Etymology
Medicine (British English /ˈmɛdsɪn/ (About this sound
listen); American English /ˈmɛdɪsɪn/ (About this sound listen)) is the science
and practice of the diagnosis, treatment, and prevention of disease.The word
"medicine" is derived from Latin medicus, meaning "a
physician".
Clinical practice
The Doctor by Sir Luke Fildes (1891) | Lu |
Medical availability and clinical practice varies across the
world due to regional differences in culture and technology. Modern scientific
medicine is highly developed in the Western world, while in developing
countries such as parts of Africa or Asia, the population may rely more heavily
on traditional medicine with limited evidence and efficacy and no required
formal training for practitioners. Even in the developed world however,
evidence-based medicine is not universally used in clinical practice; for
example, a 2007 survey of literature reviews found that about 49% of the interventions
lacked sufficient evidence to support either benefit or harm.
In modern clinical practice, physicians personally assess
patients in order to diagnose, treat, and prevent disease using clinical
judgment. The doctor-patient relationship typically begins an interaction with
an examination of the patient's medical history and medical record, followed by
a medical interview and a physical examination. Basic diagnostic medical
devices (e.g. stethoscope, tongue depressor) are typically used. After
examination for signs and interviewing for symptoms, the doctor may order medical
tests (e.g. blood tests), take a biopsy, or prescribe pharmaceutical drugs or
other therapies. Differential diagnosis methods help to rule out conditions
based on the information provided. During the encounter, properly informing the
patient of all relevant facts is an important part of the relationship and the
development of trust. The medical encounter is then documented in the medical
record, which is a legal document in many jurisdictions. Follow-ups may be
shorter but follow the same general procedure, and specialists follow a similar
process. The diagnosis and treatment may take only a few minutes or a few weeks
depending upon the complexity of the issue.
The components of the medical interview] and encounter are:
Chief complaint (CC): the reason for the current medical
visit. These are the 'symptoms.' They are in the patient's own words and are
recorded along with the duration of each one. Also called 'chief concern' or
'presenting complaint'.
History of present illness (HPI): the chronological order of
events of symptoms and further clarification of each symptom. Distinguishable
from history of previous illness, often called past medical history (PMH).
Medical history comprises HPI and PMH.
Current activity: occupation, hobbies, what the patient
actually does.
Medications (Rx): what drugs the patient takes including
prescribed, over-the-counter, and home remedies, as well as alternative and
herbal medicines/herbal remedies. Allergies are also recorded.
Past medical history (PMH/PMHx): concurrent medical
problems, past hospitalizations and operations, injuries, past infectious
diseases or vaccinations, history of known allergies.
Social history (SH): birthplace, residences, marital
history, social and economic status, habits (including diet, medications,
tobacco, alcohol).
Family history (FH): listing of diseases in the family that
may impact the patient. A family tree is sometimes used.
Review of systems (ROS) or systems inquiry: a set of
additional questions to ask, which may be missed on HPI: a general enquiry
(have you noticed any weight loss, change in sleep quality, fevers, lumps and
bumps? etc.), followed by questions on the body's main organ systems (heart,
lungs, digestive tract, urinary tract, etc.).
The physical examination is the examination of the patient
for medical signs of disease, which are objective and observable, in contrast
to symptoms which are volunteered by the patient and not necessarily
objectively observable. The healthcare provider uses the senses of sight, hearing,
touch, and sometimes smell (e.g., in infection, uremia, diabetic ketoacidosis).
Four actions are the basis of physical examination: inspection, palpation
(feel), percussion (tap to determine resonance characteristics), and
auscultation (listen), generally in that order although auscultation occurs
prior to percussion and palpation for abdominal assessments.
The clinical examination involves the study of:
Vital signs including height, weight, body temperature,
blood pressure, pulse, respiration rate, and hemoglobin oxygen saturation
General appearance of the patient and specific indicators of
disease (nutritional status, presence of jaundice, pallor or clubbing)
Skin
Head, eye, ear, nose, and throat (HEENT)
Cardiovascular (heart and blood vessels)
Respiratory (large airways and lungs)
Abdomen and rectum
Genitalia (and pregnancy if the patient is or could be
pregnant)
Musculoskeletal (including spine and extremities)
Neurological (consciousness, awareness, brain, vision,
cranial nerves, spinal cord and peripheral nerves)
Psychiatric (orientation, mental state, evidence of abnormal
perception or thought).
It is to likely focus on areas of interest highlighted in
the medical history and may not include everything listed above.
The treatment plan may include ordering additional medical
laboratory tests and medical imaging studies, starting therapy, referral to a
specialist, or watchful observation. Follow-up may be advised. Depending upon
the health insurance plan and the managed care system, various forms of
"utilization review", such as prior authorization of tests, may place
barriers on accessing expensive services.
The medical decision-making (MDM) process involves analysis
and synthesis of all the above data to come up with a list of possible
diagnoses (the differential diagnoses), along with an idea of what needs to be
done to obtain a definitive diagnosis that would explain the patient's problem.
On subsequent visits, the process may be repeated in an
abbreviated manner to obtain any new history, symptoms, physical findings, and
lab or imaging results or specialist consultations.
