the interplay of each organ system, and the mental exercise of deeply thinking about your

各個器官系統之間的相互作用，以及深思熟慮自己的心理鍛鍊。

patients for hours on end while rounding. Let's debunk the public perception myths,

患者在圍觀時，連續幾個小時。讓我們來揭穿公眾的認知誤區。

and give it to you straight. This is the reality of internal medicine.

並直接給你。這就是內科的現實。

Dr. Jubbal, MedSchoolInsiders.com.

朱波醫生，醫派內參網。

Welcome to our next installment in So You Want to Be. In this series, we highlight a

歡迎來到我們的下一期《所以你想成為》。在這個系列中，我們將重點介紹

specific specialty within medicine, such as internal medicine, and help you decide if

醫學內的特定專業，如內科，並幫助您決定是否

it's a good fit for you. You can find the other specialties on our So You Want to Be

是很適合你的。你可以在我們的 "你想成為 "網站上找到其他的專業。

playlist. If you want to vote in upcoming polls to decide what future specialties we

播放列表。如果你想在即將到來的民意調查中投票，以決定我們未來的專業。

cover, make sure you're subscribed.

蓋，確保你已經訂閱了。

If you'd like to see what being an IM doc looks like, check out my second channel, Kevin

如果你想看看作為一個IM醫生是什麼樣子的，看看我的第二個頻道，凱文。

Jubbal, M.D., where we have multiple day in the life episodes with internal medicine doctors.

朱波，醫學博士，在這裡，我們與內科醫生有多日的生活情節。

When you think of a doctor, it's very likely that the picture you conjure up in your mind

當你想到醫生的時候，你腦海中浮現的畫面很可能是

is that of an internal medicine physician, or internist. Internal medicine is the specialty

是內科醫生，或內科醫生。內科是專業

that deals with the diagnosis, treatment, and prevention of a broad and extensive number

診斷、治療和預防廣泛而又廣泛的疾病。

of diseases that affect adult patients. Think real life Dr. House.

的疾病，影響成年患者。想想現實生活中的豪斯醫生。

But internal medicine is more difficult than other specialties to categorize and nail down

但內科比其他專科更難歸類、更難釘死。

because it's so broad and expansive in what you can do with it. There are also more fellowship

因為它的範圍很廣，你可以用它來做什麼。也有更多的交情

options after internal medicine than just about any other specialty, which we'll get

內科後的選擇比任何其他專業，我們將得到

to shortly.

到不久。

Those that choose internal medicine are stereotypically the inquisitive and thoughtful ones who love

選擇內科的人，都是刻板印象中好奇心強、有思想的人，他們喜歡的是

learning, want to be heavily involved with direct patient care, and enjoy the challenge

學習，希望大量參與直接護理病人，並享受挑戰的樂趣

of analyzing broad information to figure out the puzzle to help their patients get back

分析廣泛的資訊，找出幫助病人恢復健康的難題。

to a healthy baseline. Internal medicine doctors are the generalists of generalists, treating

到一個健康的基線。內科醫生是全科醫生中的全科醫生，治療的是

a vast variety of medical conditions, whether common or rare, complex or straightforward,

各種各樣的病症，無論是常見的還是罕見的，複雜的還是簡單的。

acute or chronic.

急性或慢性；

The stereotype of internal medicine physicians is that they sit around, hours on end, thinking

內科醫生的刻板印象是，他們坐在那裡，幾個小時的時間，思考。

about how to micromanage each of their patient's conditions, without ever using their hands.

關於如何微觀管理每個病人的病情，而不需要用手。

This is partially true. Internal medicine is much more of an intellectual specialty

這是部分事實。內科是更多的知識專業

compared to some other specialties, but they do minor procedures occasionally, such as

與其他一些專科相比，他們偶爾會做一些小手術，如

thoracentesis, paracentesis, central line placement, intubation, and others, though

胸腔穿刺術、腹腔穿刺術、中心線置入術、插管術等，儘管如此。

it's rare to do so following residency training. In the outpatient setting, it's more common

在住院醫師培訓後很少這樣做。在門診環境中，比較常見的是

to do steroid joint injections, PAP smears, ultrasound, skin tag or wart removals, and

做類固醇關節注射、PAP塗片、超音波、皮膚標籤或疣的去除，以及。

the like.

