A physician—also known as doctor of medicine It is a professional doctorate / first professional degree in some countries, including the United States and Canada, although training is entered after obtaining from 90 to 120 credit hours of university level work (see second entry degree) and in most cases after having obtained a Bachelors Degree. In other countries, such as United Kingdom and, medical doctor, or simply doctor—practices the ancient profession A profession is a vocation founded upon specialised educational training, the purpose of which is to supply disinterested counsel and service to others, for a direct and definite compensation, wholly apart from expectation of other business gain of medicine Medicine is the science and art of healing. It encompasses a range of health care practices evolved to maintain and restore health by the prevention and treatment of illness. Before scientific medicine, healing arts were practised in accordance with alchemical treatments and ritual practices that developed out of religious and cultural traditions, which is concerned with maintaining or restoring human 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" through the study, diagnosis 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 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 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 or 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. This properly requires both a detailed knowledge Knowledge is defined by the Oxford English Dictionary as expertise, and skills acquired by a person through experience or education; the theoretical or practical understanding of a subject; (ii) what is known in a particular field or in total; facts and information; or (iii) awareness or familiarity gained by experience of a fact or situation of the academic disciplines (such as anatomy Anatomy is a branch of biology and medicine that is the consideration of the structure of living things. It is a general term that includes human anatomy, animal anatomy (zootomy) and plant anatomy (phytotomy). In some of its facets anatomy is closely related to embryology, comparative anatomy and comparative embryology, through common roots in and physiology Physiology is the science of the functioning of living systems. It is a subcategory of biology. In physiology, the scientific method is applied to determine how organisms, organ systems, organs, cells and biomolecules carry out the chemical or physical function that they have in a living system. The word physiology is from Ancient Greek: φύσις) underlying diseases and their treatment—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, of medicine—and also a decent competence Competence is a standardized requirement for an individual to properly perform a specific job. It encompasses a combination of knowledge, skills and behavior utilized to improve performance. More generally, competence is the state or quality of being adequately or well qualified, having the ability to perform a specific role in its applied practice—the art or craft A craft is a skill, especially involving practical arts. It may refer to a trade or particular art of medicine.

Both the role of the physician and the meaning of the word itself vary significantly around the world, but as generally understood, the ethics of medicine Medical ethics is primarily a field of applied ethics, the study of moral values and judgments as they apply to 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 require that physicians show consideration Consideration is the legal concept of value in connection with contracts. It is anything of value in the common sense, promised to another when making a contract. It can take the form of money, physical objects, services, promised actions, abstinence from a future action and much more. Under the notion of "pre-existing duties," if either, 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 and benevolence for their patients A patient is any person who receives medical attention, care, or treatment. The person is most often ill or injured and in need of treatment by a physician or other health care professional, although one who is visiting a physician for a routine check-up may also be viewed as a patient.

Life is short, and Art long; the crisis fleeting; experience perilous, and decision difficult. The physician must not only be prepared to do what is right himself, but also to make the patient, the attendants, and externals cooperate. —First aphorism of Hippocrates Hippocrates of Cos or Hippokrates of Kos - Greek: Ἱπποκράτης; Hippokrátēs was an ancient Greek physician of the Age of Pericles (Classical Athens), and is considered one of the most outstanding figures in the history of medicine. He is referred to as the Western father of medicine in recognition of his lasting contributions to the, c. 400 BCE, from the Hippocratic Corpus online (translated by Francis Adams)

Etymology

The word physician comes from the Ancient Greek Ancient Greek is the historical stage in the development of the Greek language spanning the Archaic , Classical (c. 5th–4th centuries BC), and Hellenistic (c. 3rd century BC – 6th century AD) periods of ancient Greece and the ancient world. It is predated in the 2nd millennium BC by Mycenaean Greek. Its Hellenistic phase is known as Koine (& word φύσις (physis) and its derived adjective physikos, meaning "nature" and "natural". From this, amongst other derivatives came the Vulgar Latin Vulgar Latin was the nonstandard form of the Latin language; because of its nonstandard nature, it had no official orthography, and only Classical Latin was used in writing. It is sometimes called colloquial Latin physicus, which meant a medical practitioner. After the Norman Conquest The Norman conquest of England began on 28 September 1066 with the invasion of the Kingdom of England by the troops of William the Conqueror, Duke of Normandy and their victory at the Battle of Hastings (on the other side of the Channel in Southeast England) on 14 October 1066 over King Harold II of England. Harold's army had been badly depleted, the word entered Middle English Middle English is the name given by historical linguists to the diverse forms of the English language in use between the late 11th century and about 1470, when the Chancery Standard, a form of London-based English, began to become widespread, a process aided by the introduction of the printing press into England by William Caxton in the late 1470s, via Old French Old French was the Romance dialect continuum spoken in territories that span roughly the northern half of modern France and parts of modern Belgium and Switzerland from the 9th century to the 14th century. It is a direct descendent of Old Gallo-Romance. It was then known as the langue d'oïl to distinguish it from the langue d'oc (Occitan language, fisicien, as early as 1100. Originally, physician meant a practitioner of physic (pronounced with a hard C). This archaic noun had entered Middle English by 1300 (via Old French fisique). Physic meant the art or science of treatment with drugs or medications (as opposed to 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), and was later used both as a verb and also to describe the medications themselves.^[2][3][4]

