Clinical decision support that reasons like an internist: individualize the target, choose the organ-protective agent, risk-stratify the disposition — with the decision rule and exactly what would change it. Built for verified internists.
Two real internal-medicine questions, each reasoned the way HeyHippocrates answers: the skills fire, the answer is cited, the decision rule is explicit, and what's missing is flagged. Scroll to each.
58-year-old with type-2 diabetes, HbA1c 8.5%, established ASCVD and CKD, already on metformin — which agent next?
With established ASCVD and CKD, the next agent is chosen for organ protection, not just glucose. An SGLT2 inhibitor is preferred here — it slows CKD progression and reduces heart-failure and cardiovascular events, independent of the HbA1c. A GLP-1 receptor agonist is the alternative or add-on with strong cardiovascular benefit and weight loss. Continue metformin and lifestyle, and titrate to an individualized target.
Decision ruleT2DM + ASCVD/CKD/HF → add an SGLT2 inhibitor (or GLP-1 RA) for organ protection regardless of HbA1c; keep metformin; individualize the glycemic target.
Not established from this alone — eGFR, heart-failure status, weight, hypoglycemia risk and cost change the choice.
72-year-old, productive cough and fever, new confusion, respiratory rate 24, blood pressure 100/60, urea elevated — CURB-65 and disposition?
Score CURB-65: confusion (1), a raised urea (1), and age ≥65 (1) give at least 3 — a high-risk community-acquired pneumonia. That supports hospital admission with consideration of higher-level care, blood cultures, and prompt empirical antibiotics per local guidance. Reassess the respiratory rate and blood pressure, which can push toward critical care.
Decision ruleCURB-65 0–1 → outpatient; 2 → consider admission; ≥3 → admit and consider critical care; start prompt empirical antibiotics.
Not established from this alone — oxygenation, the exact vitals, comorbidity and social support change the disposition.
Illustrative simulations. The physician always decides.
The exact questions your field searches for — answered in the format the knowledge base speaks: the answer, the decision rule, what's missing, and the source.
Individualize the HbA1c target — around 7% for many, tighter in the young and healthy, looser in the frail or those at hypoglycemia risk. Metformin and lifestyle are foundational, but the second agent is chosen by comorbidity: an SGLT2 inhibitor or GLP-1 receptor agonist for established ASCVD, heart failure or CKD (independent of HbA1c), a GLP-1 RA when weight matters, and cost and hypoglycemia risk always weighed.ADA/EASD · guideline
Decision ruleIndividualize HbA1c (~7%); metformin + lifestyle; comorbidity-driven second agent (SGLT2i/GLP-1 RA for ASCVD/HF/CKD, regardless of HbA1c).
Missing data: eGFR, heart failure, weight, hypoglycemia risk and cost change the agent and the target.
CURB-65 scores Confusion, Urea over 7 mmol/L, Respiratory rate ≥30, low Blood pressure (SBP under 90 or DBP 60 or less) and age ≥65, one point each. A score of 0–1 usually allows outpatient care, 2 warrants consideration of admission, and 3–5 means admit with consideration of critical care. Pair it with oxygenation and clinical judgment, and start prompt empirical antibiotics.CURB-65
Decision ruleCURB-65 0–1 → outpatient; 2 → consider admission; 3–5 → admit ± critical care; add oxygenation and judgment; do not delay antibiotics.
Missing data: oxygen saturation, comorbidity, the exact vitals and social factors refine the disposition.
Confirm hypertension with out-of-office readings before committing to lifelong therapy. The target is generally below 130/80 for most adults. Start lifestyle change, and choose a first-line agent from a thiazide-type diuretic, an ACE inhibitor or ARB, or a calcium-channel blocker; stage-2 hypertension usually needs two agents from the start. Match the choice to comorbidity — an ACEi/ARB in diabetes or CKD.ACC/AHA · guideline
Decision ruleConfirm out-of-office; target <130/80 for most; first-line thiazide/ACEi-ARB/CCB; stage 2 → two agents; match to comorbidity.
Missing data: the confirmed readings, comorbidity, age and secondary causes change the target and the agent.
A microcytic anemia with a low ferritin is iron deficiency. The task is not just to replace iron but to find the source: in men and postmenopausal women, evaluate for gastrointestinal blood loss with upper and lower endoscopy; in menstruating women, weigh menstrual and dietary causes but still investigate alarm features. Replace iron orally or intravenously, and recheck the response.guideline synthesis
Decision ruleMicrocytic + low ferritin → iron deficiency; find the source (GI evaluation in men/postmenopausal women); replace iron and confirm the response.
Missing data: the ferritin, red-cell indices, symptoms and alarm features drive the investigation.
Your whole practice, one specialist brain — grounded in champion-authored, cited knowledge.
A generalist internist colleague across diabetes, cardiovascular, respiratory, renal and the diagnostic workup — cited, non-directive, always with the decision rule.
Deep specialist agents for endocrinology, cardiology, pulmonology, nephrology and infectious diseases — each its own soul and knowledge base — plus your own uploaded materials.
In the undifferentiated patient the margin is thin. Only one of these reasons like an internal-medicine colleague whose every claim you can trace.
The waitlist is a founding cohort. Members shape the internal medicine build, get in before anyone else, and lock the founding price for good.
Leave your name and work email. We'll reach out the moment internal medicine opens — with your Founding Internist offer.
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It reasons in the tools you use — the individualized HbA1c target, CURB-65 and cardiovascular risk — and always shows the reasoning, the decision rule and what would change it. The decision always stays your call.
Both. Residents use it to pressure-test a plan and learn the decision rule; attendings use it as a fast, cited second opinion on rounds and in clinic. Access is gated to verified physicians.
The main internal-medicine sub-specialties — endocrinology, cardiology, pulmonology, nephrology and infectious diseases — each have their own deep specialist agent on the Pro plan, on top of the full general-internal-medicine scope on Basic.
No. It is physician-facing clinical decision support — a cited thinking partner. It does not diagnose, does not treat, and gives no patient-facing advice. The decision always stays with you.
Every answer is grounded only in champion-authored, cited internal-medicine knowledge — traceable, not hallucinated — and always states the decision rule plus what data is missing, instead of a confident guess.
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