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| ORIGINAL ARTICLE |
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| Year : 2022 | Volume
: 5
| Issue : 1 | Page : 36-39 |
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Saudi Population Perception about Medical Internists, 2020
Fahad Ali Abdullah Dokhaikh1, Mohammad Ali Alzubaidi2, Abdullah Hameed Saleh Alghamdi1, Abdulaziz Ayedh Alghamdi3, Thamer Ahmed Alghamdi1
1 Department of Internal Medicine, King Fahad Hospital, Al-Baha, Saudi Arabia
2 Department of Internal Medicine, Security Forces Hospital, Makkah, Saudi Arabia
3 Department of Internal Medicine, Dr. Erfan and Bagedo General Hospital, Jeddah, Saudi Arabia
| Date of Submission | 18-Apr-2021 |
| Date of Decision | 21-May-2021 |
| Date of Acceptance | 01-Jun-2021 |
| Date of Web Publication | 07-Feb-2022 |
Correspondence Address:
Fahad Ali Abdullah Dokhaikh
Department of Internal Medicine, King Fahad Hospital, Al-Baha
Saudi Arabia
 Source of Support: None, Conflict of Interest: None
DOI: 10.4103/jnsm.jnsm_42_21
Background: As a specialty, internal medicine's historical and philosophical roots lie in the German medical tradition of the second half of the 19th century. However, what uniquely defines the specialty of internal medicine is certainly not fully captured in its name. Objective: To assess the knowledge of Saudi population regarding the scope of internal medicine speciality, 2020. Methods: This is a cross-sectional study that utilized an online questionnaire for data collection. All those who consent and can fill the Arabic online form were eligible to participate in the study. The only exclusion criteria were health-care workers and non-Arabic speakers. Data were analyzed using the Statistical Package for the Social Sciences software (SPSS, version 26.0). Results: A total of 1692 responses were analyzed, of which 60.7% were females and (76.8%) had university education. The majority (77.5%) see that the term is clear. Of the total sample, only (35.8%) answered correctly when asked about the role of internal medicine doctor. When asked if the term (internal medicine) is clear, educational level and region were significantly associated (P = 0.004, 0.03), respectively. Conclusion: The Arabic contrast of the term (internal medicine) may not describe the true meaning or the job of internal medicine doctors as approximately only one third (35.8%) knew the role of medical internists. A variety of factors other than the Arabic synonymous of the term (internal medicine) can influence the understanding of the public to what is internal medicine.
Keywords: Internal medicine, internists, perception, Saudi Arabia
How to cite this article:
Abdullah Dokhaikh FA, Alzubaidi MA, Saleh Alghamdi AH, Alghamdi AA, Alghamdi TA. Saudi Population Perception about Medical Internists, 2020. J Nat Sci Med 2022;5:36-9 |
How to cite this URL:
Abdullah Dokhaikh FA, Alzubaidi MA, Saleh Alghamdi AH, Alghamdi AA, Alghamdi TA. Saudi Population Perception about Medical Internists, 2020. J Nat Sci Med [serial online] 2022 [cited 2023 Mar 21];5:36-9. Available from: https://www.jnsmonline.org/text.asp?2022/5/1/36/337377 |
| Introduction | |  |
Internal medicine doctors treat various diseases of different organs in the human body. The great variation and the diversity of internal medicine speciality have made finding a name that meets the role of internal medicine hard. Originally, the name of internal medicine has been derived from the German roots.[1] The name was adopted and used in the USA and the speciality became well known as internal medicine worldwide.[1] One of the first physician that acknowledged the name and barrowed adopted it from the original German term and used it, was Dr. William Osler. He has emphasized the role medical internists and the need for training programs.[2]
The German term (internal medicine) was more specifically to denote a basis in the experimental science.[2] This means that the “internal” in internal medicine does not refer to the interior of the body, as usually thought, but rather refers to a physician who gets to the inside of a clinical problem by using knowledge that comes from experimental sciences.[2] In compare with the names of other medical fields such as emergency medicine and general surgery, the name of internal medicine does not reflect the real meaning of internal medicine or the role of internal medicine doctors. While it is thought that internal medicine treats only internal (hidden) symptoms and diseases, this is not applicable in all the cases as medical internists manage some apparent dermatological abnormalities that can be associated with major organ diseases.[1]
