for substances that treat patients. This article is aboutmedical practice.
Medicine is a branch of
concernedwith restoring and maintaining
. Broadly, it is the practical
of preventing andcuring
. However, medicine often refers more specifically tomatters dealt with by
Medicine is both an area of knowledge (a
), and the application of thatknowledge (the medical profession). The various specialized branches of the science of medicine correspond to equally specializedmedical professions dealing with particular organs or diseases. The
ofmedicine is the body of knowledge about body systems and diseases, while the
of medicine refers to the social structure of the group of people formally trained to apply thatknowledge to treat disease.
There are traditional and schools of healing which are usually not considered to be part of (Western) medicine in a strictsense (see
for an overview). The most highly developedsystems of medicine outside of the Western or
tradition are the
. The remainder of this article focuses on modern (Western) medicine.
History of medicine
See the main articles
History of medicine
Timeline of medicine andmedical technology
Medicine as it is practiced now is rooted in various traditions, but developed mainly in the late
and others). The new, "scientific" medicine replaced more traditional views based on the "
". The development of clinical medicine shifted to the
during the early
Sir William Osler
is the recent movement tolink the practice and the science of medicine more closely through the use of the
is already having a large influence on medical practice, as most
have now been linked to causative
techniques are influencing medicaldecision-making.
The practice of medicine
The medical encounter or
relationship is what medicine is about. A person with a health problem or concern sees a doctor forhelp. The practice of medicine combines both
. Science and
are the evidence base for many clinicalproblems for the general population at large. The art of medicine is the application of this medical knowledge in combinationwith intuition and clinical judgment to determine the proper diagnoses and treatment plan for this unique patient.
The doctor needs to:
- develop a relationship with the patient
- gather data (medical history and
combined with laboratory or imaging studies)
- analyze and synthesize that data (assessment and/or
), and then
- develop a treatment plan (more testing, therapy, watchful observation, referral and follow-up).
The medical encounter is documented in a medical record. One method that is used is called the Problem Oriented MedicalRecord (POMR), which includes a problem list of diagnoses and a "SOAP" method of documentation for each visit:
- S - Subjective, the medical history of the problem from the point-of-view of the patient.
- O - Objective, the physical examination and any laboratory or imaging studies.
- A - Assessment, is the medical decision-making process including the differential diagnoses and most probablediagnoses.
- P - Plan, the way resolve the problem and monitor progress
The patient-doctor relationship is important in order to obtain an accurate medical history and obtain compliance with thetreatment plan; respect, understanding, and trust is important.
A complete medical evaluation includes a medical history, a physical examination, appropriate laboratory or imaging studies,analysis of data and medical decision making to obtain diagnoses, and treatment plan.
The components of the medical history are:
- Chief complaint (CC) - the reason for the current medical visit.
- History of present illness (HPI) - the chronological order of events of symptoms. A
PQRST is sometimes helpful is obtaining the history:
- Provocative-Palliative factors - what makes a symptom worse or better.
- Quality - description of the symptom
- Region - which part of the body is affected
- Severity - what is the intensity of the symptom; using a scale of 0-10 (10 worst)
- Timing - what is the course of the symptom
- Current activity - occupation, hobbies, what the patient actually does.
- what drugs including
, and home remedies. Drug allergies are important
- Past medical history (PMH) - other medical diagnoses, past hospitalizations and
, injuries, past
- Review of systems (ROS) - an outline of additional symptoms to ask which may be missed on HPI, generally following thebody's main organ systems (heart, lungs,
- Social history (SH) - birthplace, residences, marital history, social and economic status, habits including
- Family history (FH) - listing of diseases in the family that may impact the patient. A family tree is sometimesused.
is the examination of thepatient from head to toe looking for signs of disease. The doctor uses his senses of sight, hearing, touch, and sometimes smell(taste has been replaced by modern lab tests). Four chief methods are used: inspection, palpation, percussion, and auscultation;smelling may be useful (e.g. infection,
- Vital signs include height, weight, body temperature, blood pressure,
- General appearance of the patient
- Head, eye, ear, nose, and throat (HEENT)
- Cardiovascular - heart and vessels
- Respiratory - lungs
- Abdomen and rectosigmoid
- Spine and extremities - musculoskeletal
results, if any.
