Internal medicine, also known as general medicine, specializes in dealing with prevention, diagnosis, and treatment of adult diseases.
The Dr. Laurie Mortara, MD, talks about the more common conditions that an Internal Medicine (Internist) physician treat and manage and how he/she takes care of the entire patient.
Internal Medicine: Caring for the “Whole Patient”
Featured Speaker:
Organization: MemorialCare Medical Group
Dr. Mortara's Bio
Dr. Laurie Mortara, MD
Dr. Laurie Mortara was in private practice in Long Beach, CA for over 18 years prior to joining MemorialCare Medical Group earlier this year. She has been honored as a Top Doctor in her field in 1999 and 2010.Organization: MemorialCare Medical Group
Dr. Mortara's Bio
Transcription:
Internal Medicine: Caring for the “Whole Patient”
Deborah Howell (Host): Hello, and welcome to the show. You're listening to Weekly Dose of Wellness brought to you by MemorialCare Healthsystem. I'm Deborah Howell and today's guest is Dr. Laurie Mortara, a board certified internist who is interested in caring for the whole patient. Dr. Mortara was in private practice in Long Beach, California for over 18 years prior to joining MemorialCare Medical Group earlier this year. She has been honored as a top doctor in her field in both 1999 and in 2010. Welcome, Dr. Mortara.
Dr. Laurie Mortara: Thank you very much.
Deborah: As always, we like to start with a definition of what we are talking about in each show. So if you could
please tell us in laymen's terms just what is an internal medicine physician or an internist?
Dr. Mortara: An internist is a physician whose chosen specialization is the study of adult patients and no longer practices OB/GYN, pediatrics, or surgery.
Deborah: I thought I knew a lot about medicine but I just learned more in ten seconds from you. I didn't know that. Just adults only, right? And when does an adult begin, 21?
Dr. Mortara: An adult begins technically at 18 but I would probably say that family practitioners see more of the teenage and early 20 patients and an internist tends to see more of the over 55 set.
Deborah: This is great information. It must be very basic to you but I've been this old and I just didn't know that until now. Really good information. How does an internist differ really from a general practitioner or a family medicine practitioner?
Dr. Mortara: A general practitioner was the old family doctor, and we think of Marcus Welby and people like that. However, in the 1970s, family medicine became recognized as a specialty and at that time in the United States, the general practitioners who had had medical school and one year of internship were given a choice to be what's called grandfathered into family practice. In other words, not have to take any additional training. After 1970, however, to call yourself a family practitioner, you would have to have had completed an additional two years of training and to get board certification. An internist varies in that the training is different from a family practitioner. In addition to not doing any additional training in pediatrics, surgery, or OB/GYN, the internist spends more of their training in additional studies such as cardiology, pulmonary medicine, kidney disease, the specialties, as well as more time in the hospital.
Deborah: I see. Well, you definitely shed some light for me. My father is a specialized general practitioner, albeit retired. And I always wondered. To me, that sounded like an oxymoron, a specialized general practitioner. But you cleared it up for me.
Dr. Mortara: He probably developed an interest in one specific part of being a general practitioner and held out taking care of the whole person as an outpatient doctor to be very near and dear to him.
Deborah: Okay. I think you answered my next question as well: What are some of the subspecialties of internal medicine? You mentioned a few.
Dr. Mortara: The subspecialties tend to be divided into those that are organ specific. You think of a pulmonologist and the lung and think of a cardiologist and the heart. And then other specialties focus on disease process such as oncology, taking care of cancer, and my personal favorite, infectious disease.
Deborah: How many years have you specialized in infectious disease?
Dr. Mortara: I've specialized in infectious disease for approximately almost 20 years now. But during that entire time, my first love has always been internal medicine. I maintained a primary care practice.
Deborah: The other love of your life is caring for the whole patient.
Dr. Mortara: Right.
Deborah: Maybe you can speak to that a little bit.
Dr. Mortara: The internist cares for the whole patient really by developing several skills. The way I look at it is the internist really needs to be part detective, part confidant, and has to be able to be a resource and interpret the Google searches that we all do whenever we have a symptom. But they also have to be a partner for their patients. Many of my patients I've cared for now for over a decade. And I think the relationship that the patient has with their primary doctor is closer than almost any other relationship they have other than their family members. If you have a chronic illness or a complex set of illnesses, the internist is able to sort through those and help you understand what's happening to you.
