Medicine is the science Science is a systematic enterprise of gathering knowledge about nature and organizing and condensing that knowledge into testable laws and theories. As knowledge has increased, some methods have proved more reliable than others, and today the scientific method is the standard for science. It includes the use of careful observation, experimentation, and art Art is the process or product of deliberately arranging elements in a way to affect the senses or emotions. It encompasses a diverse range of human activities, creations, and modes of expression, including music, literature, film, photography, sculpture, and paintings. The meaning of art is explored in a branch of philosophy known as aesthetics (ars medicina) of healing Physiological healing is the restoration of damaged living tissue to normal function. It is the process by which the cells in the body regenerate and repair to reduce the size of a damaged or necrotic area. Healing incorporates both the removal of necrotic tissue , and the replacement of this tissue. It encompasses a range of health care Health care or healthcare is the treatment and prevention of illness. Health care is delivered by professionals in medicine, dentistry, nursing, pharmacy and allied health practices evolved to maintain and restore health At the time of the creation of the World Health Organization , in 1948, health was defined as being "a state of complete physical, mental, and social well-being and not merely the absence of disease or infirmity" by the prevention Preventive medicine or preventive care refers to measures taken to prevent diseases, rather than curing them or treating their symptoms. The term contrasts in method with curative and palliative medicine, and in scope with public health methods (which work at the level of population health rather than individual health) and treatment Therapy , or treatment, is the attempted remediation of a health problem, usually following a diagnosis. In the medical field, it is synonymous with the word "treatment". Among psychologists, the term may refer specifically to psychotherapy or "talk therapy" of illness Illness is a state of poor health. Illness is sometimes considered a synonym for disease. Others maintain that fine distinctions exist. Some have described illness as the subjective perception by a patient of an objectively defined disease. Before scientific medicine, healing arts were practised in accordance with alchemical Alchemy, derived from the Arabic word al-kimia , is both a philosophy and an ancient practice focused on the attempt to change base metals into gold, investigating the preparation of the "elixir of longevity", and achieving ultimate wisdom, involving the improvement of the alchemist as well as the making of several substances described treatments and ritual A ritual is a set of actions, performed mainly for their symbolic value. It may be prescribed by a religion or by the traditions of a community. The term usually excludes actions which are arbitrarily chosen by the performers, or dictated purely by logic, chance, necessity, etc practices that developed out of religious Religion (from O.Fr. religion "religious community," from L. religionem "respect for what is sacred, reverence for the gods," "obligation, the bond between man and the gods" is the belief in and worship of a god or gods, or more in general a set of beliefs explaining the existence of and giving meaning to the universe, and cultural traditions A tradition is any established routine. Usually, routines established in order to preserve a wide range of culturally significant ideas. The word tradition comes from the Latin traditio [meaning: giving up , surrendering, instructing, relating] Today, the word tradition is commonly used to designate specific practices and the various methods used. The term "Western medicine" was until recently used to refer to scientific and science-based practices to distinguish it from "Eastern medicine" — which are typically based in traditional, anecdotal, or otherwise non-scientific practices.

Contemporary medicine applies health science There are two approaches to health science: the study and research of the food that we eat; and the study and research of health-related issues to understand how humans and other animals function, and the application of that knowledge to improve health and to prevent and cure diseases, biomedical research Biomedical research , in general simply known as medical research, is the basic research, applied research, or translational research conducted to aid and support the body of knowledge in the field of medicine. Medical research can be divided into two general categories: the evaluation of new treatments for both safety and efficacy in what are, and medical technology Medical technology is a part of the Health technology which encompasses a wide range of health care products and, in one form or another, is used to diagnose, monitor or treat every disease or condition that affects humans. These innovative technologies are improving the quality of health care delivered and patient outcomes through earlier to diagnose Medical diagnosis refers both to the process of attempting to determine the identity of a possible disease or disorder and to the opinion reached by this process and treat injury Injury is damage or harm caused to the structure or function of the body caused by an outside agent or force, which may be physical or chemical, and either by accident or intentional. Personal Injury also refers to damage caused to the reputation of another rather than physical harm to the body. A severe and life-threatening injury is referred to and disease A disease is an abnormal condition affecting the body of an organism. It is often construed to be a medical condition associated with specific symptoms and signs. It may be caused by external factors, such as infectious disease, or it may be caused by internal disfunctions, such as autoimmune diseases, typically through medication A pharmaceutical drug, also referred to as medicine, medication or medicament, can be loosely defined as any chemical substance intended for use in the medical diagnosis, cure, treatment, or prevention of disease, surgery Surgery is a medical specialty that uses operative manual and instrumental techniques on a patient to investigate and/or treat a pathological condition such as disease or injury, to help improve bodily function or appearance, and sometimes for religious reasons. An act of performing surgery may be called a surgical procedure, operation, or simply, or some other form of therapy Therapy , or treatment, is the attempted remediation of a health problem, usually following a diagnosis. In the medical field, it is synonymous with the word "treatment". Among psychologists, the term may refer specifically to psychotherapy or "talk therapy". The word medicine is derived from the Latin Latin or sometimes Roman is an Italic language originally spoken in Latium and Ancient Rome. Although often considered a dead language, in view of the fact that it has no native, fluent speakers, Latin continues to be taught in schools and has been, and currently is, used in the process of new word production in modern languages from many ars medicina, meaning the art of healing.[1][2]