Medical decision making (MDM) process involves the analysis and synthesis of all the above data to come with a list ofpossible diagnoses (the
) andwhat needs to be done to come up with a final diagnosis which would explain the patient's problem.
Treatment plan may include ordering additional labs and studies, starting therapy, referring to a specialist, or watchfulobservation. Follow-up may be needed.
This process is used by primary care providers and well as specialists. It may take only a few minutes if the problem issimple and straightforward. Or it may take weeks for a patient who has been hospitalized with multiple system problems involvingseveral specialists.
On subsequent visits, the process may be repeated in an abbreviated manner to obtain any new history, symptoms, physicalfindings, and lab or imaging results or specialist consultations.
Medical sciences and health professions
The delivery of modern health care depends, not just on medical practitioners, but on an expanding group of highly trained
coming together as an
. A full list is given on the
page. Some examples include:
The scope and sciences underpinning human medicine overlap many other fields.
, while separatedisciplines from medicine, are sometimes also considered medical fields.
treat patients andprescribe medication in many legal jurisdictions.
applies similar techniques to the care of animals.
Medical doctors have many specializations and subspecializations which are listed below.
Basic, supplementary, and related sciences
is the study of the physical structure of organisms. In contrastto macroscopic or gross anatomy, cytology and histology are concerned with microscopicstructures.
is the study of the chemistry taking place inliving organisms, especially the structure and function of their chemical components.
is a field of study which concerns the relationshipbetween biology, science, medicine and ethics, philosophy and theology.
is the application of statistics to biologicalfields in the broadest sense. A knowledge of biostatistics is essential in the planning, evaluation, and interpretation ofmedical research. It is also fundamental to
is the microscopic study of individual
is the study of the early development oforganisms.
is the study of the demographics of diseaseprocesses, and includes, but is not limited to, the study of epidemics.
is the study of genes, and their role in
is the study of the structures of
by light microscopy, electron microscopy andhistochemistry.
is the study of the
, which includes the innate and adaptive immune system in human, for example.
is the study of microorganisms, includingprotozoa, bacteria, fungi, and viruses.
is a comprehensive term for those disciplines ofscience that are related to the study of the nervous system. A main focus of neuroscience is the biology and physiology of thehuman brain.
is the study of the relationship of food and drink tohealth and disease, especially in determining an optimal diet. Medical nutrition therapy is done by
and is prescribed for diabetes, cardiovascular diseases, weight and eating disorders, allergies,malnutrition and neoplastic diseases.
is the study of disease - the causes, course, progressionand resolution thereof.
is the study of
and their actions.
is the study of the normal functioning of the body andthe underlying regulatory mechanisms.
is the study of hazardous effects of drugs and
Diagnostic and imaging specialties
Clinical laboratory sciences
are the clinical diagnostic services which apply laboratorytechniques to
and management of patients. In the United States theseservices are supervised by a Pathologist. The personnel that work in these
departments are technically trained staff, each of whom usually hold a
degree, who actually perform the tests, assays, andprocedures needed for providing the specific services.
is concerned with thetransfusion of blood and blood component, including the maintenance of a "
is concerned with diagnosis using samples from patients taken as tissues and cells using
is concerned with diagnosis bymaking biochemical analysis of blood, body fluids and tissues.
is concerned with diagnosis by looking at changes inthe cellular composition of the
as well as the
in the blood.
is concerned with the
diagnosis of diseasescaused by
is concerned with disorders of the
andrelated body defenses. It also deals with diagnosis of
is concerned with imaging of the human body, e.g. byx-ray, x-ray
nuclear magnetic resonance
is concernedwith using imaging of the human body, usually from CT, ultrasound, or fluoroscopy, to do
, place certain tubes, and perform intravascular procedures.
diagnosis using either imaging of the location of radioactive substancesplaced into a patient, or using in vitro diagnostic tests utilizing radioactive substances.
