Unlike most specialists, who are clearly identified by technique (for example, surgery), body part (for example, ophthalmology), or target population (for example, pediatrics) [1], internists are commonly confused with interns and are frequently asked by patients and friends, "Exactly what does internal medicine mean?" Although everyone understands the meaning of the word family and ascribes value to it, the word internal suggests something mysterious, unseen, and quite possibly unpleasant.

In recognition of this problem, the American College of Physicians has developed a brochure entitled "Internal medicine. Doctors for adults. Where we fit in today's primary care picture" [2] and a campaign to educate the public on the role and function of the internist. An analogous but far less ambitious campaign was undertaken more than a decade ago, when the upsurge in primary care internal medicine was just beginning and the distinction between the diagnostic consultant [3] and the primary care internist needed to be clarified. At that time, Kurtz and Goodman [4] argued that internists, including both generalists and subspecialists, should be called adult medicine specialists.

Many years later, it still seems that an unhelpful or poorly descriptive name should be changed, not clarified with subtitles. My suggestion is that we change the name from internal medicine to adult medicine.

Why adult? The answer is simple: Internists care for adults and only adults. Family physicians will always have an advantage for persons who are looking for one doctor to take care of all members of a family, but physicians who specialize in adult medicine should be distinguished for their expertise and be able to benefit from it.

Why medicine? Medicine has historically been differentiated from surgery, and it capitalizes on such concepts as "medical doctor." The strong cache and tradition associated with that term would quickly be adopted by various pretenders if it were abandoned.

Any time an individual or an organization changes its name, the first question is, "Why?" Does the change imply different missions or values? Will the new name be preferable in explanatory power, marketability, or prestige?

For practitioners of internal medicine, professional pride is linked to the German roots of our name. We have historically emphasized the scientific basis of diagnosis and therapy, and both our training and practice emphasize an understanding of disease mechanisms rather than a symptom-driven approach. This detailed knowledge of the physiology, chemistry, cell biology, and genetics of the human organism is a fundamental part of our heritage, and our belief that an improved understanding of normal and abnormal biology is the cornerstone for better patient care.

Unfortunately, in the modern English vernacular, the word internal does not symbolize this emphasis. In our current lexicon, the term scientific more closely captures the distinction sought in 19th-century Germany. It seems unlikely, however, that we would want to rename our field scientific medicine or expect to be called scientists. Although we must be sure that our training, continuing education, and practice emphasize the scientific basis that engendered the term internal and that still distinguishes our culture, adult medicine must also indicate expertise in screening, preventive care, common ambulatory problems, and the behavioral and ethical aspects of health and disease. Adoption of the term adult medicine does not mean an abandonment of diagnostic or therapeutic skills that are based firmly in fundamental biomedical and psychosocial sciences, yet it can symbolize that our discipline now expresses these skills in a spectrum that includes prevention and comprehensive care as well as acute disease.

Adult medicine could easily apply to both generalists and specialists. For general adult medical doctors, the new label would probably be helpful in explaining how their expertise can be distinguished from that of a family physician. When patients in a managed care environment choose a primary care physician, a listing under adult medicine is likely to be far more understandable than a listing under internal medicine.

Adult medical subspecialists would probably notice little (if any) difference, and their disciplinary labels, which generally refer to body parts, would remain unchanged. A cardiologist, with or without the prefix "adult," would be an adult heart specialist, whereas a counterpart who cares for children would continue to be a "pediatric cardiologist."

Of course, any name change has some potential downsides. For example, internists specializing in adolescent medicine may feel abandoned by the new name, although it is consistent with the reality that this specialty sits at the interface between pediatrics and adult medicine. A name change might also be seen as the first step down a slippery slope toward a merger of general internal medicine with family medicine, with joint programs and a single certification process, whereas medical specialists would diverge from general internal medicine with separate certifying boards, academic departments, and so forth. The change in name from internal medicine to adult medicine should not have a major effect on this generalist-specialist debate. If anything, a clearer definition of adult general medicine may enhance unity among adult generalists and specialists.

For physicians from disciplines other than internal medicine, the change in name is unlikely to have profound implications. A possible exception is that family physicians may contend that the new name represents advertisement or aggrandizement. However, just as pediatrics and family medicine are labels that recognize the segment of the population served, the same is clearly true of the label adult medicine.

From the patients' perspective, there seem to be few disadvantages. Of course, the occasional patient who understands what an internist is would have to be reeducated about the new name. Informal surveys, however, suggest that most patients do not understand the current name, and those cognoscenti who do are probably the easiest to reeducate.

An implicit effect of naming a specialty is that its practitioners assume an analogous name. Doctors who do surgery are surgeons, doctors who do family medicine are family physicians, and doctors who do internal medicine are internists. The term internist is often confused with intern and is thus ambiguous at best. A potential concern is that adult medicine physicians would be called adultists; however, an analogous issue has been successfully addressed in family medicine, whose practitioners are routinely called family physicians, not familialists. Practitioners of adult medicine could promulgate such terms as doctors for adults [2], adult doctor, adult physician, or adult medical doctor.

A name change, although certainly not sufficient to address the many vexing issues facing internal medicine, would capitalize on the current initiatives of the American College of Physicians and related groups. The change in name and its implied extension of professional scope to include prevention and comprehensive care as well as science-based diagnostics and acute therapy will not signify an abandonment of traditional strengths but rather a recognition that broader strengths are likely to be more important for the foreseeable future. If adult medicine doctors do those things well, their value and role in the health care system of the future will be apparent to everyone.