In English, there have been many synonyms Synonyms are different words with identical or very similar meanings. Words that are synonyms are said to be synonymous, and the state of being a synonym is called synonymy. The word comes from Ancient Greek syn ("with") and onoma (ὄνομα) ("name"). The words car and automobile are synonyms. Similarly, if we talk about a for physician, both old and new, with some semantic variation. The noun phrase medical practitioner is perhaps the most widely understood and neutral synonym. Medical practitioner is lengthy but inclusive: it covers both medical specialists A specialty in medicine is a branch of medical science. After completing medical school, physicians or surgeons usually further their medical education in a specific specialty of medicine by completing a multiple year residency. Medical practitioners who engage in a medical specialty are known as medical specialists and general practitioners A general practitioner or GP is a medical practitioner who provides primary care and specializes in nothing and sees everything. A general practitioner treats acute and chronic illnesses and provides preventive care and health education for all ages and both sexes. They have particular skills in treating people with multiple health issues and (family physicians, family practitioners), and historically would include physicians (in the narrow sense), surgeons and apothecaries Apothecary is a historical name for a medical professional who formulates and dispenses materia medica to physicians, surgeons and patients — a role now served by a pharmacist (or a chemist or dispensing chemist), and some caregivers. In England, apothecaries historically included those who now would be called general practitioners and pharmacists Pharmacists are health professionals who practice the science of pharmacy. In their traditional role, pharmacists typically take a request for medicines from a prescribing health care provider in the form of a medical prescription, evaluate the appropriateness of the prescription, dispense the medication to the patient and counsel them on the.

The term doctor (medical doctor) is older and shorter, but can be confused with holders of other academic doctorates (see doctor of medicine It is a professional doctorate / first professional degree in some countries, including the United States and Canada, although training is entered after obtaining from 90 to 120 credit hours of university level work (see second entry degree) and in most cases after having obtained a Bachelors Degree. In other countries, such as United Kingdom and). Doctor (gen. In grammar, the genitive case is the case that marks a noun as modifying another noun. It often marks a noun as being the possessor of another noun but it can also indicate various relationships other than possession; certain verbs may take arguments in the genitive case; and it may have adverbial uses (see Adverbial genitive). Modern English does: doctoris) means teacher in Latin Latin is an Italic language originally spoken in Latium and Ancient Rome. With the Roman conquest, Latin was spread to countries around the Mediterranean, including a large part of Europe. Romance languages such as Aragonese, Corsican, Catalan, French, Italian, Portuguese, Romanian, Sardinian, Spanish and others, are descended from Latin, while and is an agent noun In linguistics, an agent noun is a word that is derived from another word denoting an action, and that identifies an entity that does that action. For example, "driver" is an agent noun formed from the verb "drive". The endings "-er", "-or", and "-ist" are commonly used in English to form agent derived from the verb docere ('teach').^[5] A cognate An example of cognates within the same language would be English shirt and skirt, the former from Old English sċyrte, the latter loaned from Old Norse skyrta, both from the same Common Germanic *skurtjōn-. Words with this type of relationship within a single language are called doublets. Further cognates of the same word in other Germanic expression occurs in French French is a Romance language spoken as a first language by about 136 million people worldwide. Around 190 million people speak French as a second language, and an additional 200 million speak it as an acquired foreign language. French speaking communities are present in 57 countries and territories. Most native speakers of the language live in as docteur médecin, a direct equivalent of medical doctor or doctor of medicine, and commonly found as its contraction, médecin (doctor, physician).