Deborah: Sort of the anti-Dr. House who is not a partner.
Dr. Mortara: Well, Dr. House, many people would think, is an internist in that he really focuses on being the detective. However, his social skills leave a lot to be desired.
Deborah: Not exactly the partner you want to have.
Dr. Mortara: No.
Deborah: Okay. What are some of the more common conditions that internal medicine physicians treat in managing their patients?
Dr. Mortara: That depends if the internist is choosing to be more of a generalist, being out in the outer setting, or whether they've chosen to specialize into one of the specialties we've talked about before. But I think what is really typical of the practice of the internist is that you're going to be seeing multiple patients each day that have a variety of chronic illnesses and diagnoses as well as some with very rare conditions. And variety really is the spice of life. You have to be able to hop between the different diagnoses and multitask. I think that's one of the strengths of the internist.
Deborah: What do you do when you're stumped by a patient's condition?
Dr. Mortara: What you do when you're stumped is you research. Internal medicine started out with Dr. William Osler way back in the late 1800s. In his view, internal medicine doctors did not specialize into internal medicine until they'd had 10 to 15 years of working in laboratories in the outpatient setting. Then they would go into the hospital wards as sort of a college to study the diseases. But what internists really would be known for was the continued academia, the continued going in and researching and doing experiments to see what was going on with the patient. I think a lot of that still remains in the specialty.
Deborah: So after you do research of this type and there still isn't an answer, how do you treat a patient where we are at a point in medicine where we don't have a cure or a treatment?
Dr. Mortara: Well, the patient is having to live through that and the patient is looking for help. So you're there to give them whatever comfort you can, help them to deal with the issues and the choices they have, but you're also there to be their advocate. And to be a really good internist is to keep looking and staying up to date, keep looking for what's coming down the pike and what can help. Often, you can't cure but you have to be there. You have to be in the patient's corner to help them.
Deborah: Absolutely. Why are internists sometimes referred to as the doctor's doctor?
Dr. Mortara: Traditionally, because internists went into specialties so frequently and spent time in the hospitals, the internist has become the doctor that other doctors ask to help them diagnose particularly unusual or difficult patient problems. The surgeon or the generalist to the hospitals will call in the internist or call in the internal medicine subspecialist and say, "Look, I'm stumped. I've done all I can. Can you shed some new light on it?"
Deborah: Would you say that the great majority of patients who come to you, you are able to find some form of treatment for them?
Dr. Mortara: I would like to think that I'm able to help them understand and I'd like to think that I can make their condition better. I will really go to the mat trying. But I think all doctors have to be humble and understand that there's a lot that we don't know.
Deborah: Sure. What are some of the exciting breakthroughs you've seen in the last few years?
Dr. Mortara: Tremendous breakthroughs as far as treating heart disease and putting automatic defibrillators out into the community so that many of the people who would die suddenly are now saved. The advances in AIDS in that we've taken people from dying very early to now having very long life expectancies and being able to continue to work. The ability for patients to take control of their own health and to have a lot of the healthcare come to them so that they don't have to go into the hospital or into specialized treatment areas; they might be able to, for instance, check their blood sugar at home or have their heart monitored over the telephone. Some of these developments are tremendous. But coming down the pike are even more exciting things such as the field called pharmacogenomics where hopefully, very soon, we'll be able to run a blood panel on a patient and tell them which medications they might respond better to or which ones they're more likely to be allergic to. Progress like that is tremendous.
Deborah: I've even seen patients being treated with an iPhone placed up against their chest where the doctor has his...
Dr. Mortara: Exactly. That's taking the telemedicine, which was over your landline, to the next level which is using the apps.
Deborah: Truly an exciting time. We haven't even gotten into cell therapy and there's just so many things, as you say, coming down the pike.
Dr. Mortara: You are just never bored as a doctor, ever.
Deborah: So don't be afraid to go to your internist when your doctor says, "We need to get more eyes on what's going on with you," because your internist can be your partner.
Dr. Mortara: The more people thinking about you and trying to come up with different options, the better.
