Internal Medicine & Adult Primary Care

Updated September 16, 2026

Internal medicine is the anchor of the practice. A large share of our primary care patients arrived for a urologic or gynecologic problem and turned out not to have a primary care physician at all — a pattern that is particularly common among men, who are considerably less likely than women to have seen anyone in the past year.

The service covers what primary care covers: annual physicals, blood pressure, cholesterol, diabetes, thyroid disease, asthma and COPD, allergy, acute illness with same-week appointments, vaccination review, cancer screening and pre-operative clearance.

What being inside a specialty group changes

Internal medicine connects your primary care with the wider group. Your clinician can discuss appropriate office testing and coordinate referral to urology, gynecology or interventional radiology when needed. Echocardiograms, treadmill stress tests and allergy testing take place with outside providers, not in our offices. Ask who will review each result and what follow-up is needed.

The annual physical, done usefully

The ritual annual physical has taken deserved criticism: a head-to-toe examination on a symptom-free adult finds very little, and broad untargeted blood panels generate more false alarms than diagnoses. What does have value is the deliberate part — blood pressure measured properly, cardiovascular risk estimated and acted on, cancer screening brought up to date, immunisations reviewed, alcohol and mood asked about directly, and medications reconciled, which is where a surprising number of problems are found.

So the visit here is built around those rather than around the examination. Where a test is ordered, we say what decision it will change. Where a test is not ordered, we say why — vitamin D and thyroid panels in people without symptoms are requested constantly and rarely alter anything.

Cardiovascular risk

Most of what will determine how the next twenty years go for an average adult sits here, and most of it is silent. Blood pressure is treated to target rather than to a number that seemed acceptable a decade ago. Lipids are treated according to overall risk rather than by chasing a single figure; where the decision is genuinely borderline, ApoB and coronary calcium scoring resolve it better than repeated argument. Smoking cessation remains the single highest-value intervention available in primary care, and we treat it as a medical problem with medical treatments rather than as a matter of resolve.

Sleep apnea is screened for actively, particularly in men with nocturia, resistant hypertension or daytime somnolence. It is common, it is under-diagnosed, and treating it improves blood pressure, metabolic health and how well everything else works.

Diabetes and metabolic health

Type 2 diabetes management has changed substantially with the GLP-1 receptor agonists and SGLT2 inhibitors, which improve cardiovascular and kidney outcomes independently of glucose control. Choosing among them now depends on what else the patient has — established cardiovascular disease, heart failure, chronic kidney disease, obesity — rather than on HbA1c alone. Our weight management service handles the obesity side of this with body composition measurement rather than weight alone.

Thyroid, anemia and the complaints that get dismissed

A large share of primary care consists of symptoms that are easy to wave away and occasionally are not: fatigue, breathlessness on stairs, poor concentration, feeling cold, hair thinning. Thyroid disease accounts for some of it and is straightforward to test for and treat. Iron deficiency accounts for a great deal more, particularly in menstruating women, and is regularly missed because the blood count is normal — ferritin is the test that finds it, and iron deficiency without anemia produces the full symptom picture on its own. In men and postmenopausal women, iron deficiency is not a nutritional finding to be corrected with a supplement; it is a reason to look for a source of bleeding, and that investigation should not be deferred.

Vitamin B12 deficiency is worth checking in anyone on long-term metformin or acid suppression. Sleep is asked about directly, because insufficient or fragmented sleep produces most of the same symptoms and no blood test will show it.

Medication review

The most valuable ten minutes in many annual visits is going through everything you take, including what was started by someone else and never stopped, and what you buy without a prescription. Anticholinergic burden accumulates quietly across antihistamines, sleep aids, bladder drugs and some antidepressants, and in older patients it affects cognition and balance. Proton pump inhibitors started for a short course routinely run for years. Sedatives and alcohol interact with waking at night in ways that increase the risk of a fall on the way to the bathroom. None of this is exotic, and all of it is found by asking rather than by testing.

Vaccination and travel

Vaccination review covers the adult schedule that most people have drifted out of: tetanus, shingles from fifty, pneumococcal, hepatitis B, RSV in older adults and those with lung or heart disease, annual influenza and current COVID-19 vaccination. HPV vaccination is approved through forty-five and is regularly assumed to be unavailable to adults. Our travel medicine service handles pre-trip vaccination, malaria prophylaxis and the practical advice that matters more than most travellers expect.

Who provides it

Internal medicine is provided by Dr. Yulya Timashpolsky, with pathology support from Dr. Luoquan Wang. Appointments are available at both the Manhattan and Forest Hills offices, and follow-ups, results and medication management can be handled by video.