Although this proposed origin of “internal medicine” is appealing, the name is less clear than those of other specialties, and for some individuals, it is unsatisfactory. It often requires frequent explanations, which is awkward.[2]
Even today, it is defined more in negative terms (no pediatrics, no obstetrics, and no surgery) than in positive terms.[2] Many have tried to find a better name, without success. Diagnostician, physician, clinician, and consultant are other terms that have been suggested or used for physicians in this specialty, but they did not take hold.[1],[3] This makes it difficult for patients to know exactly what internal medicine is. Internal medicine is perhaps the only specialty whose name is not emblematic of the body part on which it concentrates (e.g., cardiology or orthopaedics), the location where it practices (e.g., emergency medicine or critical care medicine), its target population (e.g., pediatrics, geriatrics, or family medicine), or the techniques it uses (e.g., radiology, anesthesiology, or surgery). No wonder patients are confused.[3]
A previous study was done to measure the patient's opinion about the internist capabilities. The results showed that almost half of the patients (45%) confused internist with family physician and (39%) thought that internist treat children as well. The study also found that those with college education were significantly able to differentiate the internal medicine doctor from the interns. However, the authors concluded that patients showed confidence in the internist's abilities to treat symptoms, specific diseases, and to perform clinical examination.[4]
As internal medicine physicians in the K.S.A, through our daily duty we faced such confusion every day. Therefore, we conducted this research to assess the knowledge of Saudi population regarding the scope of Internal Medicine speciality, 2020.
| Methods | | |
Study design
This is a cross-sectional analytic study that utilized a questionnaire designed by the authors based on the literature search and the common misconceptions seen among patients. The questionnaire was distributed online using (Google forms). The questionnaire was designed in the Arabic language.
Study area and population
The study was conducted in the Kingdom of Saudi Arabia (K.S.A.) which has around (33.7) millions of population. The population includes both Saudis and non-Saudis. All those who have access to the online form of any nationality were eligible to participate in the study. The exclusion criteria included non-Arabic speakers and health-care workers.
Sampling
The sample size was calculated using online calculators (Raosoft and epitools), both gave the same required sample size (385). However, the authors increased the sample size up to five folds to have a better measurement of all the regions of Saudi Arabia. The sampling technique was convenient sampling by distributing the link to the online form through social media.
Data analysis
The data were analyzed using the Statistical Package for the IBM Corp. Released 2020. IBM SPSS Statistics for Mac, Version 27.0. Armonk, NY: IBM Corp. Frequency and proportion were used to summarize the data. The Chi-square test was performed to test the associations between the variables. The predetermined alpha is 0.05.
Ethical approval
The ethical approval was obtained from the scientific and research committee at King Fahad hospital, Al-Baha, Saudi Arabia (IRB reference number KFHRC/23122020/4, on JAN 24, 2020). Moreover, the online form contained an introductory message that explained the purpose of the study to gain individual consent. All the data were used for research purposes only, gained, and analyzed anonymously. Our study included human participation in answering the questionnaire. Thus, the investigators have adhered to ethical guidelines of the declaration of Helsinki.
| Results | | |
A total of (1692) responses were analyzed. The collected responses were of both genders, from all regions of Saudi Arabia and of different age groups. The sociodemographic characteristics of our sample are shown in [Table 1]. | Table 1: The sociodemographic characteristics of the study population (n=1692)
Click here to view |
The participants were asked directly about the clearness of the name (internal medicine), the majority (77.5%) see that the term is clear. Those who are interested to know the specialty of their treating doctor represented the majority of the sample (88%). Those who have visited an internal medicine doctor were (71.6%). Participants also were asked if they have an idea about internal medicine, about half (48.3%) were not sure, one third (33.7%) answered yes, (9.1%) answered no and (7.9%) indicated that they did not think about it before.
