Thanks greatly for the responses thus far.  You have proved my silent hypothesis – defining who we are challenges even this blog’s highly intelligent and experienced readers.  The comments have come from internists and they do not approach a consensus.

I like the comment about diagnostician, because in my experience that is the crux of the issue.  Our job always involves diagnosing the patient, whether diagnosing a disease, the severity of disease, the response to medication (including unacceptable side effects), the patient’s goals of therapy, or the social situation.  Internists diagnosis and then appropriately treat adult patients.  The location of our practice or the scope of our practice (generalist or subspecialist) does not change with that definition.  Excellent internists order diagnostic tests (laboratory tests, observation over time, imaging studies or even referral to a subspecialist) in order to help the patient receive the most desirable outcome.  That outcome depends on our diagnosis of the patient’s desires.

But while I understand clearly the strengths and weaknesses of internal medicine, we have never explained our specialty well to non-physicians.  The ACP has tried mightily, but the problem of defining an internist never disappears.  Our colleagues in other specialties have great respect for us, and usually choose us as their physicians.  Our medical students have great respect for us, because we discuss the broad expanse of medicine.  We diagnose and treat patients who have diseases, not a disease that exists in a patient.

One patient recently called me House with a better personality.  Perhaps that is how we can describe ourselves.  This definitional problem continues to have an impact on our field.  I wish it were not so.