諸如此類。

There are a few ways to categorize the specialty.

專業的分類有幾種方法。

Outpatient internal medicine doctors work exclusively in the clinic, or outpatient setting,

內科門診醫生專門在診所或門診工作。

where patients schedule an appointment, have a brief 15 minute visit, and head back home.

在那裡，患者預約，進行15分鐘的簡短訪問，然後回家。

In this setting, you'll be dealing with health screenings, vaccinations, addressing chronic

在這個環境中，你將會處理健康檢查、疫苗接種、解決慢性

and milder conditions, and serving as their healthcare quarterback, referring them to

和較輕的病症，並作為他們的保健四分衛，將他們轉診到。

specialists as necessary.

必要的專家。

With inpatient, on the other hand, you'll be treating patients who are admitted, meaning

另一方面，對於住院病人，你要治療的是入院的病人，也就是說......。

they are staying in the hospital for several days. These are usually sicker patients than 

他們要在醫院住上幾天。這些病人通常比

what you'll see in the outpatient setting, often including acute conditions or exacerbations

您將在門診環境中看到的內容，通常包括急性病症或病情惡化

of chronic conditions. For example, when I was newly diagnosed and in the middle of a

的慢性病。例如，當我剛被診斷出患有慢性病時，正處於

severe inflammatory bowel disease flare, I was hospitalized, spending several days recovering

炎症性腸病嚴重發作，我住進了醫院，花了好幾天的時間恢復。

until I was feeling well enough to be discharged. My primary care hospitalist doctor in that

直到我感覺好了，可以出院了。我的主治醫院醫生在那

setting was the one who coordinated and facilitated my care throughout my stay, consulting the

在我住院的整個過程中，我的護理工作是由他來協調和促進的，他向我的醫生諮詢。

GI docs as necessary for colonoscopy and other recommendations.

腸鏡檢查所需的GI醫生及其他建議。

Physicians who practice in an academic setting are involved not only in patient care, but

在學術環境中行醫的醫生不僅要參與病人的護理，還要

also teaching the next generation of physicians, meaning medical students and residents. There

同時也教授下一代醫生，即醫學生和住院醫師。有

are also usually requirements with regards to research, and most faculty are involved

通常也是對研究的要求，大多數教師都參與了

in some number of projects at any given time. Academic institutions are also usually better

在任何時候都有一定數量的項目。學術機構通常也比較好

equipped to handle more complex patients, so these doctors are more likely to work with

有能力處理更復雜的病人，所以這些醫生更有可能與之合作。

sicker patients.

患病的病人。

In a community practice, you can work within a smaller or larger organization. At these

在社區實踐中，你可以在一個較小或較大的組織中工作。在這些

institutions, your job first and foremost is to be an internal medicine physician, and

機構，你的工作首先是做一個內科醫生，而。

research or teaching are not principal responsibilities.

研究或教學不是主要職責。

The third and least common option is to pursue private practice, where you'll be your own

第三種也是最不常見的選擇是追求私人執業，在那裡你將是你自己的。

boss, working primarily in an outpatient clinic setting. Private practice is becoming more

老闆，主要在門診工作。私人診所越來越

of a rarity for many reasons, including that health care organizations and hospitals are

罕見，原因有很多，包括醫療機構和醫院都是。

buying out private practices

收購私人診所

After medical school, internal medicine residency is 3 years. It's categorical, meaning you

醫學院畢業後，內科住院醫師是3年。它是斷然的，意味著你

match into one program and complete all three years there, including your intern year. Other

匹配到一個項目，並在那裡完成所有的三年，包括你的實習年。其他項目

specialties can have a transitional or preliminary year prior to the dedicated specialty training,

專科專業在進行專項專業訓練之前，可以有一個過渡年或初步年。

and you can watch our other So You Want to Be specialties for more information about

您可以觀看我們的其他《你想成為》專題節目，瞭解更多有關的資訊。

that.