Further questions about internal medicine were asked. Three answers were proposed when asking about their perception regarding internal medicine; “he is the doctor treating the internal adults' organs which are not apparent” (54.7%), “he is the doctor treating adult organ diseases” (35.8%) and (9.5%) answered “I do not know.” Finally, we asked the participants if it is difficult to understand the role of internal medicine doctors. Almost half (51.5%) indicated that the name is clear and does not need explanation, (38%) found it difficult and that the name has no clear meaning, and the rest (10.5%) have no interest in understanding the role of internal medicine doctors.
Further analysis was done to find association between different answers by the participants. Two thirds (66%) of those who were not interested in knowing the specialty of their treating doctor thought that the term (internal medicine) was clear, compared to (79%) of the other group who thought that the term was clear (P = 0.000). Of those who indicated that they have an idea about internal medicine, (43.2%) answered correctly about the role of internal medicine doctors (P = 0.000). Tests were done for association significance between sociodemographic variables and the question “do you think the term (internal medicine) is clear?” Results are shown in [Table 2]. | Table 2: The factors associated with the question “do you think the term internal medicine is clear” with the related P values (n=1692)
Click here to view |
| Discussion | | |
The term (internal medicine) came from a German term (Inneren Medizin).[5] This term when translated or adopted by other languages have made a sort of confusion where internal medicine doctors can be mistaken as interns.[6] Surgeons and dermatologists for example are known by the name to be practicing their medical field as the names suggest. In the case of internal medicine, the name is not just unclear, the translation of internal medicine to Arabic is (Tabeeb Batena) which resembles the word “abdomen” in Arabic.[7] This may have led patients to think that internal medicine doctors are specialized in diseases of abdomen or gastrointestinal tract diseases. This is evident as the majority (77.5%) see that internal medicine term is clear in Arabic. Meanwhile, only (35.8%) of the sample knew the role of internal medicine doctors. As internal medicine has many sub-specialties such as cardiology, rheumatology, nephrology, etc.,[8] and as the specialists handle a variety of diseases related to different organs of the body. This can make the confusion even greater among patients and the role of internal medicine doctors would remain unknown for the public.
About two thirds (60.8%) of our sample were females, the majority were of (20–29) years of age, and three quarters (76.8%) indicated university as educational level. This indicates that the knowledge about such a very common and general specialty like internal medicine should be good. The population were expected to know at least the role of internal medicine doctors. The role of internal medicine is not merely clinical in nature, medical internists have academic responsibilities and can contribute greatly in research.[9] In addition to the caring of chronic and polypharmacy patients, internal medicine is considered the cornerstone for any health care system. Moreover, of all the individuals who indicated that they have an idea about internal medicine, more than half (55.1%) answered wrong when asked about their perception of internal medicine. This indicates that the public may assume that their understanding is enough when it is actually wrong.