Disciplines of clinical medicine
), Anaesthesia (
), is theclinical discipline concerned with providing
is often practiced by specialised anesthesiologists.
is concerned with the skin and its diseases.
is concerned with the diagnosisand treatment of acute or life-threatening conditions, including trauma, surgical, medical, pediatric, and psychiatricemergencies.
or family medicine orprimary care is, in many countries, the first port-of-call for patients with non-emergency medical problems. Familydoctors are usually able to treat over 90% of all complaints without referring to specialists.
is concerned with medical care of the elderly.
is the general medical care ofhospitalized patients. Doctors whose primary professional focus is hospital medicine are called hospitalist.
Intensive care medicine
is concernedwith the therapy of patients with serious and life-threatening disease or injury. Intensive care medicine employs invasivediagnostic techniques and (temporary) replacement of organ functions by technical means.
is concerned with diseases ofinner organs and systemic dieseases of adults, i.e. such that affect the body as a whole. There are several subdisciplines ofinternal medicine:
is concerned with the heart and cardiovascular systemand their diseases.
is concerned with how systems of therapeutics interact with patients.
is concerned with the organs ofdigestion.
is concerned with the endocrine system, i.e.endocrine glands and hormones.
(or haematology) is concerned with the bloodand its diseases.
is concerned with the study,diagnosis and treatment of diseases caused by biological agents.
is concerned with diseases of the kidneys.
is devoted to the study, diagnosis and treatment of
and other malignant diseases.
(or chest medicine, respiratorymedicine or lung medicine) is concerned with diseases of the lungs and the respiratory system.
is devoted to the diagnosis and treatment ofinflammatory diseases of the joints and other organ systems.
is concerned with the diagnosis and treatment of
are concerned respectively with childbirth and the female reproductive and associated organs.
is generally practiced by gynecological specialists.
is a relatively modern branch ofclinical medicine that deals with pain and symptom relief and emotional support in patients with
(or paediatrics) is devoted to the care ofchildren, and adolescents. Like internal medicine, there are many pediatric supspecialities for specific age ranges, organsystems, disease classes and sites of care delivery. Most subspecialities of adult medicine have a pediatric equivalent such as
Physical medicine and rehabilitation
(or physiatry) is concerned withfunctional improvement after injury, illness, or congenital abnormality.
is a branch of medicine that studies and treats mentaldisorders. Related non-medical fields are
. There are several subdisciplines of Psychiatry:
Child & adolescent psychiatry
focuses on the care of children and adolescentswith mental/emotional/learning problems (i.e., ADHD, Autism, family conflicts).
focuses on the care of elderly people with mental illnesses (i.e., dementias, post stroke cognitive changes,depression).
focuses on substance abuse and its treatment.
focuses on the interface ofpsychiatry and the Law.
is concerned with the therapeuticuse of ionizing radiation and high energy elementary particle beams in patient treatment.
- Surgical specialties - there are many medical disciplines that employ operative treatment. Some of these are highlyspecialized and are often not considered subdisciplines of surgery, although their naming might suggest so.
is the specialty of surgery of the skin,locomotor system, and abdominal organs. In the past, it was deemed the pre-requisite training prior to progression to othersub-specialty training, but lately has evolved into its own sub-specialty.
is the surgical specialty that is concerned with the
and major blood vessels of the chest.
is concerned with the operative treatment ofdiseases of the nervous system.
(technically a subspeciality of
deals with the diseases of the eye and theirtreatment.
, surgery of the locomotorsystem, is generally practiced together with
(or otorhinolaryngology orENT/ear-nose-throat) is concerned with treatment of ear, nose and throat disorders.
includes aesthetic surgery (operationsthat are done for other than medical purposes) as well as reconstructive surgery (operations to restore function and/orappearance after traumatic or operative mutilation).
is concerned with ablative and palliative surgical approaches to
focuses on the urinary tracts of males and females, and on themale reproductive system. It is often practiced together with
is surgery of the blood vessels,usually outside of the chest.
Interdisciplinary medical fields
Interdisciplinary sub-specialties of medicine are:
deals with medical problems related to flying and
) is the preventionand treatment of diving-related problems.
deals with medical questions in
context, such as determination ofthe time and cause of death.
medical computer science
are relatively recent fieldsthat deal with the application of
is the classification of diseases for various purposes.