那。

In IM residency, the clinical focus is adult-focused primary care internal medicine and inpatient

在IM住院醫師中，臨床重點是以成人為中心的初級保健內科和住院病人。

hospital medicine, meaning taking care of patients admitted to the hospital. You'll

醫院醫學，意思是照顧住院的病人。你會

be rotating through the wards, ICU, and various subspecialty electives where you will help

輪流在病房、重症監護室和各種亞專業選修課中，您將幫助

admit, manage, and discharge patients. Outpatient clinical rotations are also foundational,

入院、管理、出院病人。門診臨床輪轉也是基礎性工作。

and provide more manageable hours compared to your inpatient rotations. Here you'll

並提供比你的住院輪轉更容易管理的時間。在這裡，您將

be seeing less acute patients while establishing continuity of care, meaning a more longitudinal

在建立護理連續性的同時，減少對急症患者的診治，這意味著更多的縱向護理。

relationship with your patients.

與患者的關係。

Some residents choose to do an optional fourth year, called a chief year, which helps to

有些居民選擇在第四年進行選修，稱為 "首席年"，這有助於

hone their clinical acumen, leadership skills, and bolsters their CV, particularly if they're

鍛鍊他們的臨床敏銳度和上司能力，並加強他們的履歷，特別是如果他們是...。

looking for an academic position. Others may do it to reapply for a fellowship position

尋找一個學術職位。還有一些人可能是為了重新申請一個研究金職位

the following cycle.

下一週期：

In terms of competitiveness, internal medicine is middle of the pack, ranking 13 out of 22

從競爭力來看，內科的競爭力居中，在22個專業中排名13位

specialties. The average Step 1 and Step 2CK scores are 235 and 248, respectively, and

專科。第1步和第2CK步的平均分分別為235分和248分。

the match rate is around 97%, which is on the higher end.

匹配率約為97%，屬於較高的水準。

Internal medicine is considered the default, largest specialty, and medical students who

內科被認為是默認的、最大的專業，而醫學生誰

apply here stereotypically are the ones who couldn't decide on a specialty. The flexibility

在這裡刻板地申請是那些無法決定專業的人。靈活性

of internal medicine is attractive, as you have a variety of options in practice setting,

內科的吸引力，因為你有各種選擇的實踐環境。

in addition to the widest variety of specialties to choose from through fellowship. After a

除了通過獎學金可以選擇最廣泛的專業外。經過

couple years of residency, you are in a position to make another decision - do you want to

幾年的居住期，您可以做出另一個決定--您是否要在這裡居住。

go out and practice after general IM, or subspecialize into cardiology, gastroenterology, immunology,

普通IM後出去實習，或者分科到心內科、消化科、免疫科。

or something else?

還是別的什麼？

Medical students that choose internal medicine are also generally inquisitive, and love the

選擇內科的醫學生一般也都是求知慾很強的人，而且喜歡在

intellectual aspects of medicine. They're the ones who enjoy complex puzzles, taking

醫學的智力方面。他們是那些喜歡複雜的謎題的人，採取的是

in vast quantities of information through history, physical exam, and various labs and

通過病史、體檢和各種化驗，掌握大量資訊。

imaging, and putting together a diagnosis and management plan for each individual patient.

影像學，併為每個病人制定診斷和管理計劃。

After completing 3 years of internal medicine residency, you can choose to specialize with

在完成3年的內科住院醫師培訓後，您可以選擇以下專業

fellowship.

獎學金。

Cardiovascular Disease, also called cardiology, is a 3 year fellowship focusing on diseases

心血管疾病，又稱心臟病學，學制3年，主要研究疾病

relating to the heart. Cardiology is a highly competitive fellowship, offering the first

與心臟有關。心臟病學是一個競爭激烈的研究項目，提供了第一個

or second highest compensation of any internal medicine specialty, duking it out with gastroenterology.