The Greek Greek , an independent branch of the Indo-European family of languages, is the language of the Greeks. Native to the southern Balkans, it has the longest documented history of any Indo-European language, spanning 34 centuries of written records. In its ancient form, it is the language of classical ancient Greek literature and the New Testament of word ἰατρός (iatrós, doctor or healer) is often translated as physician. Ἱατρός is not preserved directly in English, but occurs in such formations as psychiatrist A psychiatrist is a physician who specializes in psychiatry and is certified in treating mental disorders. All psychiatrists are trained in diagnostic evaluation and in psychotherapy. As part of their evaluation of the patient, psychiatrists are one of the few mental health professionals who may prescribe psychiatric medication, conduct physical (translates from Greek as healer of the soul), podiatrist Podiatry is a branch of medicine devoted to the study, diagnosis and treatment of disorders of the foot, ankle and lower leg (foot healer), and iatrogenic disease The terms iatrogenesis and iatrogenic artifact refer to inadvertent adverse effects or complications caused by or resulting from medical treatment or advice. In addition to harmful consequences of actions by physicians, iatrogenesis can also refer to actions by other healthcare professionals, such as psychologists, therapists, pharmacists, nurses, (a disease caused by medical treatment). In Latin Classical Latin in simplest terms is the sociolinguistic register of the Latin language regarded by the enfranchised and empowered populations of the late Roman republic and the Roman empire as good Latin. Most writers during this time made use of it. Any unabridged Latin dictionary informs moderns that Marcus Tullius Cicero and his contemporaries, the word medicus meant much what physician or doctor does now. Compare these translations of a well-known proverb (the nouns are in vocative case The vocative case is the case used for a noun identifying the person (animal, object, etc.) being addressed and/or occasionally the determiners of that noun. A vocative expression is an expression of direct address, wherein the identity of the party being spoken to is set forth expressly within a sentence. For example, in the sentence, "I don'):

Ἰατρέ, θεράπευσον σεαυτόν (Greek New Testament The New Testament is the name given to the second major division of the Christian Bible, the first such division being the much longer Old Testament. Unlike the Old Testament, the contents of the New Testament deal explicitly with Christianity, although both the Old and New Testament are regarded, together, as Sacred Scripture. The New Testament: Luke, 4:23) Medice, cura teipsum (from the Vulgate The Vulgate is a late 4th-century Latin version of the Bible, and largely the result of the labors of Jerome, who was commissioned by Pope Damasus I in 382 to make a revision of the old Latin translations. By the 13th century this revision had come to be called the versio vulgata, that is, the "commonly used translation", and ultimately, early 5th century) Physician, heal thyself (from the Authorized King James Version The Authorized King James Version is an English translation of the Christian Holy Bible begun in 1604 and completed in 1611 by the Church of England. Printed by the King's Printer, Robert Barker, the first edition included schedules unique to the Church of England; for example, a lectionary for morning and evening prayer. This was the third such, 1611)

The ancient Romans also had the word archiater An archiater was a chief physician of a monarch, who typically retained several. At the Roman imperial court, their chief held the high rank and specific title of Comes archiatrorum, for court physician. Archiater derives from the ancient Greek ἀρχιατρός (from ἄρχω + ἰατρός, chief healer). By contraction, this title has given modern German German (Deutsch, [ˈdɔʏtʃ] ) is a West Germanic language, thus related to and classified alongside English and Dutch. It is one of the world's major languages and the most widely spoken first language in the European Union. Globally, German is spoken by approximately 120 million native speakers and also by about 80 million non-native speakers its word for physician: Arzt.

Leech and leechcraft are archaic English words respectively for doctor and medicine.^[2] The Old English Old English or Anglo-Saxon is an early form of the English language that was spoken and written in parts of what are now England and south-eastern Scotland between at least the mid-5th century and the mid-12th century. What survives through writing represents primarily the literary register of Anglo-Saxon word for "physician", læċe, which is related to Old High German The term Old High German refers to the earliest stage of the German language and it conventionally covers the period from around 500 to 1050. Coherent written texts do not appear until the second half of the 8th century, and some treat the period before 750 as 'prehistoric' and date the start of Old High German proper to 750 for this reason. There lāhhi and Old Irish Old Irish is the name given to the oldest form of the Goidelic languages for which extensive written texts are extant. It was used from the 6th to the 10th centuries, by which time it had developed into Middle Irish liaig, lives on as the modern English word leech, as these particular creatures were formerly much used by the medical profession. Cognate forms for leech exist in Scandinavian languages: in modern Swedish as läkare, in Danish as læge, in modern Norwegian as lege (bokmål) or lækjar (nynorsk), and in Finnish as lääkäri. These Scandinavian words still translate as doctor or physician rather than as a blood-sucking parasite.