Though medical technology and clinical expertise are pivotal to contemporary medicine, successful face-to-face relief of actual suffering Suffering, or pain in a broad sense, is an individual's basic affective experience of unpleasantness and aversion associated with harm or threat of harm. Suffering may be qualified as physical or mental. It may come in all degrees of intensity, from mild to intolerable. Factors of duration and frequency of occurrence usually compound that of continues to require the application of ordinary human feeling Feeling is the nominalization of "to feel". The word was first used in the English language to describe the physical sensation of touch through either experience or perception. The word is also used to describe experiences, other than the physical sensation of touch, such as "a feeling of warmth". In psychology, the word is and compassion Compassion is a virtue —one in which the emotional capacities of empathy and sympathy (for the suffering of others) are regarded as a part of love itself, and a cornerstone of greater social interconnectedness and humanism —foundational to the highest principles in philosophy, society, and personhood, known in English as bedside manner The doctor-patient relationship is central to the practice of medicine and is essential for the delivery of high-quality health care in the diagnosis and treatment of disease. The doctor-patient relationship forms one of the foundations of contemporary medical ethics. Most medical schools and universities teach medical students from the beginning,.[3]

Contents

History

Main article: History of medicine All human societies have medical beliefs that provide explanations for birth, death, and disease. Throughout history, illness has been attributed to witchcraft, demons, adverse astral influence, or the will of the gods. These ideas still retain some power, with faith healing and shrines still used in some places, although the rise of scientific The ancient Sumerian god Ningishzida Ningishzida is a Mesopotamian deity of the underworld. He is the patron of medicine[citation needed], and may also be considered a god of nature and fertility. His name in Sumerian is translated as "lord of the good tree" by Thorkild Jacobsen and "lord who makes the trees grow right" by James Well. In Sumerian mythology, he, the patron of medicine, accompanied by two gryphons The griffin, griffon, or gryphon is a legendary creature with the body of a lion and the head and wings of an eagle. As the lion was traditionally considered the king of the beasts and the eagle was the king of the birds, the griffin was thought to be an especially powerful and majestic creature. Griffins are normally known for guarding treasure

Prehistoric medicine Prehistoric medicine is a term used to describe the use of medicine before the invention of writing. As the timing of the invention of writing varies per culture and region, the term "prehistoric medicine" encompasses a wide range of time periods and dates incorporated plants (herbalism Herbalism is a traditional medicinal or folk medicine practice based on the use of plants and plant extracts. Herbalism is also known as botanical medicine, medical herbalism, herbal medicine, herbology, and phytotherapy. The scope of herbal medicine is sometimes extended to include fungal and bee products, as well as minerals, shells and certain), animal parts and minerals. In many cases these materials were used ritually as magical substances by priests A priest or priestess is a person having the authority or power to administer religious rites; in particular, rites of sacrifice to, and propitiation of, a deity or deities. Their office or position is the priesthood, a term which may also apply to such persons collectively, shamans Shamanism is an anthropological term referencing a range of beliefs and practices regarding communication with the spiritual world. A practitioner of shamanism is known as a shaman, or medicine men "Medicine man" or "Medicine woman" are English terms used to describe Native American healers and spiritual figures. Anthropologists tend to prefer the term "shaman.". Well-known spiritual systems include animism Animism is a philosophical, religious or spiritual idea that souls or spirits exist not only in humans but also in animals, plants, rocks, natural phenomena such as thunder, geographic features such as mountains or rivers, or other entities of the natural environment. Animism may further attribute souls to abstract concepts such as words, true (the notion of inanimate objects having spirits), spiritualism Spiritualism is a monotheistic belief system or religion, postulating a belief in God, but with a distinguishing feature of belief that spirits of the dead residing in the spirit world can be contacted by "mediums", who can then provide information about the afterlife (an appeal to gods or communion with ancestor spirits); shamanism Shamanism is an anthropological term referencing a range of beliefs and practices regarding communication with the spiritual world. A practitioner of shamanism is known as a shaman (the vesting of an individual with mystic powers); and divination Divination is the attempt to gain insight into a question or situation by way of a standardized process or ritual. Diviners ascertain their interpretations of how a querent should proceed by reading signs, events, or omens, or through alleged contact with a supernatural agency. Divination can be seen as a systematic method with which to organize (magically obtaining the truth). The field of medical anthropology Medical anthropology is an interdisciplinary field which studies "human health and disease, health care systems, and biocultural adaptation". It views humans from multidimensional and ecological perspectives. It is one of the most highly developed areas of anthropology and applied anthropology, and is a subfield of social and cultural examines the ways in which culture and society are organized around or impacted by issues of health, health care and related issues.