或在內科專業中報酬第二高，與消化內科對決。

Cardiology is an extremely well studied field with a robust scientific backing for its treatments,

心內科是一個研究極為深入的領域，其治療有強大的科學支撐。

meaning often good outcomes and instant gratification. After cardiology fellowship, you can specialize

意味著往往好的結果和即時的滿足。在完成心臟病學研究之後，你可以專攻

further with advanced heart failure, interventional cardiology, electrophysiology, and others. 

進一步與晚期心衰、介入心臟病學、電生理學等。

You can learn more about cardiology and these subspecializations in our So You Want to Be

您可以在我們的 "您想成為 "欄目中瞭解更多關於心臟病學和這些亞專業的資訊。

a Cardiologist video.

a心臟病專家視頻。

Similar to cardiology, gastroenterology is also a highly competitive fellowship, lasting

與心內科類似，胃腸科也是一個競爭激烈的科室，歷時

3 years, with similarly high compensation. GI doctors do many procedures, with not just

3年，報酬同樣很高。GI醫生做的手術很多，不僅有

endoscopies and colonoscopies, but ERCP and liver biopsies as well.

內窺鏡和結腸鏡檢查，但ERCP和肝臟活檢也是如此。

To be happy as a gastroenterologist, you have to be ok dealing with feces, as colonoscopies

作為一名消化科醫生，要想快樂的工作，就必須要和糞便打交道，因為結腸鏡檢查

are bread and butter. However, you can also subspecialize further, such as with transplant

是麵包和黃油。但是，你也可以進一步細分，比如移植。

hepatology, which is an additional 1 year of training after GI fellowship.

肝病學，這是在消化道院士之後多了1年的培訓。

Pulmonary and critical care is a 3 year fellowship for those who want to take care of the very

肺部和危重症護理是一個為期3年的研究項目，為那些想照顧非常重要的病人的人提供服務。

sick patients in the ICU. ICU patients, compared to floor patients, are generally more complex,

重症監護室的病患者。ICU病人與樓層病人相比，一般比較複雜。

as they're often receiving multiple interventions, such as respiratory assistance through ventilators

因為他們經常接受多種干預措施，如通過呼吸機進行呼吸輔助。

or pressors to maintain their blood pressure in states of shock. ICU doctors spend a great

或加壓器來維持他們在休克狀態下的血壓。重症監護室的醫生花了大量的時間

deal of time having deep and often very emotional discussions with families of the critically

與危重病人的家屬進行深入且經常是非常情緒化的討論，花費了大量時間。

ill, as this is an incredibly trying time for everyone involved.

病，因為這對每個人來說都是非常艱難的時刻。

Pulmonologists on the other hand are lung doctors. They see patients both in the hospital

另一方面，肺科醫生是肺部醫生。他們在醫院為病人看病

setting on the floors, and in the clinic, and are the specialists for lung pathology

樓層的設置，並在臨床上，是肺部病理的專家。

including cancers, COPD, asthma, pulmonary hypertension and many other conditions. Pulmonologists

包括癌症、慢性阻塞性肺病、哮喘、肺動脈高壓和許多其他疾病。肺科醫生

also frequently perform bronchoscopies, where a tube is inserted into the trachea to biopsy

也經常進行支氣管鏡檢查，將管子插入氣管進行活檢。

a mass or to clear a mucus plug.

腫塊或清除粘液栓。

Infectious disease, or ID doctors, deal with patients who have a variety of bacterial,

感染性疾病，也就是ID醫生，處理的是患有各種細菌的病人。

viral, fungal, and parasitic infections. If you liked microbiology and pharmacology in

病毒性、真菌性和寄生蟲性感染。如果你喜歡微生物學和藥理學在

medical school, this is the specialty for you. You'll be using labs, imaging, physical

醫學院，這是你的專業。你會用到實驗室、影像學、物理學等。

exam, and history to figure out what bug is causing the patient's symptoms. Did they go

檢查和病史，以弄清是什麼蟲子引起了病人的症狀。他們有沒有去

on a cruise recently? Travel out of the country? Any contact with animals? These all play an

最近坐郵輪？出國旅遊？有沒有接觸過動物？這些都起到了

important role in narrowing the differential diagnosis. ID is a 2 year fellowship. As a

縮小鑑別診斷範圍的重要作用。ID是一個為期2年的研究項目。作為一個

word of caution, you will be dealing with plenty of notable smells and unforgettable

慎重起見，你將面對大量顯著的氣味和令人難忘的。

infections!