Settings where medical care is delivered
Medicine is a diverse field and the provision of medical care is therefore provided in a variety of locations.
medical services are provided by physicians or other healthprofessionals who has first contact with a patient seeking medical treatment or care. These occur in physician's office,
, home visits and other places close to patients. About 90% of medical visits can betreated by the primary care provider. These include treatment of acute and chronic illnesses, preventive care and healtheducation for all ages and both sex.
Secondary care medical services are provided by medical specialists in their offices or clinics or at local communityhospitals for a patient referred by a primary care provider who first diagnosed or treated the patient. Referrals are made forthose patients who required the expertise or procedures performed by specialists. These include both
intensive care medicine
labor and delivery
centers, etc. Some primary care providers may also takecare 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 treatmentfacilities not generally available at local hospitals. These include
treatment centers, advanced neonatology unit services,
, high-risk pregnancy,
Modern medical care also depends on information - still delivered in many health care settings on paper records, butincreasingly nowadays by electronic means.
Teaching of medicine
See also the main articles
Medical training is involves several years of university study followed by several more years of residential practice at ahospital. Entry to a medical degree in some countries (such as the
) requires the completion of another degree first, while in other countries (such as the
) medical training can be commenced as an undergraduate degree immediately after
. Once graduated from medical school mostphysicians begin their residency training, where skills in a speciality of medicine are learned, supervised by more experienceddoctors. The first year of residency is known as the "
" year. The duration ofresidency training depends on the speciality.
, physician training generally follows the followingtimeline (with age of completion):
- Finish high school at 18
- College/university, 4 years, graduate at 22
, 4 years, graduate at 26 with
- Residency (internship usually synonymous with first year of residency), 3 years, finish at 29. Physicians are generallyeligible for independent licensure to practice primary care specialties at this point. Many surgical residencies are longer than3 years.
- Fellowship, 3 year, finish at 32. Fellowships are taken to become eligible for board certification in subspecialties.
The name of the medical
gained at the end varies: somecountries (e.g. the US) call it 'Doctor of Medicine' (abbreviated 'M.D.'), while others (e.g.
) call it "Bachelor of Medicine/Bachelor of Surgery" (
: "Chirurgie"); this is technically a double degree, frequently abbreviated 'M.B.B.S' or'M.B.B.Ch.', dependent on the medical school. In either case graduates of a medical degree may call themselves physician. In theUS and some other contries there is a parallel system of medicine called "
" which awards the degree
(doctor of osteopathy). In many countries, a doctorate of medicine does not require original research as does, indistinction, a
A medical graduate can then enter
and become a
(or primary care
); trainingfor these is generally shorter, while specialist training is typically longer.
In most countries, it is prohibited to practice medicine without a proper degree in that field and doctors must be licensed bya
or some other equivalent organization. This is meant as asafeguard against
. These laws are obstacles to those who would want topretend to training and expertise they have not earned, such as practitioners of
Criticism against medicine has a long history. In the
, it wasnot considered a profession suitable for Christians, as disease was considered Godsent, and interfering with the process a formof
. Barber-surgeons generally had a bad reputation that was not toimprove until the development of academic surgery as a specialism of medicine, rather than an accessory field.
Through the course of the twentieth century, doctors naturally focused increasingly on the technology that was enabling themto make dramatic improvements in patients' health. This resulted in criticism for the loss of compassion and mechanistic,detached treatment. This issue started to reach collective professional consciousness in the 1970s and the profession had begunto respond by the 1980 and 1990s.
Perhaps the most devastating criticism came from
work Medical Nemesis. In his view, modern medicine only medicalisesdisease, causing loss of health and
, while generally failing to restorehealth by eliminating disease. The human being thus becomes a lifelong patient. Other less radical philosophers havevoiced similar views, but none were as virulent as Illich. (Another example can be found in Technopoly: The Surrender ofCulture to Technology by
, which criticises overreliance on technological means in medicine.)
Criticism against modern medicine has led to some improvements in the curricula of medical schools, which now teach studentssystematically on
The inability of modern medicine to properly address many common complaints continues to prompt many people to seek supportfrom
. Although a large number ofalternative approaches to health await scientific validation, many report improvement of symptoms after obtaining alternativetherapies.
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