Institutions
The Hospital of Santa Maria della Scala, fresco by Domenico di Bartolo, 1441–1442 |
Contemporary medicine is in general conducted within health
care systems. Legal, credentialing and financing frameworks are established by
individual governments, augmented on occasion by international organizations,
such as churches. The characteristics of any given health care system have
significant impact on the way medical care is provided.
From ancient times, Christian emphasis on practical charity
gave rise to the development of systematic nursing and hospitals and the
Catholic Church today remains the largest non-government provider of medical
services in the world. Advanced industrial countries (with the exception of
the United States) and many developing countries provide medical
services through a system of universal health care that aims to guarantee care
for all through a single-payer health care system, or compulsory private or
co-operative health insurance. This is intended to ensure that the entire
population has access to medical care on the basis of need rather than ability
to pay. Delivery may be via private medical practices or by state-owned
hospitals and clinics, or by charities, most commonly by a combination of all
three.
Most tribal societies provide no guarantee of healthcare for
the population as a whole. In such societies, healthcare is available to those
that can afford to pay for it or have self-insured it (either directly or as part
of an employment contract) or who may be covered by care financed by the
government or tribe directly.
Transparency of information is another factor defining a
delivery system. Access to information on conditions, treatments, quality, and
pricing greatly affects the choice by patients/consumers and, therefore, the
incentives of medical professionals. While the US healthcare system has come
under fire for lack of openness, new legislation may encourage greater
openness. There is a perceived tension between the need for transparency on the
one hand and such issues as patient confidentiality and the possible
exploitation of information for commercial gain on the other.
Delivery
Provision of medical care is classified into primary,
secondary, and tertiary care categories.
photograph of three nurses
Nurses in Kokopo, East New Britain, Papua New Guinea
Primary care medical services are provided by physicians,
physician assistants, nurse practitioners, or other health professionals who
have first contact with a patient seeking medical treatment or care. These
occur in physician offices, clinics, nursing homes, schools, home visits, and
other places close to patients. About 90% of medical visits can be treated by
the primary care provider. These include treatment of acute and chronic
illnesses, preventive care and health education for all ages and both sexes.
Secondary care medical services are provided by medical
specialists in their offices or clinics or at local community hospitals for a
patient referred by a primary care provider who first diagnosed or treated the
patient. Referrals are made for those patients who required the expertise or
procedures performed by specialists. These include both ambulatory care and
inpatient services, emergency rooms, intensive care medicine, surgery services,
physical therapy, labor and delivery, endoscopy units, diagnostic laboratory
and medical imaging services, hospice centers, etc. Some primary care providers
may also take care of hospitalized patients and deliver babies in a secondary
care setting.
Tertiary care medical services are provided by specialist
hospitals or regional centers equipped with diagnostic and treatment facilities
not generally available at local hospitals. These include trauma centers, burn
treatment centers, advanced neonatology unit services, organ transplants,
high-risk pregnancy, radiation oncology, etc.
Modern medical care also depends on information – still
delivered in many health care settings on paper records, but increasingly
nowadays by electronic means.
In low-income countries, modern healthcare is often too
expensive for the average person. International healthcare policy researchers
have advocated that "user fees" be removed in these areas to ensure
access, although even after removal, significant costs and barriers remain.
Separation of prescribing and dispensing is a practice in
medicine and pharmacy in which the physician who provides a medical
prescription is independent from the pharmacist who provides the prescription
drug. In the Western world there are centuries of tradition for separating
pharmacists from physicians. In Asian countries it is traditional for physicians
to also provide drugs.
Branches
Working together as an interdisciplinary team, many highly
trained health professionals besides medical practitioners are involved in the
delivery of modern health care. Examples include: nurses, emergency medical
technicians and paramedics, laboratory scientists, pharmacists, podiatrists,
physiotherapists, respiratory therapists, speech therapists, occupational
therapists, radiographers, dietitians, and bioengineers, surgeons, surgeon's
assistant, surgical technologist.
The scope and sciences underpinning human medicine overlap
many other fields. Dentistry, while considered by some a separate discipline
from medicine, is a medical field.
A patient admitted to the hospital is usually under the care
of a specific team based on their main presenting problem, e.g., the cardiology
team, who then may interact with other specialties, e.g., surgical, radiology,
to help diagnose or treat the main problem or any subsequent complications/developments.
Physicians have many specializations and subspecializations
into certain branches of medicine, which are listed below. There are variations
from country to country regarding which specialties certain subspecialties are
in.
The main branches of medicine are:
Basic sciences of medicine; this is what every physician is
educated in, and some return to in biomedical research
Medical specialties
Interdisciplinary fields, where different medical
specialties are mixed to function in certain occasions.
Basic sciences
Anatomy is the study of the physical structure of organisms.
In contrast to macroscopic or gross anatomy, cytology and histology are
concerned with microscopic structures.
Biochemistry is the study of the chemistry taking place in living
organisms, especially the structure and function of their chemical components.
Biomechanics is the study of the structure and function of
biological systems by means of the methods of Mechanics.
Biostatistics is the application of statistics to biological
fields in the broadest sense. A knowledge of biostatistics is essential in the
planning, evaluation, and interpretation of medical research. It is also
fundamental to epidemiology and evidence-based medicine.