感染！

Heme/Onc is focused on blood disorders and cancers. Hematology specifically deals with

血液/腫瘤科專注於血液疾病和癌症。血液學專門處理

diseases related to the blood and its components as they affect the lymphoid and myeloid cells.

與血液及其成分有關的疾病，因為它們影響淋巴細胞和骨髓細胞；

They often deal with bleeding disorders, such as platelet disorders, leukemia, which is

他們經常處理出血性疾病，如血小板疾病、白血病，這是

cancer of the white blood cells, and various anemias involving dysfunctional red blood

白細胞癌，以及各種涉及紅血球功能障礙的貧血症。

cells.

細胞。

Oncology is focused on the diagnosis and treatment of cancer. Oncologists work closely with pathologists,

腫瘤學的重點是癌症的診斷和治療。腫瘤科醫生與病理科醫生緊密合作。

radiologists, surgeons, and other fields to coordinate care for cancer patients. This

放射科醫生、外科醫生和其他領域的醫生來協調癌症患者的護理。這

field can be emotionally draining, and patients often have poor outcomes.

場會讓人情緒低落，患者往往效果不佳。

You could do hematology for 2 years or oncology for 2 years as separate specialties, but many

你可以做2年的血液學或2年的腫瘤學作為單獨的專業，但許多人

opt for a combined heme/onc fellowship over 3 years.

選擇為期3年的血色素/腫瘤聯合研究金；

Nephrology, a 2 year fellowship, is the specialty focused on the kidney, dealing with everything

腎內科，2年的交情，是專注於腎臟的專業，處理的是一切

from acute kidney failure to end stage renal disease. You'll often be managing patients

從急性腎衰竭到終末期腎病。您將經常管理病人

on dialysis, which is a mechanical process whereby machines mimic the function of the

透析，這是一個機械的過程，機器可以模擬人體的功能。

kidney to filter the blood. This is a delicate process requiring careful attention to electrolytes,

腎臟來過濾血液。這是一個微妙的過程，需要仔細注意電解質。

acid/base levels, and mathematics.

酸鹼度和數學。

We've only just scratched the surface of fellowships you can pursue after internal medicine residency.

我們只是剛剛觸及了你在內科住院醫師之後可以追求的獎學金的表面。

There's also endocrinology, rheumatology, sports medicine, sleep medicine, hospice and

還有內分泌科、風溼科、運動醫學科、睡眠醫學科、安寧療養科等。

palliative medicine, geriatric medicine, allergy and immunology, addiction, and adolescent

姑息醫學、老年醫學、過敏和免疫學、成癮和青春期醫學

medicine to name a few.

醫學等等。

There's a lot to love about internal medicine. Most prominently, it's a specialty that offers

內科有很多值得熱愛的地方。最突出的是，它是一個專業，它提供了

tremendous flexibility. If you want to work as a hospitalist, taking care of admitted

巨大的靈活性。如果你想當一名醫院醫生，照顧住院的病人

patients, you can do that straight after IM residency. If you want to do primary care

病人，你可以在IM住院醫師後直接做。如果你想做初級保健

in an outpatient clinic, that's common too. If you'd like to specialize and further your

在門診，這也是常見的。如果你想專攻並進一步發展你的。

interest with something more focused like cardiology or gastroenterology, there's a

興趣與一些更集中的東西，如心臟病學或胃腸病學，有一個。

clear path for that as well.

