Internal Medicine Facing the Challenges of the Future of Care for Chronic Patients A Medicina Interna Perante os Desafios do Futuro dos Cuidados aos Doentes Crónicos

Abstract

Internal Medicine is in a phase of growth determined mainly by the modification of hospital demography, hyperspecialization and the threat to the sustainability of the system induced by the costs of innovation. In Portugal we have a privileged situation in the European context, because we have been able to preserve the generalist nature of Internal Medicine, unlike the countries of Central and Northern Europe, which have opted for double titration and where most internists have a medical subspecialty. However, the way we are currently organized to care for our patients is no longer adequate: in hospitals we need large departments for acute medical patients managed by the internists, the co-management of patients in the surgical services should be implemented as well as units of Ambulatory Medicine, which bring together day hospitals, rapid diagnostic units, home hospitalization programs and integrated care units, in order to reduce emergency admissions and create alternatives to hospitalization. The need for internists has grown faster than their training so we need more internists and a greater appreciation of our work, because Portuguese internists have quality, are flexible, efficient and multipotential, and these qualities are increasingly necessary for the future of care to chronic patients.