Modern meanings

In modern English, the term physician is used in two main ways, with relatively broad and narrow meanings respectively. This is the result of history and is often confusing. These meanings and variations are explained below.

North America

Especially in North America, the title physican is now widely used in the broad sense, and applies to any medical practitioner holding a medical degree. In the United States and Canada, the term physician usually describes all those holding the degrees of Doctor of Medicine (MD) and Doctor of Osteopathic Medicine (DO). Within North America, the title physician, in this broad sense, also describes the holders of medical degrees from other countries that are equivalent to the North American Doctor of Medicine degrees; typical examples of such degrees from non-North American countries are MB BChir, BM BCh, MB BCh, MB ChB, MBBS, BM, M.B.B.S. etc.. In the US, only those graduating from faculties listed in the WHO Directory of Medical Schools ^[6] are able to apply for medical licensure in the relevant US jurisdiction, via the ECFMG.^[7]

The American Medical Association, established in 1847, currently uses physician in this broad sense to describe all its members. However, the American College of Physicians, established in 1915, does not: its title uses physician in an older, narrower sense, as discussed below.

Specialist in internal medicine

Physician is still widely used in its older, more narrow sense, especially outside North America. In this usage, a physician is a specialist in internal medicine or one of its many sub-specialties (especially as opposed to a specialist in surgery). This traditional meaning of physician conveys a sense of expertise in treatment by drugs or medications, rather than by the procedures of surgeons.^[8]

This older usage is at least six hundred years old in English: physicians and surgeons were once members of separate professions, and traditionally were rivals. The Shorter Oxford English Dictionary, third edition, gives a Middle English quotation making this contrast, from as early as 1400:

O Lord, whi is it so greet difference betwixe a cirugian and a physician.^[2]

Henry VIII granted a charter to the London Royal College of Physicians in 1518. It was not until 1540 that he granted the Company of Barber/Surgeons (ancestor of the Royal College of Surgeons) its separate charter. In the same year, the English monarch established the Regius Professorship of Physic at the University of Cambridge.^[9] Newer universities would probably describe such an academic as a professor of internal medicine. Hence, in the 16th century, physic meant roughly what internal medicine does now.

Currently, a specialist physician in this older, narrower sense would probably be described in the United States as an internist. Another term, hospitalist, was introduced in 1996,^[10] to describe US specialists in internal medicine who work largely or exclusively in hospitals. Such 'hospitalists' now make up about 19% of all US general internists,^[11] who are often called general physicians in Commonwealth countries.

The older, more narrow usage of physician as an internist is common in the United Kingdom and other Commonwealth countries (such as Australia, Bangladesh, India, New Zealand, Pakistan, South Africa, Sri Lanka, Zimbabwe), as well as in places as diverse as Brazil, Hong Kong, Indonesia, Japan, Ireland, and Taiwan. In such places, the more general English terms doctor or medical practitioner are prevalent, describing any practitioner of medicine (whom an American would likely call a physician, in the newer, broad sense).^[12] In Commonwealth countries, specialist pediatricians and geriatricians are also described as specialist physicians who have sub-specialized by age of patient rather than by organ system.

"Physician and surgeon"

Around the world, the combined term "Physician and Surgeon" is a venerable way to describe either a general practitioner, or else any medical practitioner irrespective of specialty.^[2][8] This usage still shows the older, narrower meaning of physician and preserves the old difference between a physician, as a practitioner of physic, and a surgeon. The term may be used by state medical boards in the United States of America, and by equivalent bodies in provinces of Canada, to describe any medical practitioner.

Other designations

Osteopaths are recognized as physicians in 48 countries, particularly in the United States, where they are no longer called osteopaths, but osteopathic physicians or just physicians, and where they have unlimited practicing rights in all specialties and subspecialties of medicine. In the US, osteopathic medical schools (DO) have a curriculum almost identical to allopathic (MD) schools with the exception of osteopathic manipulative medicine, which focuses on extra instruction in the musculoskeletal system. Internationally, there are variations in the DO degree; osteopathic education includes teaching manipulative medicine.^[13] In the U.S.A. the American Podiatric Medical Associaiton (APMA) defines podiatrists as physicians and surgeons that fall under the department of surgery in hospitals.^[14]

In India and many other countries, BHMS (homeopathic) and BAMS (ayurvedic) degree holders like MBBS (allopathic) holders, are treated equally as a registered medical practitioner. They have the right to practice medicine of their systems. They are referred to as physicians. They have to undergo further specialization post-graduate degree to become a specialist in a particular field of medicine/surgery.

