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May 16, 1990

Internal Medicine

JAMA. 1990;263(19):2649-2651. doi:10.1001/jama.1990.03440190105055

Several important trends suggest that the 1990s will prove to be a critical decade for internal medicine. Recent data that involve the practice of general internal medicine indicate that general internists are experiencing some changes in practice patterns. More care is being provided in the ambulatory setting as internists are making fewer hospital visits and seeing more patients in the office.1 Those patients who are admitted to the hospital tend to be very ill, older, or decompensating because of a previously diagnosed disease or are undergoing a specific procedure. Office patients, on the other hand, tend to need diagnostic efforts, chronic disease follow-up, and management of psychosocial dysfunction. In addition, increasing emphasis on preventive care and health maintenance requires internists to spend more time talking with and educating their patients. These changing practice patterns have pragmatic implications such as how internists may set up and staff their offices. They