Statuette of ancient Egyptian physician Imhotep Imhotep (sometimes spelled Immutef, Im-hotep, or Ii-em-Hotep; called Imuthes by the Greeks), fl. 27th century BC (2655-2600 BC) (Egyptian ii-m-ḥtp *jā-im-ḥatāp meaning "the one who comes in peace") was an Egyptian polymath, who served under the Third Dynasty king, Djoser, as chancellor to the pharaoh and high priest of the sun god, the first physician from antiquity known by name.

Early records on medicine have been discovered from ancient Egyptian medicine Ancient Egyptian Medicine refers to the practices of healing common in Ancient Egypt from c. 33rd century BC until the Persian invasion of 525 BC. This medicine was highly advanced for the time, and included simple, non-invasive surgery, setting of bones and an extensive set of pharmacopoeia. While ancient Egyptian remedies are often, Babylonian medicine, Ayurvedic Ayurveda Ayurvedic medicine is a system of traditional medicine native to the Indian subcontinent and practiced in other parts of the world as a form of alternative medicine. In Sanskrit, the word ayurveda consists of the words āyus, meaning "longevity", and veda, meaning "related to knowledge" or "science". Evolving medicine (in the Indian subcontinent The Indian subcontinent, also Indian Subcontinent and other terms, is a region of the Asian continent on the Indian tectonic plate south of the Himalayas, forming a land mass which extends southward into the Indian Ocean), classical Chinese medicine Classical Chinese medicine is Chinese medical practice that is explicitly based on ancient texts. Its advocates sometimes distinguish it from traditional Chinese medicine (TCM).[page needed]. Classical Chinese medicine was canonized and collated during the Han dynasty (with some classical texts emerging in the Wei and Jin dynasties). Therefore, (predecessor to the modern traditional Chinese Medicine Traditional Chinese Medicine, also known as TCM, includes a range of traditional medicine practices originating in China. Although well accepted in the mainstream of medical care throughout East Asia, it is considered an alternative medical system in much of the Western world), and ancient Greek medicine The first known Greek medical school opened in Cnidus in 700 BC. Alcmaeon, author of the first anatomical work, worked at this school, and it was here that the practice of observing patients was established. Ancient Greek medicine centered around the theory of humours. The most important figure in ancient Greek medicine is the physician and Roman medicine Ancient Roman medicine combined various techniques using different tools and rituals. Ancient Roman medicine included a number of specializations such as intemistic, ophthalmology and urology. Romans believed in supernatural causes for many diseases and in some supernatural cures . The Romans favoured the prevention of diseases over the cures of. The Egyptian Imhotep Imhotep (sometimes spelled Immutef, Im-hotep, or Ii-em-Hotep; called Imuthes by the Greeks), fl. 27th century BC (2655-2600 BC) (Egyptian ii-m-ḥtp *jā-im-ḥatāp meaning "the one who comes in peace") was an Egyptian polymath, who served under the Third Dynasty king, Djoser, as chancellor to the pharaoh and high priest of the sun god (3rd millennium BC) is the first physician in history known by name. Earliest records of dedicated hospitals come from Mihintale in Sri Lanka Sri Lanka , officially the Democratic Socialist Republic of Sri Lanka and known as Ceylon (/sɪˈlɒn/) before 1972, is an island country in South Asia, located about 31 kilometres (19.3 mi) off the southern coast of India where evidence of dedicated medicinal treatment facilities for patients are found.[4][5] The Indian surgeon Sushruta The Sushruta Samhita is a Sanskrit redaction text on all of the major concepts of ayurvedic medicine with innovative chapters on surgery, attributed to Sushruta. Cataract surgery was performed by Sushruta before 800 BC described numerous surgical operations, including the earliest forms of plastic surgery.[6][dubious – discuss][7]