Our sample showed a significant lack of knowledge among the general population in regards with internal medicine scope of practice as of (1692) participants only (35.8%) reported correct definition of internal medicine profession. This huge lack could be attributed to a variety of reasons. For instance, internal medicine practitioners in the K.S.A tend to enrol in subspecialties more often and those who remain practicing internal medicine as a general specialty do not represent the majority. Indeed, this is a worldwide trend, as Dr. Humberto Reyes stated in his article “the proportion of young physicians who remain in practice as general internists appears to be considerably lower than those who choose a subspecialty.”[10] This trend is, indeed, a need since the demand on subspecialties is noticeably increasing from both employers and patients who look for “much specialized physicians” and this leads to another important factor that is financial income. The availability of fellowship programs in Saudi Arabia is another reason why general internists choose to practice a subspecialty following an internal medicine residency program. Moreover, a subspecialized internist would usually introduce themselves as a hepatologist, pulmonologist, endocrinologist, or infectious disease specialist which shadows the scope of internal medicine more. In fact, from the authors' observation, even residents rotating in a subspecialty would present themselves as nephrology or gastroenterology residents. This is mostly seen as the majority of the residents have plans to subspecialize after general internal medicine.[11]
The previously mentioned factors are related to the internal medicine physicians yet the general population contributes to the internal medicine scope lack of understanding issue. Patients when complaining of any symptoms or signs would seek help from a physician who is specialized in a discipline related to the patient's complains, for example, if a patient is complaining of a psychiatry-related issue he or she would look for a psychiatrist and if the complaint was a pulmonary complaint they would look for a pulmonologist instead of a an internal medicine practitioner. In addition, patients with established chronic illnesses such as diabetes would know their treating physicians as diabetologists. This is, in fact, a very common phenomenon in Saudi Arabia as patients usually jump to the most specialized person instead of following the right pathway and going to family physicians in primary care centers. On the other hand, patients' interest to know the specialty of their treating physician was significantly associated knowing the term internal medicine. Furthermore, educational level was also significantly associated the participants' perception about the clarity of the term internal medicine. While educational level can be a motive to understand different medical specialities, interest to know the specialty would mostly origin from a good background of specialties and their roles.
The limitation of this study is the lack of similar articles and studies concerning the term (internal medicine) or its Arabic synonymous. This limitation has affected the authors' ability to compare the results and give a clear finding regarding the issue of how public perceive internal medicine. Thus, the authors of this article recommend further detailed researches in the topic. Qualitative studies can give a better understanding to guide future investigations.
| Conclusion | | |
The Arabic contrast of the term (internal medicine) may not describe the true meaning or the job of internal medicine doctors as only one third (35.8%) knew the role of medical internists. The way people may recognize internal medicine can be influenced by another factor, which is the way the internal medicine doctors are presented by the subspecialty not by general internal medicine. A probable solution might be a replacement term of internal medicine such as adult medicine or medicine of adult diseases which is self-explanatory and implies an explicit meaning. Additionally, public awareness should be promoted regarding a speciality that almost every individual in the community may visit. In an attempt to aid in this issue, this study questionnaire included an educational material at the end about the scope of internal medicine speciality. Further research should be conducted to identify the depth of public perception of internal medicine.
Financial support and sponsorship
Nil.
Conflicts of interest
There are no conflicts of interest.
| References | | |
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| 3. | Goldman L. The name game: Tradition and change. Am J Med 2001;110:153-5. |
| 4. | Salerno SM, Landry FJ, Kaboli PJ. Patient perceptions of the capabilities of internists: A multi-center survey. Am J Med 2001;110:111-7. |
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| 6. | Goldman L. Adult (not internal) medicine. Ann Intern Med 1997;127:835. |
| 7. | Rana E, Amer E, Gadallah M. “Example-Based English to Arabic Machine Translation: Matching Stage Using Internal Medicine Publications.” Proceedings of the 7 th International Conference on Software and Information Engineering. 2018. https://dl.acm.org/doi/abs/10.1145/3220267.3220294 . |
| 8. | Al-Onazi M, Almahfouz N, Aldaher A, Alghamdi O, Crisera V, Ware J, et al. Medical Speciality Selection Guide. Riyadh. Saudi Commission for Health Specialities; 2015. |
| 9. | Tanriover MD, Rigby S, van Hulsteijn LH, Ferreira F, Oliveira N, Schumm-Draeger PM, et al. What is the role of general internists in the tertiary or academic setting? Eur J Intern Med 2015;26:9-11. |
| 10. | Reyes, Humberto. “What is internal medicine”. Medical journal of Chile. 134.10 (2006):1338-44. |
| 11. | West CP, Dupras DM. General medicine vs subspecialty career plans among internal medicine residents. JAMA 2012;308:2241-7. |
[Table 1], [Table 2]
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