清楚的路徑，以及。

Internists generally have favorable work-life balance. As a hospitalist, the most common

內科醫生一般都有良好的工作與生活平衡。作為一名醫院醫生，最常見的

model is 7 on 7 off, but it's not uncommon to have 2 weeks on and 2 off, meaning you

模式是7上7下，但有2週上2周下的情況並不少見，這意味著你

work for 14 days straight, followed by 2 weeks off. During those weeks on, it can sometimes

連續工作14天，然後休息2周。在這幾周裡，有時會

be hectic, but those weeks off are glorious. If you're admitting on call, you can work

是忙碌的，但這些星期的休息是光榮的。如果你是隨叫隨到的錄取者，你可以在這裡工作

12 hours or more in a day, depending on many variables. You won't necessarily be admitting

一天12個小時或者更多，這取決於很多變量。你不一定會承認

every day, and often times you'll be able to leave for the day after completing daily

每天都有，很多時候你完成每天的工作後，就可以離開一天。

tasks and rounding on your patients.

任務和對病人的巡視。

Because just about every patient who walks into the hospital needs an internist, there

因為幾乎每一個走進醫院的病人都需要內科醫生，都有

is never a shortage of patients! While some other services rely on consults to see patients,

是從來不缺病人的!而其他一些服務機構則是靠諮詢來看病。

as an internist you'll always have patients to see.

作為一個內科醫生，你總是有病人要看。

In many outpatient gigs these days, you can choose to work 4 or 5 days per week. This

在現在的很多門診工作中，你可以選擇每週工作4天或5天。這個

is appealing for those who enjoy working regular business hours with holiday vacations.

對於那些喜歡正常工作時間和節假日休假的人來說，是很有吸引力的。

IM doctors also maintain their level of medicine knowledge. Medical students in their later

IM醫生也要保持自己的醫學知識水準。醫學生在以後的

years know what I'm talking about. You spend thousands of hours and incredible effort learning

年知道我在說什麼。你花了數千小時和難以置信的努力學習

about the various organ systems and their pathologies. Internal medicine is one of the

關於各個器官系統及其病理的知識。內科是一個

few specialties where you continue to develop that broad knowledge. Many other specialties

少數專業，你繼續發展這種廣泛的知識。許多其他專業

narrow down and dive deep at the expense of most other things you learned in medical school.

縮小和深入，而犧牲了你在醫學院學到的大多數其他東西。

There's an inherent satisfaction in knowing you're able to manage most anything that walks

有一種內在的滿足感，因為你知道你有能力管理大多數的東西，走在路上。

through the door to some extent. You genuinely feel like you are a true doctor, and know

在一定程度上通過門。你真心覺得自己是一個真正的醫生，而且知道

a little something about everything!

什麼都有一點

While internal medicine is an awesome specialty, it's not for everyone.

雖然內科是個很厲害的專業，但並不是每個人都適合。

Given the medicolegal ramifications, bureaucratic processes, and social issues in medicine,

鑑於醫學上的醫療法律後果、官僚程序和社會問題。

you'll often find yourself babysitting patients in a hospital bed that don't necessarily require

你會發現自己經常在病床上照看病人，而這些病人並不一定需要。

your care.

你的照顧。

Compared to surgical specialties, there's much more charting and computer work. You'll

與外科專業相比，圖表和計算機工作要多得多。你會

often be consulting other services, such as cardiology or gastroenterology, who will give

往往會諮詢其他服務，如心臟病學或胃腸病學，他們將提供

you recommendations on caring for your patient, but ultimately it's up to you to assess these

護理病人的建議，但最終還是由您來評估這些建議。

recommendations, place the orders, write notes, and monitor the patient despite these other

建議、下單、寫筆記、監測病人，儘管有這些其他的建議。

consulting services.

諮詢服務；

Compensation is in the bottom quartile of specialties, with internal medicine doctors

薪酬在各專科中處於倒數第一，內科醫生

making on average $251,000 per year. But remember that by subspecializing with something like

平均每年賺25.1萬美元。但要記住，通過分專業與諸如

cardiology or gastroenterology, you can greatly increase your earning potential.

心內科或胃腸科，你可以大大增加你的收入潛力。

IM doctors also find themselves inundated with social tasks including many logistics

IM醫生也發現自己的社會任務非常繁重，包括很多後勤工作

of patient care and stay. For example, if a patient cannot safely go home and requires

的病人護理和住院。例如，如果病人不能安全回家，需要進行

discharge from the hospital to a skilled nursing facility or acute rehabilitation center, you'll