The Greek physician Hippocrates (ca. 460 BCE – ca. 370 BCE), considered the father of Western medicine.[8][9]

The Greek physician Hippocrates, considered the "father of medicine",[9][10] 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".[11][12] 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 Dark Ages, the Greek tradition of medicine went into decline in Western Europe, although it continued uninterrupted in the Eastern Roman (Byzantine) Empire.

A Latin copy of The Canon of Medicine, written by Avicenna, who is also considered the father of medicine.

After 750 CE, the Muslim Arab 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 polymath, Avicenna, who, along with Imhotep and Hippocrates, has also been called the "father of medicine".[13][14] He wrote The Canon of Medicine, considered one of the most famous books in the history of medicine.[15] Others include Abulcasis,[16] Avenzoar,[17] Ibn al-Nafis,[18] and Averroes.[19] Rhazes [20] was one of first to question the Greek theory of humorism, which nevertheless remained influential in both medieval Western and medieval Islamic medicine.[21] The Islamic Bimaristan hospitals were an early example of public hospitals.[22][23] However, the fourteenth and fifteenth century Black Death was just as devastating to the Middle East as to Europe, and it has even been argued that Western Europe was generally more effective in recovering from the pandemic than the Middle East.[24] In the early modern period, important early figures in medicine and anatomy emerged in Europe, including Gabriele Falloppio and William Harvey.

An ancient Greek patient gets medical treatment: this aryballos (circa 480-470 BCE, now in Paris's Louvre Museum) probably contained healing oil

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 Ibn al-Nafis and Vesalius improved upon or disproved some of the theories from the past.

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 Austrian doctors (such as Rudolf Virchow, Wilhelm Conrad Röntgen, Karl Landsteiner, and Otto Loewi) made contributions. In the United Kingdom Alexander Fleming, Joseph Lister, Francis Crick, and Florence Nightingale are considered important. From New Zealand and Australia came Maurice Wilkins, Howard Florey, and Frank Macfarlane Burnet). In the United States William Williams Keen, Harvey Cushing, William Coley, James D. Watson, Italy (Salvador Luria), Switzerland (Alexandre Yersin), Japan (Kitasato Shibasaburo), 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.

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.[25] Pharmacology developed from herbalism and many drugs are still derived from plants (atropine, ephedrine, warfarin, aspirin, digoxin, vinca alkaloids, taxol, hyoscine, etc.). The first of these was arsphenamine / Salvarsan discovered by Paul Ehrlich in 1908 after he observed that bacteria took up toxic dyes that human cells did not. Vaccines were discovered by Edward Jenner and Louis Pasteur. The first major class of antibiotics was the sulfa drugs, derived by French chemists originally from azo dyes. This 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 which are then disseminated to healthcare providers. One problem with this 'best practice' approach is that it could be seen to stifle novel approaches to treatment[citation needed]. 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.[26]

Clinical practice

The Doctor, by Sir Luke Fildes (1891)

In clinical practice doctors 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 a medical interview[27] 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.[28] Followups may be shorter but follow the same general procedure.

The components of the medical interview[27] and encounter are:

The physical examination is the examination of the patient looking for signs of disease ('Symptoms' are what the patient volunteers, 'Signs' are what the healthcare provider detects by examination). The healthcare provider uses the senses of sight, hearing, touch, and sometimes smell (e.g. in infection, uremia, diabetic ketoacidosis). Taste has been made redundant by the availability of modern lab tests. Four actions are taught as the basis of physical examination: inspection, palpation (feel), percussion (tap to determine resonance characteristics), and auscultation (listen). This order may be modified depending on the main focus of the examination (e.g. a joint may be examined by simply "look, feel, move". Having this set order is an educational tool that encourages the practitioner to be systematic in their approach and refrain from using tools such as the stethoscope before they have fully evaluated the other modalities.

The clinical examination involves study of:

It is likely to be focussed on areas of interest highlighted in the medical history and may not include everything listed above.