Biophysics is an interdisciplinary science that uses the
methods of physics and physical chemistry to study biological systems.
Cytology is the microscopic study of individual cells.
Louis Pasteur, as portrayed in his laboratory, 1885 by
Albert Edelfelt
Embryology is the study of the early development of
organisms.
Endocrinology is the study of hormones and their effect
throughout the body of animals.
Epidemiology is the study of the demographics of disease
processes, and includes, but is not limited to, the study of epidemics.
Genetics is the study of genes, and their role in biological
inheritance.
Histology is the study of the structures of biological
tissues by light microscopy, electron microscopy and immunohistochemistry.
Immunology is the study of the immune system, which includes
the innate and adaptive immune system in humans, for example.
Medical physics is the study of the applications of physics
principles in medicine.
Microbiology is the study of microorganisms, including
protozoa, bacteria, fungi, and viruses.
Molecular biology is the study of molecular underpinnings of
the process of replication, transcription and translation of the genetic
material.
Neuroscience includes those disciplines of science that are
related to the study of the nervous system. A main focus of neuroscience is the
biology and physiology of the human brain and spinal cord. Some related
clinical specialties include neurology, neurosurgery and psychiatry.
Nutrition science (theoretical focus) and dietetics
(practical focus) is the study of the relationship of food and drink to health
and disease, especially in determining an optimal diet. Medical nutrition
therapy is done by dietitians and is prescribed for diabetes, cardiovascular
diseases, weight and eating disorders, allergies, malnutrition, and neoplastic
diseases.
Pathology as a science is the study of disease—the causes,
course, progression and resolution thereof.
Pharmacology is the study of drugs and their actions.
Photobiology is the study of the interactions between
non-ionizing radiation and living organisms.
Physiology is the study of the normal functioning of the
body and the underlying regulatory mechanisms.
Radiobiology is the study of the interactions between
ionizing radiation and living organisms.
Toxicology is the study of hazardous effects of drugs and
poisons.
Specialties
Main article: Medical
specialty
In the broadest meaning of "medicine", there are
many different specialties. In the UK, most specialities have their own body or
college, which have its own entrance examination. These are collectively known
as the Royal Colleges, although not all currently use the term
"Royal". The development of a speciality is often driven by new
technology (such as the development of effective anaesthetics) or ways of
working (such as emergency departments); the new specialty leads to the
formation of a unifying body of doctors and the prestige of administering their
own examination.
Within medical circles, specialities usually fit into one of
two broad categories: "Medicine" and "Surgery."
"Medicine" refers to the practice of non-operative medicine, and most
of its subspecialties require preliminary training in Internal Medicine. In the
UK, this was traditionally evidenced by passing the examination for the
Membership of the Royal College of Physicians (MRCP) or the equivalent college
in Scotland or Ireland. "Surgery" refers to the practice of operative
medicine, and most subspecialties in this area require preliminary training in
General Surgery, which in the UK leads to membership of the Royal College of
Surgeons of England (MRCS). At present, some specialties of medicine do not fit
easily into either of these categories, such as radiology, pathology, or
anesthesia. Most of these have branched from one or other of the two camps
above; for example anaesthesia developed first as a faculty of the Royal
College of Surgeons (for which MRCS/FRCS would have been required) before
becoming the Royal College of Anaesthetists and membership of the college is
attained by sitting for the examination of the Fellowship of the Royal College
of Anesthetists (FRCA).
Surgical specialty
Main article: Surgery
Surgeons in an operating room
Surgery is an ancient medical specialty that uses operative
manual and instrumental techniques on a patient to investigate or treat a
pathological condition such as disease or injury, to help improve bodily
function or appearance or to repair unwanted ruptured areas (for example, a
perforated ear drum). Surgeons must also manage pre-operative, post-operative,
and potential surgical candidates on the hospital wards. Surgery has many
sub-specialties, including general surgery, ophthalmic surgery, cardiovascular
surgery, colorectal surgery, neurosurgery, oral and maxillofacial surgery,
oncologic surgery, orthopedic surgery, otolaryngology, plastic surgery,
podiatric surgery, transplant surgery, trauma surgery, urology, vascular
surgery, and pediatric surgery. In some centers, anesthesiology is part of the
division of surgery (for historical and logistical reasons), although it is not
a surgical discipline. Other medical specialties may employ surgical
procedures, such as ophthalmology and dermatology, but are not considered
surgical sub-specialties per se.
Surgical training in the U.S. requires a minimum of five
years of residency after medical school. Sub-specialties of surgery often
require seven or more years. In addition, fellowships can last an additional
one to three years. Because post-residency fellowships can be competitive, many
trainees devote two additional years to research. Thus in some cases surgical
training will not finish until more than a decade after medical school.
Furthermore, surgical training can be very difficult and time-consuming.
Internal specialty
Main article: Internal
medicine
Internal medicine is the medical specialty dealing with the
prevention, diagnosis, and treatment of adult diseases. According to some
sources, an emphasis on internal structures is implied.In North America,
specialists in internal medicine are commonly called "internists."
