealing with co-morbidities and recognizing when specialty opinion or care is required It’s a holistic specialty - treatment takes into account symptoms of the disease and other factors (mental & social), making it specific for the individual The aim is to minimize the adverse effects of disease, while allowing children to live as normal a life as possible A referring E diagnosing B managing F admitted C treating G providing D co-morbidities H emergency The work involves: - (1) _ and treating the wide spectrum of medical disorders that present acutely to hospital (2) _ departments and acute medical units, (3) _ for specialist opinion and care as appropriate - (4) _ advice and care for patients (5) _ to hospital under other specialties (e.g surgery, obstetrics & gynecology) who have or develop medical problems - Diagnosing and (6) _ the wide spectrum of medical conditions that are referred to medical outpatient clinics - (7) _ inpatients and outpatients with (8) _, including elderly patients with frailty and dementia 1 OVERVIEW WORKING LIFE - INTERNISTS GIM is mainly a hospital inpatient specialty, with some outpatient work in rapid access clinics and for patient follow-up A large part of the working day involves reviewing newly admitted patients, continuing treatment of the most unwell patients, or providing care for patients who have developed an acute illness whilst admitted for another reason such as a surgical operation Outpatients may be referred with chest pain or other urgent symptoms The EU Working Time Directive limits the working week to 48 hours Some out-of-hours work is required when there are sick patients requiring attention, but this is compensated for by appropriate time off Over 70% of consultants say they are routinely on-call at weekends 1 OVERVIEW WORKING LIFE - PEDIATRICIANS Pediatricians see a wide range of patients, from babies through to teenagers Adapting quickly to different situations is often a daily requirement For example, the care of a small baby is completely different to the care of a teenager, and pediatricians must rapidly meet the needs of diverse patients throughout their working day Pediatrics is a progressive specialty, embracing flexible training and working Many pediatricians work less than full time, and enjoy flexible hours in a variety of settings including hospitals, clinics and in the community Day-to-day responsibilities may include 24-hour services for acute inpatient care and Accident and Emergency (A&E); outpatient consultations & clinical management for long-term conditions; clinical advice to social services, education and other agencies OVERVIEW Video: https://www.acponline.org/about-acp/aboutinternal-medicine HOW DO YOU DEFINE INTERNAL MEDICINE? scientific-based, evidence-based, comprehensive approach to the care of adults; most of the great leaders; breadth and depth of academic & clinical work; complexity of the cases; unique & challenging; not only treating but also preventing disease; so much to learn & read; never stop learning; truly understand the human body; close to the patients, their needs, problems & families PERSONAL SHARING When I began my training, I was able to spend six months working in public health because I have an interest in prevention That was in addition to my rotations in different aspects of pediatrics I think it is important to see the big picture, not just the illness I like being able to build up a relationship with children and their families In hospital, you tend to work with children who have acute problems, maybe in emergency situations, but in the community it is more common to deal with children with long-term conditions, such as cerebral palsy or behavioral problems You see and treat the whole child, not just the ‘sick’ child Another satisfying aspect is that I work in a truly multidisciplinary team to provide the care that is needed So, as well as other clinicians, there will be social workers, dietitians, health visitors and a range of other professionals sharing skills 2 SUB-SPECIALTIES INTERNAL MEDICINE          Cardiovascular Disease Endocrinology, Diabetes, and Metabolism Gastroenterology Hematology Infectious Disease Nephrology Neurology Pulmonary Disease Rheumatology SUB-SPECIALTIES PEDIATRICS          Allergy, immunology & infectious disease Diabetes & endocrinology Neonatology Nephrology Neurodisability Neurology Gastroenterology, hepatology and nutrition Respiratory medicine Rheumatology WHAT SYSTEM DO THEY BELONG TO? Nephrolithiasis CHD Peptic ulcer Hydronephrosis Ileostomy Hemodialysis Endarterectomy Enteritis Aneurysm Appendicitis Hemorrhoid Hydrocephalus Multiple sclerosis CVA Diabetes mellitus MI COPD asthma TB Bronchitis Hypertension UTIs Urethral stricture DVT Acromegaly Graves disease Gigantism Pneumonia CPR Lumbar puncture Gastritis Angioplasty KEY CONCEPTS First-line treatment Empiric treatment Evidence-based medicine Clinical trial Placebo effect Diagnostic criteria Specificity Sensitivity Treatment algorithm Risk factor Absorption & Distribution Bioavailability Clearance & half life Metabolism Pharmacokinetics Toxicokinetics KEY CONCEPTS sensitivity KEY CONCEPTS specificity KEY CONCEPTS Treatment algorithm KEY CONCEPTS Placebo effect KEY CONCEPTS Clearance & half-life (T1/2) WRITING PRACTICE What is Evidence-based medicine? (3 sentences) What is empiric treatment? (3 sentences) Imagine you are an internist or a pediatrician, describe your specialty and your working life (2 paragraphs) QUESTIONS & ANSWERS ... YOU KNOW ABOUT: INTERNAL MEDICINE? PEDIATRICS? OVERVIEW MAKE A COMPARISON INTERNAL MEDICINE SAME DIFFERENT - PEDIATRICS - OVERVIEW NATURE OF THE WORK Doctors working in general internal medicine... teenager, and pediatricians must rapidly meet the needs of diverse patients throughout their working day Pediatrics is a progressive specialty, embracing flexible training and working Many pediatricians... 70% of consultants say they are routinely on-call at weekends 1 OVERVIEW WORKING LIFE - PEDIATRICIANS Pediatricians see a wide range of patients, from babies through to teenagers Adapting quickly