Walk into any major teaching hospital in India and look at the signboards. You are likely to find Cardiology, Neurology, Nephrology, Gastroenterology, Endocrinology departments—and, somewhere among them, a General Medicine. Now travel outside India and ask for the corresponding specialty. In most countries and in much of international medical literature, you will be directed to Internal Medicine. Are these two different specialties? No.
The Indian ‘general medicine’ physician and the international ‘internal medicine’ physician belong, essentially, to the same broad specialty: the discipline concerned principally with the diagnosis and non-surgical management of disease in adults. The question, therefore, is not whether Indian general medicine is different from internal medicine; it is whether India should continue using a name that has become increasingly ambiguous when a more precise and internationally intelligible name is available.
When the term ‘general medicine’ became entrenched, medicine was far less specialised than it is today. Today, internal medicine is the parent discipline from which numerous subspecialties have emerged: cardiology, gastroenterology, nephrology, endocrinology, rheumatology, pulmonology, infectious diseases, haematology, medical oncology and others. The first problem is the word ‘general’. To the ordinary patient, a ‘general physician’ can sound like a doctor who treats common ailments—a doctor one sees before being referred to a specialist. But that is not what an MD or DNB physician in General Medicine represents. An internist (one who practices general medicine or internal medicine) has undergone intensive specialist training in the diagnosis and management of complex adult diseases. The internist is expected to integrate information from multiple organ systems, recognise patterns that may not fit neatly into one specialty and manage patients with several simultaneous illnesses. Consider an elderly patient with breathlessness, anaemia, kidney dysfunction, diabetes, weight loss and abnormal liver tests. Which specialist should he be treated by? His condition falls within the specialities of haematology, nephrology, endocrinology and gastroenterology/hepatology — all of which are sub-specialties of internal medicine in most other parts of the world. But in India they continue to be called super specialties. The terminology subsequently became part of Indian medical law and was reinforced by Indian institutions. By the 1990s, the nomenclature had become even more firmly standardised. Thus, what may have begun as part of a British medical tradition became entrenched in India’s own regulatory system. The word ‘general’ is increasingly misleading in the age of sub-specialisation. The existence of these subspecialties does not make the internist a non-specialist: quite the opposite. The internist’s expertise lies in understanding the patient when disease does not respect these boundaries. That is a specialty in its own right. Indian medicine is no longer operating in an isolated linguistic environment. Indian doctors train abroad; foreign doctors train in India. Indian postgraduate qualifications are evaluated internationally. Medical journals, conferences, guidelines and clinical research operate across national boundaries. A doctor introducing himself or herself internationally as a specialist in internal medicine is immediately understood. The title general medicine may require explanation. That may appear trivial. It is not. Specialty names communicate the scope of a physician’s expertise to patients, colleagues, hospitals, universities, regulators and international institutions. A clear professional vocabulary matters. Every profession periodically has to ask whether the language it inherited still accurately describes what it does. Indian medicine has changed enormously since the terminology of its postgraduate specialties was first codified. We now practise medicine in an era of molecular diagnostics, precision medicine, artificial intelligence, genomics, transplantation, complex multisystem disease and unprecedented sub-specialisation. Perhaps it is time to be more specific.
The Indian Medical Council Act of 1956 formally recognised Doctor of Medicine (General Medicine) as a postgraduate medical qualification. The Medical Council of India’s 1993 regulations explicitly stated that the nomenclature for postgraduate degree courses should be uniformly adopted and prescribed M.D in General Medicine.
Yet one of our principal adult medical specialties still carries a name that essentially says: general.