Elsewhere, especially in Commonwealth nations, such specialists are often
called physicians. These terms, internist or physician (in the narrow
sense, common outside North America), generally exclude practitioners of
gynecology and obstetrics, pathology, psychiatry, and especially surgery and
its subspecialities.
Because their patients are often seriously ill or require
complex investigations, internists do much of their work in hospitals.
Formerly, many internists were not subspecialized; such general physicians
would see any complex nonsurgical problem; this style of practice has become
much less common. In modern urban practice, most internists are subspecialists:
that is, they generally limit their medical practice to problems of one organ
system or to one particular area of medical knowledge. For example,
gastroenterologists and nephrologists specialize respectively in diseases of
the gut and the kidneys.
In the Commonwealth of Nations and some other countries,
specialist pediatricians and geriatricians are also described as specialist
physicians (or internists) who have subspecialized by age of patient rather
than by organ system. Elsewhere, especially in North America, general
pediatrics is often a form of primary care.
There are many subspecialities (or subdisciplines) of internal medicine:
Angiology/Vascular Medicine
Cardiology
Critical care medicine
Endocrinology
Gastroenterology
Geriatrics
Hematology
Hepatology
Infectious disease
Nephrology
Neurology
Oncology
Pediatrics
Pulmonology/Pneumology/Respirology/chest medicine
Rheumatology
Sports Medicine
Training in internal medicine (as opposed to surgical
training), varies considerably across the world: see the articles on medical
education and physician for more details. In North America, it requires at
least three years of residency training after medical school, which can then be
followed by a one- to three-year fellowship in the subspecialties listed above.
In general, resident work hours in medicine are less than those in surgery,
averaging about 60 hours per week in the US. This difference does not apply in
the UK where all doctors are now required by law to work less than 48 hours per
week on average.
Diagnostic specialties
Clinical laboratory sciences are the clinical diagnostic
services that apply laboratory techniques to diagnosis and management of
patients. In the United States, these services are supervised by a pathologist.
The personnel that work in these medical laboratory departments are technically
trained staff who do not hold medical degrees, but who usually hold an
undergraduate medical technology degree, who actually perform the tests,
assays, and procedures needed for providing the specific services.
Subspecialties include transfusion medicine, cellular pathology, clinical
chemistry, hematology, clinical microbiology and clinical immunology.
Pathology as a medical specialty is the branch of medicine
that deals with the study of diseases and the morphologic, physiologic changes
produced by them. As a diagnostic specialty, pathology can be considered the
basis of modern scientific medical knowledge and plays a large role in
evidence-based medicine. Many modern molecular tests such as flow cytometry,
polymerase chain reaction (PCR), immunohistochemistry, cytogenetics, gene
rearrangements studies and fluorescent in situ hybridization (FISH) fall within
the territory of pathology.
Diagnostic radiology is concerned with imaging of the body,
e.g. by x-rays, x-ray computed tomography, ultrasonography, and nuclear
magnetic resonance tomography. Interventional radiologists can access areas in
the body under imaging for an intervention or diagnostic sampling.
Nuclear medicine is concerned with studying human organ
systems by administering radiolabelled substances (radiopharmaceuticals) to the
body, which can then be imaged outside the body by a gamma camera or a PET
scanner. Each radiopharmaceutical consists of two parts: a tracer that is
specific for the function under study (e.g., neurotransmitter pathway,
metabolic pathway, blood flow, or other), and a radionuclide (usually either a
gamma-emitter or a positron emitter). There is a degree of overlap between
nuclear medicine and radiology, as evidenced by the emergence of combined
devices such as the PET/CT scanner.
Clinical neurophysiology is concerned with testing the
physiology or function of the central and peripheral aspects of the nervous
system. These kinds of tests can be divided into recordings of: (1) spontaneous
or continuously running electrical activity, or (2) stimulus evoked responses.
Subspecialties include electroencephalography, electromyography, evoked
potential, nerve conduction study and polysomnography. Sometimes these tests are
performed by techs without a medical degree, but the interpretation of these
tests is done by a medical professional.
Other major specialties[edit]
The followings are some major medical specialties that do
not directly fit into any of the above-mentioned groups:
Anesthesiology (also known as anaesthetics): concerned with
the perioperative management of the surgical patient. The anesthesiologist's
role during surgery is to prevent derangement in the vital organs' (i.e. brain,
heart, kidneys) functions and postoperative pain. Outside of the operating
room, the anesthesiology physician also serves the same function in the labor
& delivery ward, and some are specialized in critical medicine.
Dermatology is concerned with the skin and its diseases. In
the UK, dermatology is a subspecialty of general medicine.
Emergency medicine is concerned with the diagnosis and
treatment of acute or life-threatening conditions, including trauma, surgical,
medical, pediatric, and psychiatric emergencies.
Family medicine, family practice, general practice or
primary care is, in many countries, the first port-of-call for patients with
non-emergency medical problems. Family physicians often provide services across
a broad range of settings including office based practices, emergency room
coverage, inpatient care, and nursing home care.
Gynecologist Michel Akotionga of Ouagadougou, Burkina Faso
Obstetrics and gynecology (often abbreviated as OB/GYN
(American English) or Obs & Gynae (British English)) are concerned
respectively with childbirth and the female reproductive and associated organs.