Laboratory and imaging studies results may be obtained, if necessary.

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.

The treatment plan may include ordering additional laboratory tests and studies, starting therapy, referral to a specialist, or watchful observation. Follow-up may be advised.

This process is used by primary care providers as well as specialists. It may take only a few minutes if the problem is simple and straightforward. On the other hand, it may take weeks in a patient who has been hospitalized with bizarre symptoms or multi-system problems, with involvement by several specialists.

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

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. The characteristics of any given health care system have significant impact on the way medical care is provided.

Advanced industrial countries (with the exception of the United States) [29][30] and many developing countries provide medical services through a system of universal health care which 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, but also some communist countries (e.g. China) and the United States,[29][30] provide no guarantee of health care for the population as a whole. In such societies, health care 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.

Modern drug ampoules

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 health care system has come under fire for lack of openness,[31] 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

See also: clinic, hospital, and hospice

Provision of medical care is classified into primary, secondary and tertiary care categories.

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.

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, physiotherapists, respiratory therapists, speech therapists, occupational therapists, radiographers, dietitians and bioengineers.

The scope and sciences underpinning human medicine overlap many other fields. Dentistry, while a separate discipline from medicine, is considered a medical field.

A patient admitted to 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 used in Wikipedia are:

Basic sciences

Specialties

Main article: Medical specialty

In the broadest meaning of "medicine", there are many different specialties. In the UK most specialities will have their own body or college (collectively known as the Royal Colleges, although currently not all use the term "Royal") which have their own entrance exam. The development of a speciality is often driven by new technology (such as the development of effective anaesthetics) or ways of working (e.g. emergency departments) which leads to the desire to form a unifying body of doctors and thence the prestige of administering their own exam.

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 subspecialties in this area require preliminary training in "Internal Medicine". In the UK this would traditionally have been evidenced by obtaining the MRCP (An exam allowing Membership of the Royal College of Physicians 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." (In the UK: Membership of the Royal College of Surgeons of England (MRCS).)There are some specialties of medicine that at the present time 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 by sitting the FRCA (Fellowship of the Royal College of Anesthetists).

Surgery

Main article: Surgery

Surgical specialties employ operative treatment. In addition, surgeons must decide when an operation is necessary, and also treat many non-surgical issues, particularly in the surgical intensive care unit (SICU), where a variety of critical issues arise. Surgery has many subspecialties, e.g. general surgery, cardiovascular surgery, colorectal surgery, neurosurgery, maxillofacial surgery, orthopedic surgery, otolaryngology, plastic surgery, oncologic 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.

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.

'Medicine' as a specialty

Main article: Internal Medicine

Internal medicine is the medical specialty concerned with the diagnosis, management and nonsurgical treatment of unusual or serious diseases, either of one particular organ system or of the body as a whole. According to some sources, an emphasis on internal structures is implied.[32] In North America, specialists in internal medicine are commonly called "internists". Elsewhere, especially in Commonwealth nations, such specialists are often called physicians.[33] 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.[34]

In Commonwealth 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:

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 USA. 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

Other major specialties

The followings are some major medical specialties that do not directly fit into any of the above mentioned groups.

Interdisciplinary fields

Some interdisciplinary sub-specialties of medicine include:

Education

Main articles: Medical education and Medical school Painted by Toulouse-Lautrec in the year of his own death: an examination in the Paris faculty of medicine, 1901

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, and/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.

Many regulatory authorities require continuing medical education, since knowledge, techniques and medical technology continue to evolve at a rapid rate.

Legal controls

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.

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.

Controversy

The Catholic social theorist Ivan Illich subjected contemporary western medicine to detailed attack in his Medical Nemesis, first published in 1975. He argued that the medicalization in recent decades of so many of life's vicissitudes — birth and death, for example — frequently caused more harm than good and rendered many people in effect lifelong patients. He marshalled a body of statistics to show what he considered the shocking extent of post-operative side-effects and drug-induced illness in advanced industrial society. He was the first to introduce to a wider public the notion of iatrogenesis.[35] Others have since voiced similar views, but none so trenchantly, perhaps, as Illich.[36]

Through the course of the twentieth century, healthcare providers focused increasingly on the technology that was enabling them to make dramatic improvements in patients' health. The ensuing development of a more mechanistic, detached practice, with the perception of an attendant loss of patient-focused care, known as the medical model of health, led to criticisms that medicine was neglecting a holistic model.[citation needed] The inability of modern medicine to properly address some common complaints continues to prompt many people to seek support from alternative medicine. Although most alternative approaches lack scientific validation, some, notably acupuncture for some conditions and certain herbs, are backed by evidence.[37]