Nurse practitioners (NPs) are not described as physicians; the American College of Nurse Practitioners do not describe themselves this way. They are classified as advance practice registered nurses/clinicians, and are also known as mid-level (healthcare) practitioners in US government regulations.^[15] Nurse practitioners may perform work similar to that of physicians, especially within the realm of primary care, but use advanced nursing models instead of medical models. The scope of practice for a Nurse Practitioner in the United States is defined by individual state boards of registration in nursing, as opposed to state boards of registration in medicine. Physician Assistants are also classified as midlevel advance practice clinicians, have a similar scope of practice as nurse practitoners, and are regulated by state boards of registration in medicine.

Social role and world view

Biomedicine

Within Western culture and over recent centuries, conventional Western medicine has become increasingly based on scientific reductionism and materialism. This style of medicine is now dominant throughout the industrialized world, and is often termed Biomedicine by medical anthropologists.^[16] Biomedicine "formulates the human body and disease in a culturally distinctive pattern",^[17] and is a world view learnt by medical students. Within this tradition, the medical model is a term for the complete "set of procedures in which all doctors are trained" (R. D. Laing, 1972),^[18] including mental attitudes. A particularly clear expression of this world view, currently dominant among conventional physicians, is evidence-based medicine. Within conventional Western medicine, most physicians still pay heed to their ancient traditions:

The critical sense and sceptical attitude of the Hippocratic school laid the foundations of modern medicine on broad lines, and we owe to it: first, the emancipation of medicine from the shackles of priestcraft and of caste; secondly, the conception of medicine as an art based on accurate observation, and as a science, an integral part of the science of man and of nature; thirdly, the high moral ideals, expressed in that most "memorable of human documents" (Gomperz), the Hippocratic oath; and fourthly, the conception and realization of medicine as the profession of a cultivated gentleman. — Sir William Osler, Chauvanism in Medicine (1902)^[19]

In this Western tradition, physicians are considered to be members of a learned profession, and enjoy high social status, often combined with expectations of a high and stable income and job security. However, medical practitioners often work long and inflexible hours, with shifts at unsociable times. Their high status is partly from their extensive training requirements, and also because of their occupation's special ethical and legal duties. The term traditionally used by physicians to describe a person seeking their help is the word patient (although one who visits a physician for a routine check-up may also be so described). This word patient is an ancient reminder of medical duty, as it originally meant 'one who suffers'. The English noun comes from the Latin word patiens, the present participle of the deponent verb, patior, meaning 'I am suffering,' and akin to the Greek verb πάσχειν (= paskhein, to suffer) and its cognate noun πάθος (= pathos).^[2][3]

Physicians in the narrow sense (specialist physicians or internists—see above) are commonly members or fellows of professional organizations, such as the American College of Physicians or the Royal College of Physicians in the United Kingdom, and such hard-won membership is itself a mark of status.

Complementary and alternative medicine

While contemporary biomedicine has distanced itself from its ancient roots in religion and magic, many forms of traditional medicine^[20] and complementary and alternative medicine (CAM) continue to espouse vitalism in various guises: 'As long as life had its own secret properties, it was possible to have sciences and medicines based on those properties' (Grossinger 1980). ^[21] The US National Center for Complementary and Alternative Medicine (NCCAM) classifies CAM therapies into five categories or domains, including:^[22] alternative medical systems, or complete systems of therapy and practice;mind-body interventions, or techniques designed to facilitate the mind's effect on bodily functions and symptoms;biologically based systems, including herbalism; and manipulative and body-based methods, such as chiropractic and massage therapy.

In considering these alternate traditions that differ from biomedicine (see above), medical anthropologists emphasize that all ways of thinking about health and disease have a significant cultural content, including conventional western medicine.^{[16][17][23][24]}

Homeopathy is a popular complementary system of medicine. Homeopathy is included in national system of medicine in many countries including India and neighbouring countries. The practitioners of homeopathic medicine in these countries are generally referred to as homeopathic doctor/homeopath/homeopathic physician on par with conventional medical physicians.