Reproductive medicine and fertility medicine are generally practiced by
gynecological specialists.
Medical genetics is concerned with the diagnosis and
management of hereditary disorders.
Neurology is concerned with diseases of the nervous system.
In the UK, neurology is a subspecialty of general medicine.
Ophthalmology is exclusively concerned with the eye and
ocular adnexa, combining conservative and surgical therapy.
Pediatrics (AE) or paediatrics (BE) is devoted to the care
of infants, children, and adolescents. Like internal medicine, there are many
pediatric subspecialties for specific age ranges, organ systems, disease
classes, and sites of care delivery.
Pharmaceutical medicine is the medical scientific discipline
concerned with the discovery, development, evaluation, registration, monitoring
and medical aspects of marketing of medicines for the benefit of patients and
public health.
Physical medicine and rehabilitation (or physiatry) is concerned
with functional improvement after injury, illness, or congenital disorders.
Podiatric medicine is the study of, diagnosis, and medical
& surgical treatment of disorders of the foot, ankle, lower limb, hip and
lower back.
Psychiatry is the branch of medicine concerned with the
bio-psycho-social study of the etiology, diagnosis, treatment and prevention of
cognitive, perceptual, emotional and behavioral disorders. Related non-medical
fields include psychotherapy and clinical psychology.
Preventive medicine is the branch of medicine concerned with
preventing disease.
Community health or public health is an aspect of health
services concerned with threats to the overall health of a community based on
population health analysis.
Interdisciplinary fields
Some interdisciplinary sub-specialties of medicine include:
Aerospace medicine deals with medical problems related to
flying and space travel.
Addiction medicine deals with the treatment of addiction.
Medical ethics deals with ethical and moral principles that
apply values and judgments to the practice of medicine.
Biomedical Engineering is a field dealing with the
application of engineering principles to medical practice.
Clinical pharmacology is concerned with how systems of
therapeutics interact with patients.
Conservation medicine studies the relationship between human
and animal health, and environmental conditions. Also known as ecological
medicine, environmental medicine, or medical geology.
Disaster medicine deals with medical aspects of emergency
preparedness, disaster mitigation and management.
Diving medicine (or hyperbaric medicine) is the prevention
and treatment of diving-related problems.
Evolutionary medicine is a perspective on medicine derived
through applying evolutionary theory.
Forensic medicine deals with medical questions in legal
context, such as determination of the time and cause of death, type of weapon
used to inflict trauma, reconstruction of the facial features using remains of
deceased (skull) thus aiding identification.
Gender-based medicine studies the biological and
physiological differences between the human sexes and how that affects
differences in disease.
Hospice and Palliative Medicine is a relatively modern
branch of clinical medicine that deals with pain and symptom relief and
emotional support in patients with terminal illnesses including cancer and
heart failure.
Hospital medicine is the general medical care of
hospitalized patients. Physicians whose primary professional focus is hospital
medicine are called hospitalists in the United States and Canada. The term Most
Responsible Physician (MRP) or attending physician is also used interchangeably
to describe this role.
Laser medicine involves the use of lasers in the diagnostics
or treatment of various conditions.
Medical humanities includes the humanities (literature,
philosophy, ethics, history and religion), social science (anthropology,
cultural studies, psychology, sociology), and the arts (literature, theater, film,
and visual arts) and their application to medical education and practice.
Health informatics is a relatively recent field that deal
with the application of computers and information technology to medicine.
Nosology is the classification of diseases for various
purposes.
Nosokinetics is the science/subject of measuring and
modelling the process of care in health and social care systems.
Occupational medicine is the provision of health advice to
organizations and individuals to ensure that the highest standards of health
and safety at work can be achieved and maintained.
Pain management (also called pain medicine, or algiatry) is
the medical discipline concerned with the relief of pain.
Pharmacogenomics is a form of individualized medicine.
Podiatric medicine is the study of, diagnosis, and medical
treatment of disorders of the foot, ankle, lower limb, hip and lower back.
Sexual medicine is concerned with diagnosing, assessing and
treating all disorders related to sexuality.
Sports medicine deals with the treatment and prevention and
rehabilitation of sports/exercise injuries such as muscle spasms, muscle tears,
injuries to ligaments (ligament tears or ruptures) and their repair in
athletes, amateur and professional.
Therapeutics is the field, more commonly referenced in
earlier periods of history, of the various remedies that can be used to treat
disease and promote health.[24]
Travel medicine or emporiatrics deals with health problems
of international travelers or travelers across highly different environments.
Tropical medicine deals with the prevention and treatment of
tropical diseases. It is studied separately in temperate climates where those
diseases are quite unfamiliar to medical practitioners and their local clinical
needs.
Urgent care focuses on delivery of unscheduled, walk-in care
outside of the hospital emergency department for injuries and illnesses that
are not severe enough to require care in an emergency department. In some
jurisdictions this function is combined with the emergency room.
Veterinary medicine; veterinarians apply similar techniques
as physicians to the care of animals.
Wilderness medicine entails the practice of medicine in the
wild, where conventional medical facilities may not be available.