Medical errors and overmedication are also the focus of complaints and negative coverage. Practitioners of human factors engineering believe that there is much that medicine may usefully gain by emulating concepts in aviation safety, where it is recognized that it is dangerous to place too much responsibility on one "superhuman" individual and expect him or her not to make errors. Reporting systems and checking mechanisms are becoming more common in identifying sources of error and improving practice. Clinical versus statistical, algorithmic diagnostic methods were famously examined in psychiatric practice in a 1954 book by Paul E. Meehl, which controversially found statistical methods superior.[38] A 2000 meta-analysis comparing these methods in both psychology and medicine found that statistical or "mechanical" diagnostic methods were generally, although not always, superior.[38]

Disparities in quality of care given are often an additional cause of controversy.[39] For example, elderly mentally ill patients received poorer care during hospitalization in a 2008 study.[40] Rural poor African-American men were used in a study of syphilis that denied them basic medical care.

Honors and awards

The highest honor awarded in medicine is the Nobel Prize in Medicine, awarded since 1901 by the Royal Swedish Academy of Sciences.

Nobel Laureates in Physiology or Medicine
1901 – 1925

Behring (1901) · Ross (1902) · Finsen (1903) · Pavlov (1904) · Koch (1905) · Golgi / Ramón y Cajal (1906) · Laveran (1907) · Mechnikov / Ehrlich (1908) · Kocher (1909) · Kossel (1910) · Gullstrand (1911) · Carrel (1912) · Bárány (1913) · Bordet (1919) · Krogh (1920) · Hill / Meyerhof (1922) · Banting / Macleod (1923) · Einthoven (1924)
1926 – 1950

Fibiger (1926) · Wagner-Jauregg (1927) · Nicolle (1928) · Eijkman / Hopkins (1929) · Landsteiner (1930) · Warburg (1931) · Sherrington / Adrian (1932) · Morgan (1933) · Whipple / Minot / Murphy (1934) · Spemann (1935) · Dale / Loewi (1936) · Szent-Györgyi (1937) · Heymans (1938) · Domagk (1939) · Dam / Doisy (1943) · Erlanger / Gasser (1944) · Fleming / Chain / Florey (1945) · Muller (1946) · C.Cori / G.Cori / Houssay (1947) · Müller (1948) · Hess / Moniz (1949) · Kendall / Reichstein / Hench (1950)
1951 – 1975

Theiler (1951) · Waksman (1952) · Krebs / Lipmann (1953) · Enders / Weller / Robbins (1954) · Theorell (1955) · Cournand / Forssmann / Richards (1956) · Bovet (1957) · Beadle / Tatum / Lederberg (1958) · Ochoa / Kornberg (1959) · Burnet / Medawar (1960) · Békésy (1961) · Crick / Watson / Wilkins (1962) · Eccles / Hodgkin / Huxley (1963) · Bloch / Lynen (1964) · Jacob / Lwoff / Monod (1965) · Rous / Huggins (1966) · Granit / Hartline / Wald (1967) · Holley / Khorana / Nirenberg (1968) · Delbrück / Hershey / Luria (1969) · Katz / Euler / Axelrod (1970) · Sutherland (1971) · Edelman / Porter (1972) · Frisch / Lorenz / Tinbergen (1973) · Claude / Duve / Palade (1974) · Baltimore / Dulbecco / Temin (1975)
1976 – 2000

Blumberg / Gajdusek (1976) · Guillemin / Schally / Yalow (1977) · Arber / Nathans / Smith (1978) · Cormack / Hounsfield (1979) · Benacerraf / Dausset / Snell (1980) · Sperry / Hubel / Wiesel (1981) · Bergström / Samuelsson / Vane (1982) · McClintock (1983) · Jerne / Köhler / Milstein (1984) · Brown / Goldstein (1985) · Cohen / Levi-Montalcini (1986) · Tonegawa (1987) · Black / Elion / Hitchings (1988) · Bishop / Varmus (1989) · Murray / Thomas (1990) · Neher / Sakmann (1991) · Fischer / Krebs (1992) · Roberts / Sharp (1993) · Gilman / Rodbell (1994) · Lewis / Nüsslein-Volhard / Wieschaus (1995) · Doherty / Zinkernagel (1996) · Prusiner (1997) · Furchgott / Ignarro / Murad (1998) · Blobel (1999) · Carlsson / Greengard / Kandel (2000)
2001 – present