Physicians' own health

Some commentators have argued that physicians have duties to serve as role models for the general public in matters of health, for example by not smoking cigarettes.^[25] Indeed, in most western nations relatively few physicians smoke, and their professional knowledge does appear to have a beneficial effect on their health and lifestyle. According to a study of male physicians,^[26] life expectancy is slightly higher for physicians (73.0 years for white and 68.7 for black) than lawyers or many other highly educated professionals. Causes of death less likely in physicians than the general population include respiratory disease (including pneumonia, pneumoconioses, COPD, but excluding emphysema and other chronic airway obstruction), alcohol-related deaths, rectosigmoidal and anal cancers, and bacterial diseases.^[26]

However ... "By medicine life may be prolong'd, yet death will seize the Doctor too" (Cymbeline).^[27] Physicians are exposed to occupational hazards and temptations, and there is a well-known aphorism that "doctors make the worst patients".^[28] Causes of death that may be higher in physicians than in the general population include suicide and self-inflicted injury, drug-related causes, traffic accidents, and cerebrovascular and ischaemic heart disease.^[26]

Desired behaviour

Interviews with patients have indicated that the ideal physician would be confident, empathetic, humane, personal, forthright, respectful, and thorough. Incorporating clues to such behaviors may create a better doctor-patient relationship.^[29]

Undesired behaviors are essentially the opposites, specially being insensitive or disrespectful, e.g. arrogance in dismissing the patient's input, disinterest in the patient as an individual, impatience in answering a patient's questions or callousness in discussing the patient's prognosis. Another undesired behavior is seemingly providing excellent service in the original visit but then failing to meet the created expectations about the speed or quality of follow-up service.^[29]

Still, when having to choose between high technical quality and high interpersonal quality, two thirds of patients choose high technical quality.^[30] Nevertheless, the level of technical quality may be hard for a non-professional to assess, which in reality results in a tendency of patients to primarily judge physicians on behavior.^[29]

Education and training

Medical education and career pathways for doctors vary considerably across the world.

All medical practitioners

In all developed countries, entry-level medical education programs are tertiary-level courses, undertaken at a medical school attached to a university. Depending on jurisdiction and university, entry may follow directly from secondary school or require pre-requisite undergraduate education. The former commonly take five or six years to complete. Programs that require previous undergraduate education (typically a three or four year degree, often in Science) are usually four or five years in length. Hence, gaining a basic medical degree may typically take from five to eight years, depending on jurisdiction and university.

Following completion of entry-level training, newly graduated medical practitioners are often required to undertake a period of supervised practice before full registration is granted, typically one or two years. This may be referred to as "internship" or "conditional registration". Some jurisdictions, including the United States, require residencies for practice.

Medical practitioners hold a medical degree specific to the university from which they graduated. This degree qualifies the medical practitioner to become licensed or registered under the laws of that particular country, and sometimes of several countries, subject to requirements for internship or conditional registration.

Specialists in internal medicine

After graduation, medical practitioners often undertake further training in a particular field, to become a medical specialist. In North America, this is often referred to as residency training; in Commonwealth countries, such trainees are often called registrars.

This further training typically takes from three to six years, but can be longer depending on specialty and jurisdiction. Primary care is increasingly recognized as a specialty, and residency programmes in this field are becoming common. A medical practitioner who completes specialist training in internal medicine (or in one of its sub-specialties) is an internist, or a physician in the older, narrower sense.

In some jurisdictions, specialty training is begun immediately following completion of entry-level training, or even before. In other jurisdictions, junior medical doctors must undertake generalist (un-streamed) training for one or more years before commencing specialization. Hence, depending on jurisdiction, a specialist physician (internist) often does not achieve recognition as a specialist until twelve or more years after commencing basic medical training—five to eight years at university to obtain a basic medical qualification, and up to another nine years to become a specialist.

Regulation

In most jurisdictions, physicians (in either sense of the word) need government permission to practice. Such permission is intended to promote public safety, and often to protect the public purse, as medical care is commonly subsidized by national governments.

All medical practitioners

Among the English-speaking countries, this process is known either as licensure as in the United States, or as registration in the United Kingdom, other Commonwealth countries, and Ireland. Synonyms in use elsewhere include colegiación in Spain, ishi menkyo in Japan, autorisasjon in Norway, Approbation in Germany, and "άδεια εργασίας" in Greece. In France, Italy and Portugal, civilian physicians must be members of the Order of Physicians to practise medicine.

