Even author-recluse Don DeLillo knows the value of a good internist. In White Noise, he observed that:

In New York ... people ask if you have a good internist. ... "Who's your internist?" someone will say in a challenging tone. The question implies that if your internist's name is unfamiliar, you are certain to die of a mushroom-shaped tumor on your pancreas. You are meant to feel inferior and doomed not just because your inner organs may be trickling blood but because you don’t know who to see about it, how to make contacts, how to make your way in the world.

Post-modern angst aside, we'd have to agree with DeLillo about the value of a good internist. Primary care is the foundation of our health care system, and strengthening that foundation can lead to better outcomes at lower costs.

But what exactly does an internist or primary care physician do that makes them so important? The Happy Hospitalists has a good explanation today about of what it takes to be a "doctor's doctor." He writes:

Every possible illness can be categorized by organ system, type of disease process, a systemic or localized process and acute or chronic nature. But we aren't done yet. This is just the disease. Full of randomized controlled trials with objective data points. What about the patient? Where do they fall into the loop? Patients don't come to your office complaining of Factor V Leiden. They don't come to your hospital complaining of systemic inflammatory response syndrome. They don't come to your office or hospital complaining of grade II esophageal varices. They come to your office complaining of a swollen leg. They come to your office with dizziness and pain when they pee. They come to your hospital vomiting blood. The goal of all physicians is to try and match the subjective complaints of the patient with the object data points. [...]

It can be very simple

• I'm coughing, short of breath and have fever and an infiltrate on chest x-ray which turns out to be a simple pneumonia.

Or it can be something much more complex.

• I'm coughing, short of breath and have fever and an infiltrate on chest x-ray may in fact be Wegener's granulomatosis, an autoimmune process associated with acute renal failure. It may in fact be a post-obstructive infiltrate caused by large lung mass and complicated by an empyema. It may in fact be acute lung injury caused by amiodarone toxicity. It may in fact be tuberculosis. It may in fact be an infarct from a pulmonary embolism. It may be a lot of things.

It may be a lot of things. That's what you can expect from your internist. That's why you should want an internist taking care of you. [...] Because we have the ability to do something nobody else in the world can. And that is to be the doctor's doctor.

Maybe some of us look to internists to be the kind of oracles of internal organs that DeLillo described, but most of us want the kind of "doctor's doctor" described by the Happy Hospitalist. We want someone to help us navigate our complex health care system, to coordinate our care, and to assist us in deciding between treatment options. Instead of asking "Who's your internist?" we should be asking what can we do to make sure everyone has access to a good primary care physician. As DeLillo said: "People, ask about tax lawyers, estate planners, dope dealers. But it’s the internist who really matters."