Hartwell / Hunt / Nurse (2001) · Brenner / Horvitz / Sulston (2002) · Lauterbur / Mansfield (2003) · Axel / Buck (2004) · Marshall / Warren (2005) · Fire / Mello (2006) · Capecchi / Evans / Smithies (2007) · Barré-Sinoussi / Montagnier / zur Hausen (2008) · Blackburn / Greider / Szostak (2009)
·

See also

Main article: Outline of medicine
Medicine portal

References

  1. ^ Etymology: Latin: medicina, from ars medicina "the medical art," from medicus "physician."(Etym.Online) Cf. mederi "to heal," etym. "know the best course for," from PIE base *med- "to measure, limit. Cf. Greek medos "counsel, plan," Avestan vi-mad "physician")
  2. ^ "Medicine" Online Etymology Dictionary
  3. ^ Culliford Larry (December 2002). "Spirituality and clinical care (Editorial)". British Medical Journal 325 (7378): 1434–5. doi:10.1136/bmj.325.7378.1434. PMID 12493652.
  4. ^ Prof. Arjuna Aluvihare, "Rohal Kramaya Lovata Dhayadha Kale Sri Lankikayo" Vidhusara Science Magazine, Nov. 1993.
  5. ^ Resource Mobilization in Sri Lanka's Health Sector - Rannan-Eliya, Ravi P. & De Mel, Nishan, Harvard School of Public Health & Health Policy Programme, Institute of Policy Studies [disambiguation needed], February 1997, Page 19. Accessed 2008-02-22.
  6. ^ A. Singh and D. Sarangi (2003). "We need to think and act", Indian Journal of Plastic Surgery.
  7. ^ H. W. Longfellow (2002). "History of Plastic Surgery in India", Journal of Postgraduate Medicine.
  8. ^ Useful known and unknown views of the father of modern medicine, Hippocrates and his teacher Democritus., U.S. National Library of Medicine
  9. ^ a b The father of modern medicine: the first research of the physical factor of tetanus, European Society of Clinical Microbiology and Infectious Diseases
  10. ^ Grammaticos P.C. & Diamantis A. (2008). "Useful known and unknown views of the father of modern medicine, Hippocrates and his teacher Democritus". Hell J Nucl Med 11 (1): 2–4. PMID 18392218.
  11. ^ Garrison 1966, p. 97
  12. ^ Martí-Ibáñez 1961, p. 90
  13. ^ Becka J (1980). "The father of medicine, Avicenna, in our science and culture: Abu Ali ibn Sina (980-1037) (Czech title: Otec lékarů Avicenna v nasí vĕdĕ a kulture)" (in Czech). Cas Lek Cesk 119 (1): 17–23. PMID 6989499.
  14. ^ Medical Practitioners
  15. ^ ""The Canon of Medicine" (work by Avicenna)". Encyclopædia Britannica. 2008. http://www.britannica.com/eb/topic-92902/The-Canon-of-Medicine. Retrieved 2008-06-11.
  16. ^ Ahmad, Z. (St Thomas' Hospital) (2007). "Al-Zahrawi - The Father of Surgery". ANZ Journal of Surgery 77 (Suppl. 1): A83. doi:10.1111/j.1445-2197.2007.04130_8.x
  17. ^ Rabie E. Abdel-Halim (2006), "Contributions of Muhadhdhab Al-Deen Al-Baghdadi to the progress of medicine and urology", Saudi Medical Journal 27 (11): 1631-1641.
  18. ^ Chairman's Reflections (2004), "Traditional Medicine Among Gulf Arabs, Part II: Blood-letting", Heart Views 5 (2): 74-85 [80].
  19. ^ Martín-Araguz A, Bustamante-Martínez C, Fernández-Armayor Ajo V, Moreno-Martínez JM (2002-05-01—15). "Neuroscience in al-Andalus and its influence on medieval scholastic medicine" (in Spanish). Revista de neurología 34 (9): 877–892. PMID 12134355.
  20. ^ David W. Tschanz, PhD (2003), "Arab(?) Roots of European Medicine", Heart Views 4 (2).
  21. ^ On the dominance of the Greek humoral theory, which was the basis for the practice of bloodletting, in medieval Islamic medicine see Peter E. Pormann and E. Savage Smith,Medieval Islamic medicine, Georgetown University, Washington DC, 2007 p. 10, 43-45.
  22. ^ Micheau, Françoise. "The Scientific Institutions in the Medieval Near East". pp. 991–2 , in (Morelon & Rashed 1996, pp. 985–1007)