Many other health science fields, e.g. dietetics
Education and legal controls
Main articles: Medical
education and Medical license
Medical students learning about stitches
Medical education and training varies around the world. It
typically involves entry level education at a university medical school,
followed by a period of supervised practice or internship, or residency. This
can be followed by postgraduate vocational training. A variety of teaching
methods have been employed in medical education, still itself a focus of active
research. In Canada and the United States of America, a Doctor of Medicine
degree, often abbreviated M.D., or a Doctor of Osteopathic Medicine degree,
often abbreviated as D.O. and unique to the United States, must be completed in
and delivered from a recognized university.
Since knowledge, techniques, and medical technology continue
to evolve at a rapid rate, many regulatory authorities require continuing
medical education. Medical practitioners upgrade their knowledge in various
ways, including medical journals, seminars, conferences, and online programs.
Headquarters of the Organización Médica Colegial de España,
which regulates the medical profession in Spain
In most countries, it is a legal requirement for a medical
doctor to be licensed or registered. In general, this entails a medical degree
from a university and accreditation by a medical board or an equivalent
national organization, which may ask the applicant to pass exams. This
restricts the considerable legal authority of the medical profession to
physicians that are trained and qualified by national standards. It is also
intended as an assurance to patients and as a safeguard against charlatans that
practice inadequate medicine for personal gain. While the laws generally
require medical doctors to be trained in "evidence based", Western,
or Hippocratic Medicine, they are not intended to discourage different
paradigms of health.
In the European Union, the profession of doctor of medicine
is regulated. A profession is said to be regulated when access and exercise is
subject to the possession of a specific professional qualification. The
regulated professions database contains a list of regulated professions for
doctor of medicine in the EU member states, EEA countries and Switzerland. This
list is covered by the Directive 2005/36/EC.
Doctors who are negligent or intentionally harmful in their
care of patients can face charges of medical malpractice and be subject to
civil, criminal, or professional sanctions.
Medical ethics
Main article: Medical
ethics
A 12th-century Byzantine manuscript of the Hippocratic Oath
Medical ethics is a system of moral principles that apply
values and judgments to the practice of medicine. As a scholarly discipline,
medical ethics encompasses its practical application in clinical settings as
well as work on its history, philosophy, theology, and sociology. Six of the
values that commonly apply to medical ethics discussions are:
autonomy - the patient has the right to refuse or choose
their treatment. (Voluntas aegroti suprema lex.)
beneficence - a practitioner should act in the best interest
of the patient. (Salus aegroti suprema lex.)
justice - concerns the distribution of scarce health
resources, and the decision of who gets what treatment (fairness and equality).
non-maleficence - "first, do no harm" (primum
non-nocere).
respect for persons - the patient (and the person treating
the patient) have the right to be treated with dignity.
truthfulness and honesty - the concept of informed consent
has increased in importance since the historical events of the Doctors' Trial
of the Nuremberg trials, Tuskegee syphilis experiment, and others.
Values such as these do not give answers as to how to handle
a particular situation, but provide a useful framework for understanding
conflicts. When moral values are in conflict, the result may be an ethical
dilemma or crisis. Sometimes, no good solution to a dilemma in medical ethics
exists, and occasionally, the values of the medical community (i.e., the
hospital and its staff) conflict with the values of the individual patient,
family, or larger non-medical community. Conflicts can also arise between
health care providers, or among family members. For example, some argue that
the principles of autonomy and beneficence clash when patients refuse blood
transfusions, considering them life-saving; and truth-telling was not
emphasized to a large extent before the HIV era.
History
Main articles: History of
medicine and Timeline of medicine and medical technology
Statuette of ancient Egyptian physician Imhotep, the first
physician from antiquity known by name.
Ancient world
Prehistoric medicine incorporated plants (herbalism), animal
parts, and minerals. In many cases these materials were used ritually as
magical substances by priests, shamans, or medicine men. Well-known spiritual
systems include animism (the notion of inanimate objects having spirits),
spiritualism (an appeal to gods or communion with ancestor spirits); shamanism
(the vesting of an individual with mystic powers); and divination (magically
obtaining the truth). The field of medical anthropology examines the ways in
which culture and society are organized around or impacted by issues of health,
health care and related issues.
Early records on medicine have been discovered from ancient
Egyptian medicine, Babylonian Medicine, Ayurvedic medicine (in the Indian
subcontinent), classical Chinese medicine (predecessor to the modern traditional
Chinese medicine), and ancient Greek medicine and Roman medicine.
In Egypt, Imhotep (3rd millennium BC) is the first physician
in history known by name. The oldest Egyptian medical text is the Kahun
Gynaecological Papyrus from around 2000 BCE, which describes gynaecological
diseases. The Edwin Smith Papyrus dating back to 1600 BCE is an early work on
surgery, while the Ebers Papyrus dating back to 1500 BCE is akin to a textbook
on medicine.
In China, archaeological evidence of medicine in Chinese dates
back to the Bronze Age Shang Dynasty, based on seeds for herbalism and tools
presumed to have been used for surgery.The Huangdi Neijing, the progenitor of
Chinese medicine, is a medical text written beginning in the 2nd century BCE
and compiled in the 3rd century.
In India, the surgeon Sushruta described numerous surgical
operations, including the earliest forms of plastic surgery.[28][dubious –
discuss Earliest records of dedicated hospitals come from Mihintale in Sri
Lanka where evidence of dedicated medicinal treatment facilities for patients
are found.