Deborah: Thank you so much, Dr. Mortara, for finding the time to talk to us today about caring for the whole patient and letting us know more about the role of an internist in a patient's life.
Dr. Mortara: Thank you so much, Deborah.
Deborah: It's been a real pleasure to have you on the show. I am Deborah Howell. Join us again next time. We'll be exploring another Weekly Dose of Wellness. It's all brought to you by MemorialCare Healthsystem. Have yourself a wonderful day.
Internal Medicine: Caring for the “Whole Patient”
Deborah Howell (Host): Hello, and welcome to the show. You're listening to Weekly Dose of Wellness brought to you by MemorialCare Healthsystem. I'm Deborah Howell and today's guest is Dr. Laurie Mortara, a board certified internist who is interested in caring for the whole patient. Dr. Mortara was in private practice in Long Beach, California for over 18 years prior to joining MemorialCare Medical Group earlier this year. She has been honored as a top doctor in her field in both 1999 and in 2010. Welcome, Dr. Mortara.
Dr. Laurie Mortara: Thank you very much.
Deborah: As always, we like to start with a definition of what we are talking about in each show. So if you could
please tell us in laymen's terms just what is an internal medicine physician or an internist?
Dr. Mortara: An internist is a physician whose chosen specialization is the study of adult patients and no longer practices OB/GYN, pediatrics, or surgery.
Deborah: I thought I knew a lot about medicine but I just learned more in ten seconds from you. I didn't know that. Just adults only, right? And when does an adult begin, 21?
Dr. Mortara: An adult begins technically at 18 but I would probably say that family practitioners see more of the teenage and early 20 patients and an internist tends to see more of the over 55 set.
Deborah: This is great information. It must be very basic to you but I've been this old and I just didn't know that until now. Really good information. How does an internist differ really from a general practitioner or a family medicine practitioner?
Dr. Mortara: A general practitioner was the old family doctor, and we think of Marcus Welby and people like that. However, in the 1970s, family medicine became recognized as a specialty and at that time in the United States, the general practitioners who had had medical school and one year of internship were given a choice to be what's called grandfathered into family practice. In other words, not have to take any additional training. After 1970, however, to call yourself a family practitioner, you would have to have had completed an additional two years of training and to get board certification. An internist varies in that the training is different from a family practitioner. In addition to not doing any additional training in pediatrics, surgery, or OB/GYN, the internist spends more of their training in additional studies such as cardiology, pulmonary medicine, kidney disease, the specialties, as well as more time in the hospital.
Deborah: I see. Well, you definitely shed some light for me. My father is a specialized general practitioner, albeit retired. And I always wondered. To me, that sounded like an oxymoron, a specialized general practitioner. But you cleared it up for me.
Dr. Mortara: He probably developed an interest in one specific part of being a general practitioner and held out taking care of the whole person as an outpatient doctor to be very near and dear to him.
Deborah: Okay. I think you answered my next question as well: What are some of the subspecialties of internal medicine? You mentioned a few.
Dr. Mortara: The subspecialties tend to be divided into those that are organ specific. You think of a pulmonologist and the lung and think of a cardiologist and the heart. And then other specialties focus on disease process such as oncology, taking care of cancer, and my personal favorite, infectious disease.
Deborah: How many years have you specialized in infectious disease?
Dr. Mortara: I've specialized in infectious disease for approximately almost 20 years now. But during that entire time, my first love has always been internal medicine. I maintained a primary care practice.
Deborah: The other love of your life is caring for the whole patient.
Dr. Mortara: Right.
Deborah: Maybe you can speak to that a little bit.
Dr. Mortara: The internist cares for the whole patient really by developing several skills. The way I look at it is the internist really needs to be part detective, part confidant, and has to be able to be a resource and interpret the Google searches that we all do whenever we have a symptom. But they also have to be a partner for their patients. Many of my patients I've cared for now for over a decade. And I think the relationship that the patient has with their primary doctor is closer than almost any other relationship they have other than their family members. If you have a chronic illness or a complex set of illnesses, the internist is able to sort through those and help you understand what's happening to you.
Deborah: Sort of the anti-Dr. House who is not a partner.
Dr. Mortara: Well, Dr. House, many people would think, is an internist in that he really focuses on being the detective. However, his social skills leave a lot to be desired.