  23. ^ Peter Barrett (2004), Science and Theology Since Copernicus: The Search for Understanding, p. 18, Continuum International Publishing Group, ISBN 056708969X.
  24. ^ Michael Dols has shown that the Black Death was much more commonly believed by European authorities than by Middle Eastern authorities to be contagious; as a result, flight was more commonly counseled, and in urban Italy quarantines were organized on a much wider level than in urban Egypt or Syria (The Black Death in the Middle East Princeton, 1977, p. 119; 285-290.
  25. ^ Peter Cooper, "Medicinal properties of body parts", The Pharmaceutical Journal, 18/25 December 2004, Vol. 273 / No 7330, pp. 900-902 http://www.pharmj.com/editorial/20041218/christmas/p900bodyparts.html
  26. ^ Ezzo J, Bausell B, Moerman DE, Berman B, Hadhazy V (2001). "Reviewing the reviews. How strong is the evidence? How clear are the conclusions?". Int J Technol Assess Health Care 17 (4): 457–466. PMID 11758290.
  27. ^ a b Coulehan JL, Block MR (2005). The Medical Interview: Mastering Skills for Clinical Practice (5th ed.). F. A. Davis. ISBN 0-8036-1246-X. OCLC 232304023.
  28. ^ Addison K, Braden JH, Cupp JE, Emmert D, et al. (AHIMA e-HIM Work Group on the Legal Health Record) (September 2005). "Update: Guidelines for Defining the Legal Health Record for Disclosure Purposes". Journal of AHIMA 78 (8): 64A–G. PMID 16245584. http://library.ahima.org/xpedio/groups/public/documents/ahima/bok1_027921.hcsp?dDocName=bok1_027921.
  29. ^ a b Insuring America's Health: Principles and Recommendations, Institute of Medicine at the National Academies of Science, 2004-01-14
  30. ^ a b "The Case For Single Payer, Universal Health Care For The United States". Cthealth.server101.com. http://cthealth.server101.com/the_case_for_universal_health_care_in_the_united_states.htm. Retrieved 2009-05-04.
  31. ^ Martin Sipkoff (January 2004). "Transparency called key to uniting cost control, quality improvement". Managed Care. http://www.managedcaremag.com/archives/0401/0401.forum.html.
  32. ^ internal medicine at Dorland's Medical Dictionary
  33. ^ H.W. Fowler. (1994). A Dictionary of Modern English Usage (Wordsworth Collection) (Wordsworth Collection). NTC/Contemporary Publishing Company. ISBN 1853263184.
  34. ^ "The Royal Australasian College of Physicians: What are Physicians?". Royal Australasian College of Physicians. Archived from the original on 2008-03-06. http://web.archive.org/web/20080306053048/http://www.racp.edu.au/index.cfm?objectid=49EF1EB5-2A57-5487-D74DBAFBAE9143A3. Retrieved 2008-02-05.
  35. ^ Illich Ivan (1974). Medical Nemesis. London: Calder & Boyars. ISBN 0714510963. OCLC 224760852.
  36. ^ Postman Neil (1992). Technopoly: The Surrender of Culture to Technology. New York: Knopf. OCLC 24694343.
  37. ^ The HealthWatch Award 2005: Prof. Edzard Ernst, Complementary medicine: the good the bad and the ugly. Retrieved 5 August 2006.
  38. ^ a b Grove WH, Zald DH, Lebow BS, Snitz BE, Nelson C. (2000). "Clinical versus mechanical prediction: A meta-analysis" (w). Psychological Assessment 12 (1): 19–30. doi:10.1037/1040-3590.12.1.19. PMID 10752360. http://www.psych.umn.edu/faculty/grove/096clinicalversusmechanicalprediction.pdf.
  39. ^ "Eliminating Health Disparities". American Medical Association. http://www.ama-assn.org/ama/pub/physician-resources/public-health/eliminating-health-disparities.shtml.
  40. ^ "Mental Disorders, Quality of Care, and Outcomes Among Older Patients Hospitalized With Heart Failure". http://archpsyc.ama-assn.org/cgi/content/abstract/65/12/1402.

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