In Greece, the Greek physician Hippocrates, the "father
of modern medicine", laid the foundation for a rational approach to
medicine. Hippocrates introduced the Hippocratic Oath for physicians, which is
still relevant and in use today, and was the first to categorize illnesses as
acute, chronic, endemic and epidemic, and use terms such as,
"exacerbation, relapse, resolution, crisis, paroxysm, peak, and
convalescence".[34][35] The Greek physician Galen was also one of the
greatest surgeons of the ancient world and performed many audacious operations,
including brain and eye surgeries. After the fall of the Western Roman Empire
and the onset of the Early Middle Ages, the Greek tradition of medicine went
into decline in Western Europe, although it continued uninterrupted in the
Eastern Roman (Byzantine) Empire.
Most of our knowledge of ancient Hebrew medicine during the
1st millennium BC comes from the Torah, i.e. the Five Books of Moses, which
contain various health related laws and rituals. The Hebrew contribution to the
development of modern medicine started in the Byzantine Era, with the physician
Asaph the Jew.
Middle Ages
A manuscript of Al-Risalah al-Dhahabiah by Ali al-Ridha, the
eighth Imam of Shia Muslims. The text says: "Golden dissertation in
medicine which is sent by Imam Ali ibn Musa al-Ridha, peace be upon him, to
al-Ma'mun."
After 750 CE, the Muslim world had the works of Hippocrates,
Galen and Sushruta translated into Arabic, and Islamic physicians engaged in
some significant medical research. Notable Islamic medical pioneers include the
Persian polymath, Avicenna, who, along with Imhotep and Hippocrates, has also
been called the "father of medicine".He wrote The Canon of Medicine,
considered one of the most famous books in the history of medicine Others
include Abulcasis, Avenzoar,Ibn al-Nafis, and Averroes. Rhazes was one of the
first to question the Greek theory of humorism, which nevertheless remained
influential in both medieval Western and medieval Islamic medicine] Al-Risalah
al-Dhahabiah by Ali al-Ridha, the eighth Imam of Shia Muslims, is revered as
the most precious Islamic literature in the Science of Medicine] The Persian
Bimaristan hospitals were an early example of public hospitals.
In Europe, Charlemagne decreed that a hospital should be
attached to each cathedral and monastery and the historian Geoffrey Blainey
likened the activities of the Catholic Church in health care during the Middle
Ages to an early version of a welfare state: "It conducted hospitals for
the old and orphanages for the young; hospices for the sick of all ages; places
for the lepers; and hostels or inns where pilgrims could buy a cheap bed and
meal". It supplied food to the population during famine and distributed
food to the poor. This welfare system the church funded through collecting
taxes on a large scale and possessing large farmlands and estates. The Benedictine
order was noted for setting up hospitals and infirmaries in their monasteries,
growing medical herbs and becoming the chief medical care givers of their
districts, as at the great Abbey of Cluny. The Church also established a
network of cathedral schools and universities where medicine was studied. The
Schola Medica Salernitana in Salerno, looking to the learning of Greek and Arab
physicians, grew to be the finest medical school in Medieval Europe.[48]
Panorama of Siena's Santa Maria della Scala Hospital, one of
Europe's oldest hospitals. During the Middle Ages, the Catholic Church
established universities which revived the study of sciences - drawing on the
learning of Greek and Arab physicians in the study of medicine.
However, the fourteenth and fifteenth century Black Death
devastated both the Middle East and Europe, and it has even been argued that
Western Europe was generally more effective in recovering from the pandemic
than the Middle East. In the early modern period, important early figures in
medicine and anatomy emerged in Europe, including Gabriele Falloppio and
William Harvey.
The major shift in medical thinking was the gradual
rejection, especially during the Black Death in the 14th and 15th centuries, of
what may be called the 'traditional authority' approach to science and
medicine. This was the notion that because some prominent person in the past
said something must be so, then that was the way it was, and anything one
observed to the contrary was an anomaly (which was paralleled by a similar
shift in European society in general – see Copernicus's rejection of Ptolemy's
theories on astronomy). Physicians like Vesalius improved upon or disproved
some of the theories from the past. The main tomes used both by medicine
students and expert physicians were Materia Medica and Pharmacopoeia.
Andreas Vesalius was the author of De humani corporis
fabrica, an important book on human anatomy.Bacteria and microorganisms were
first observed with a microscope by Antonie van Leeuwenhoek in 1676, initiating
the scientific field microbiology. Independently from Ibn al-Nafis, Michael
Servetus rediscovered the pulmonary circulation, but this discovery did not
reach the public because it was written down for the first time in the
"Manuscript of Paris" in 1546, and later published in the theological
work for which he paid with his life in 1553. Later this was described by
Renaldus Columbus and Andrea Cesalpino. Herman Boerhaave is sometimes referred
to as a "father of physiology" due to his exemplary teaching in
Leiden and textbook 'Institutiones medicae' (1708). Pierre Fauchard has been
called "the father of modern dentistry".