Deborah: Not exactly the partner you want to have.
Dr. Mortara: No.
Deborah: Okay. What are some of the more common conditions that internal medicine physicians treat in managing their patients?
Dr. Mortara: That depends if the internist is choosing to be more of a generalist, being out in the outer setting, or whether they've chosen to specialize into one of the specialties we've talked about before. But I think what is really typical of the practice of the internist is that you're going to be seeing multiple patients each day that have a variety of chronic illnesses and diagnoses as well as some with very rare conditions. And variety really is the spice of life. You have to be able to hop between the different diagnoses and multitask. I think that's one of the strengths of the internist.
Deborah: What do you do when you're stumped by a patient's condition?
Dr. Mortara: What you do when you're stumped is you research. Internal medicine started out with Dr. William Osler way back in the late 1800s. In his view, internal medicine doctors did not specialize into internal medicine until they'd had 10 to 15 years of working in laboratories in the outpatient setting. Then they would go into the hospital wards as sort of a college to study the diseases. But what internists really would be known for was the continued academia, the continued going in and researching and doing experiments to see what was going on with the patient. I think a lot of that still remains in the specialty.
Deborah: So after you do research of this type and there still isn't an answer, how do you treat a patient where we are at a point in medicine where we don't have a cure or a treatment?
Dr. Mortara: Well, the patient is having to live through that and the patient is looking for help. So you're there to give them whatever comfort you can, help them to deal with the issues and the choices they have, but you're also there to be their advocate. And to be a really good internist is to keep looking and staying up to date, keep looking for what's coming down the pike and what can help. Often, you can't cure but you have to be there. You have to be in the patient's corner to help them.
Deborah: Absolutely. Why are internists sometimes referred to as the doctor's doctor?
Dr. Mortara: Traditionally, because internists went into specialties so frequently and spent time in the hospitals, the internist has become the doctor that other doctors ask to help them diagnose particularly unusual or difficult patient problems. The surgeon or the generalist to the hospitals will call in the internist or call in the internal medicine subspecialist and say, "Look, I'm stumped. I've done all I can. Can you shed some new light on it?"
Deborah: Would you say that the great majority of patients who come to you, you are able to find some form of treatment for them?
Dr. Mortara: I would like to think that I'm able to help them understand and I'd like to think that I can make their condition better. I will really go to the mat trying. But I think all doctors have to be humble and understand that there's a lot that we don't know.
Deborah: Sure. What are some of the exciting breakthroughs you've seen in the last few years?
Dr. Mortara: Tremendous breakthroughs as far as treating heart disease and putting automatic defibrillators out into the community so that many of the people who would die suddenly are now saved. The advances in AIDS in that we've taken people from dying very early to now having very long life expectancies and being able to continue to work. The ability for patients to take control of their own health and to have a lot of the healthcare come to them so that they don't have to go into the hospital or into specialized treatment areas; they might be able to, for instance, check their blood sugar at home or have their heart monitored over the telephone. Some of these developments are tremendous. But coming down the pike are even more exciting things such as the field called pharmacogenomics where hopefully, very soon, we'll be able to run a blood panel on a patient and tell them which medications they might respond better to or which ones they're more likely to be allergic to. Progress like that is tremendous.
Deborah: I've even seen patients being treated with an iPhone placed up against their chest where the doctor has his...
Dr. Mortara: Exactly. That's taking the telemedicine, which was over your landline, to the next level which is using the apps.
Deborah: Truly an exciting time. We haven't even gotten into cell therapy and there's just so many things, as you say, coming down the pike.
Dr. Mortara: You are just never bored as a doctor, ever.
Deborah: So don't be afraid to go to your internist when your doctor says, "We need to get more eyes on what's going on with you," because your internist can be your partner.
Dr. Mortara: The more people thinking about you and trying to come up with different options, the better.
Deborah: Thank you so much, Dr. Mortara, for finding the time to talk to us today about caring for the whole patient and letting us know more about the role of an internist in a patient's life.
Dr. Mortara: Thank you so much, Deborah.
Deborah: It's been a real pleasure to have you on the show. I am Deborah Howell. Join us again next time. We'll be exploring another Weekly Dose of Wellness. It's all brought to you by MemorialCare Healthsystem. Have yourself a wonderful day.