In some countries, including the United Kingdom and Ireland, the profession largely regulates itself, with the government affirming the regulating body's authority. The best known example of this is probably the General Medical Council of Britain. In all countries, the regulating authorities will revoke permission to practice in cases of malpractice or serious misconduct.

In the large English-speaking federations (United States, Canada, Australia), the licensing or registration of medical practitioners is done at a state or provincial level. Australian states usually have a "Medical Board," while Canadian provinces usually have a "College of Physicians and Surgeons." All American states have an agency which is usually called the "Medical Board", although there are alternate names such as "Board of Medicine," "Board of Medical Examiners", "Board of Medical Licensure", "Board of Healing Arts" or some other variation.^[31] After graduating from a first-professional school, physicians who wish to practice in the U.S. usually take standardized exams, such as the USMLE for MDs or COMLEX-USA for DOs.

In India, an MBBS medical degree is required to become a basic doctor or a physician. They should undergo a three or two years post-graduate degree or diploma training to become a specialist and further study for super-specialization. MCI is responsible for controlling the above stated medical education.

Specialists in internal medicine

Most countries have some method of officially recognizing specialist qualifications in all branches of medicine, including internal medicine. Sometimes, this aims to promote public safety by restricting the use of hazardous treatments. Other reasons for regulating specialists may include standardization of recognition for hospital employment and restriction on which practitioners are entitled to receive higher insurance payments for specialist services.

Performance and professionalism supervision

The issue of medical errors, drug abuse, and other issues in physician professional behavior received significant attention across the world,^[32] particularly following a critical 2000 report^[33] which "arguably launched" the patient-safety movement.^[34] In the U.S., as of 2006 there were few organizations which systematically monitored performance. In the U.S. only the Department of Veterans Affairs randomly drug tests, in contrast to drug testing practices for other professions which have a major impact on public welfare. Licensing boards at the U.S. state level depend upon continuing education to maintain competence.^[35] In Europe, as of 2009 the health systems are governed according to various national laws, and can also vary according to regional differences similar to the United States.^[36]

See also

• Doctor's visit
• International medical graduate
• National Doctor Database
• List of physicians
• List of medical schools
• Residency (medicine)
• Society of General Internal Medicine
• Physicians per population