Modern
Paul-Louis Simond injecting a plague vaccine in Karachi,
1898
Veterinary medicine was, for the first time, truly separated
from human medicine in 1761, when the French veterinarian Claude Bourgelat
founded the world's first veterinary school in Lyon, France. Before this,
medical doctors treated both humans and other animals.
Modern scientific biomedical research (where results are
testable and reproducible) began to replace early Western traditions based on
herbalism, the Greek "four humours" and other such pre-modern
notions. The modern era really began with Edward Jenner's discovery of the
smallpox vaccine at the end of the 18th century (inspired by the method of
inoculation earlier practiced in Asia), Robert Koch's discoveries around 1880
of the transmission of disease by bacteria, and then the discovery of
antibiotics around 1900.
The post-18th century modernity period brought more
groundbreaking researchers from Europe. From Germany and Austria, doctors
Rudolf Virchow, Wilhelm Conrad Röntgen, Karl Landsteiner and Otto Loewi made
notable contributions. In the United Kingdom, Alexander Fleming, Joseph Lister,
Francis Crick and Florence Nightingale are considered important. Spanish doctor
Santiago Ramón y Cajal is considered the father of modern neuroscience.
From New Zealand and Australia came Maurice Wilkins, Howard
Florey, and Frank Macfarlane Burnet.
In the United States, William Williams Keen, William Coley,
James D. Watson, Italy (Salvador Luria), Switzerland (Alexandre Yersin), Japan
(Kitasato Shibasaburō), and France (Jean-Martin Charcot, Claude Bernard, Paul
Broca) and others did significant work. Russian Nikolai Korotkov also did
significant work, as did Sir William Osler and Harvey Cushing.
Alexander Fleming's discovery of penicillin in September
1928 marks the start of modern antibiotics.
As science and technology developed, medicine became more
reliant upon medications. Throughout history and in Europe right until the late
18th century, not only animal and plant products were used as medicine, but
also human body parts and fluids. Pharmacology developed in part from herbalism
and some drugs are still derived from plants (atropine, ephedrine, warfarin,
aspirin, digoxin, vinca alkaloids, taxol, hyoscine, etc.).Vaccines were
discovered by Edward Jenner and Louis Pasteur.
The first antibiotic was arsphenamine (Salvarsan) discovered
by Paul Ehrlich in 1908 after he observed that bacteria took up toxic dyes that
human cells did not. The first major class of antibiotics was the sulfa drugs,
derived by German chemists originally from azo dyes.
Pharmacology has become increasingly sophisticated; modern
biotechnology allows drugs targeted towards specific physiological processes to
be developed, sometimes designed for compatibility with the body to reduce
side-effects. Genomics and knowledge of human genetics is having some influence
on medicine, as the causative genes of most monogenic genetic disorders have
now been identified, and the development of techniques in molecular biology and
genetics are influencing medical technology, practice and decision-making.
Evidence-based medicine is a contemporary movement to
establish the most effective algorithms of practice (ways of doing things)
through the use of systematic reviews and meta-analysis. The movement is
facilitated by modern global information science, which allows as much of the
available evidence as possible to be collected and analyzed according to
standard protocols that are then disseminated to healthcare providers. The
Cochrane Collaboration leads this movement. A 2001 review of 160 Cochrane
systematic reviews revealed that, according to two readers, 21.3% of the
reviews concluded insufficient evidence, 20% concluded evidence of no effect,
and 22.5% concluded positive effect.[57]
Traditional medicine
Main article: Traditional
medicine
Traditional medicine (also known as indigenous or folk
medicine) comprises knowledge systems that developed over generations within
various societies before the introduction of modern medicine. The World Health
Organization (WHO) defines traditional medicine as "the sum total of the
knowledge, skills, and practices based on the theories, beliefs, and
experiences indigenous to different cultures, whether explicable or not, used
in the maintenance of health as well as in the prevention, diagnosis,
improvement or treatment of physical and mental illness."
In some Asian and African countries, up to 80% of the
population relies on traditional medicine for their primary health care needs.
When adopted outside of its traditional culture, traditional medicine is often
called alternative medicine.[58] Practices known as traditional medicines
include Ayurveda, Siddha medicine, Unani, ancient Iranian medicine, Irani,
Islamic medicine, traditional Chinese medicine, traditional Korean medicine,
acupuncture, Muti, Ifá, and traditional African medicine.
The WHO notes however that "inappropriate use of
traditional medicines or practices can have negative or dangerous effects"
and that "further research is needed to ascertain the efficacy and
safety" of several of the practices and medicinal plants used by traditional
medicine systems. The line between alternative medicine and quackery is a
contentious subject.
Traditional medicine may include formalized aspects of folk
medicine, that is to say longstanding remedies passed on and practised by lay
people. Folk medicine consists of the healing practices and ideas of body
physiology and health preservation known to some in a culture, transmitted
informally as general knowledge, and practiced or applied by anyone in the
culture having prior experience. Folk medicine may also be referred to as
traditional medicine, alternative medicine, indigenous medicine, or natural
medicine. These terms are often considered interchangeable, even though some
authors may prefer one or the other because of certain overtones they may be
willing to highlight. In fact, out of these terms perhaps only indigenous
medicine and traditional medicine have the same meaning as folk medicine, while
the others should be understood rather in a modern or modernized context.
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