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June 7, 1995

General Internal Medicine

Author Affiliations

Harvard Medical School and Harvard Community Health Plan, Boston, Mass

JAMA. 1995;273(21):1681-1682. doi:10.1001/jama.1995.03520450051025

General internists ended 1994 in an unaccustomed position—at the center of attention, along with their colleagues in generalism, family physicians and pediatricians. The marketplace has begun to create incentives for generalists and disincentives for some subspecialists.1 With changes in the practice environment have come higher expectations for general internists. What new developments will help them meet these expectations?

Several articles made clear how patients with problems often seen by general internists should be treated. Consensus has developed that Helicobacter pylori infection plays a major role in peptic ulcer disease, especially duodenal ulcers, and that clinicians should treat first presentations and recurrences with antimicrobial agents, a radical departure from past treatment recommendations.2 Patients with insulin-dependent diabetes mellitus and microalbuminuria were shown to have a reduced rate of progression to clinical proteinuria if they were treated with captopril.3 Human immunodeficiency virus infection remains a major national problem, but no major

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