References

1. ^ In 1949, Fildes' painting The Doctor was used by the American Medical Association in a campaign against a proposal for nationalized medical care put forth by President Harry S. Truman. The image was used in posters and brochures along with the slogan, "Keep Politics Out of this Picture" implying that involvement of the government in medical care would negatively affect the quality of care. 65,000 posters of The Doctor were displayed, which helped to raise public skepticism for the nationalized health care campaign.|http://correspondents.theatlantic.com/abraham_verghese/2009/06/the_ama_conflicted_in_its_interests.ph>
2. ^ ^{a b c d e} Brown, Lesley (2002). The New shorter Oxford English dictionary on historical principles. Oxford [Eng.]: Clarendon. ISBN 0198612710.
3. ^ ^{a b} Partridge, Eric (1966). Origins: a short etymological dictionary of modern English. New York: Macmillan. ISBN 0025948407.
4. ^ Steinmetz, Sol; Barnhart, Robert K. (1999). Chambers dictionary of etymology. Edinburgh: Chambers. ISBN 0550142304.
5. ^ Oxford English Dictionary, v. doctor.
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7. ^ [2]
8. ^ ^{a b} H.W. Fowler. (1994). A Dictionary of Modern English Usage (Wordsworth Collection). NTC/Contemporary Publishing Company. ISBN 1853263184.
9. ^ "University of Cambridge: History of the School of Clinical Medicine". University of Cambridge. http://www.medschl.cam.ac.uk/about/history.html. Retrieved 2008-02-05.
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11. ^ Kuo, YF; Sharma, G; Freeman, JL; Goodwin, JS (2009). "Growth in the care of older patients by hospitalists in the United States". N Engl J Med 360 (11): 1102–1112. doi:10.1056/NEJMsa0802381. PMID 19279342.
12. ^ "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.
13. ^ "JAOA Letters". http://www.jaoa.org/cgi/reprint/107/1/6.pdf. Retrieved 2008-03-01.
14. ^ http://www.apma.org/MainMenu/AboutPodiatry.aspx
15. ^ http://www.deadiversion.usdoj.gov/21cfr/cfr/1300/1300_01.htm#b28
16. ^ ^{a b} A. D. Gaines, R.A. Hahn, ed (1985). "Chapter 1: Introduction (by editors)". Physicians of western medicine. Dordrecht (Netherlands): D. Reidel. pp. 3–22. ISBN 90-277-1790-7.
17. ^ ^{a b} Good, Byron J (1994). "Chapter 3". Medicine, rationality, and experience: an anthropological perspective (based on the Lewis Henry Morgan Lectures, at the University of Rochester, NY, in March 1990). Cambridge, UK: Cambridge University Press. pp. 65, 65–87. ISBN 0-521-42576-X (pbk).
18. ^ Laing, R.D. (1971). The politics of the family and other essays. London: Tavistock Publications.
19. ^ Osler, Sir William (1902). "Chauvanism in medicine: address to the Canadian Medical Association, Montreal (17 September 1902)". The Montreal Medical Journal XXXI.
20. ^ Galdston, Iago, ed (1963). "Part 1: Medicine and primitive man (five chapters); Part 2: Medical man and medicine man in three North American Indian societies (three chapters)". Man's image in medicine and anthropology: Monograph IV, Institute of social and historical medicine, New York Academy of Medicine. New York: International Universities Press. pp. 43–334.
21. ^ Grossinger, Richard (1980, 1982 (revised edition)). Planet medicine: from stone age shamanism to post-industrial healing. Berkeley, CA, US: North Atlantic Books. pp. 116–131. ISBN 978-1-55643-369-6.
22. ^ "Complementary and Alternative Medicine – U.S. National Library of Medicine Collection Development Manual". http://www.nlm.nih.gov/tsd/acquisitions/cdm/subjects24.html. Retrieved 2008-03-31.
23. ^ Galdston, Iago, ed (1963). "Part V: Culture and the practice of modern medicine (two chapters)". Man's image in medicine and anthropology: Monograph IV, Institute of social and historical medicine, New York Academy of Medicine. New York: International Universities Press. pp. 477–520.
24. ^ Joralemon, DonaldJ (1999). "chapter 1: What's so cultural about disease?". Exploring medical anthropology. Needham Heights, MA, US: Allyn and Bacon. pp. 1–15. ISBN 0-205-27006-9 (pbk).
25. ^ Appel JM (2009). "Smoke and mirrors: one case for ethical obligations of the physician as public role model". Camb Q Healthc Ethics 18 (1): 95–100. doi:10.1017/S0963180108090142. PMID 19149049.
26. ^ ^{a b c} Frank E, Biola H, Burnett CA (October 2000). "Mortality rates and causes among U.S. physicians". Am J Prev Med 19 (3): 155–9. doi:10.1016/S0749-3797(00)00201-4. PMID 11020591.
27. ^ Shakespeare, William (~1609, publ. 1623). Cymbeline (play): Act 5, Scene 5. London[Eng.].
28. ^ Schneck SA (December 1998). "'Doctoring' doctors and their families". JAMA 280 (23): 2039–42. doi:10.1001/jama.280.23.2039. PMID 9863860.
29. ^ ^{a b c} Bendapudi NM, Berry LL, Frey KA, Parish JT, Rayburn WL (March 2006). "Patients' perspectives on ideal physician behaviors". Mayo Clin. Proc. 81 (3): 338–44. doi:10.4065/​81.3.338 (inactive 2009-12-01). PMID 16529138.
30. ^ Fung CH, Elliott MN, Hays RD, et al. (August 2005). "Patients' preferences for technical versus interpersonal quality when selecting a primary care physician". Health Serv Res 40 (4): 957–77. doi:10.1111/j.1475-6773.2005.00395.x. PMID 16033487.
31. ^ "AMA Links to state medical boards". http://www.ama-assn.org/ama/pub/category/2645.html. Retrieved 2008-03-01.
32. ^ Lim MK (February 2004). "Quest for quality care and patient safety: the case of Singapore". Qual Saf Health Care 13 (1): 71–5. doi:10.1136/qshc.2002.004994. PMID 14757804.
33. ^ Committee on Quality of Health Care in America, Institute of Medicine. (2000). To Err is Human: Building A Safer Health System. National Academies Press. Free full-text.
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35. ^ Leape LL, Fromson JA (January 2006). "Problem doctors: is there a system-level solution?". Ann. Intern. Med. 144 (2): 107–15. PMID 16418410.
36. ^ Suñol R, Garel P, Jacquerye A (February 2009). "Cross-border care and healthcare quality improvement in Europe: the MARQuIS research project". Qual Saf Health Care 18 Suppl 1: i3–7. doi:10.1136/qshc.2008.029678. PMID 19188459.

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