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Medicine

 
Dictionary: Med·i·cine
Home > Library > Literature & Language > Webster 1913

n.

[L. medicina (sc. ars), fr. medicinus medical, fr. medicus: cf. F. médecine. See Medical.]

1. The science which relates to the prevention, cure, or alleviation of disease.

2. Any substance administered in the treatment of disease; a remedial agent; a medication; a medicament; a remedy; physic.

By medicine, life may be prolonged.
Shak.

3. A philter or love potion. [Obs.] Shak.

4. [F. médecin.]
A physician. [Obs.] Shak.

5. (a) Among the North American Indians, any object supposed to give control over natural or magical forces, to act as a protective charm, or to cause healing; also, magical power itself; the potency which a charm, token, or rite is supposed to exert.
[Webster 1913 Suppl.]

The North American Indian boy usually took as his medicine the first animal of which he dreamed during the long and solitary fast that he observed at puberty.
F. H. Giddings.
[Webster 1913 Suppl.]

(b) Hence, a similar object or agency among other savages.
[Webster 1913 Suppl.]

6. Short for Medicine man.
[Webster 1913 Suppl.]

7. Intoxicating liquor; drink. [Slang]
[Webster 1913 Suppl.]

Medicine bag, a charm; -- so called among the North American Indians, or in works relating to them. -- Medicine man (among the North American Indians), a person who professes to cure sickness, drive away evil spirits, and regulate the weather by the arts of magic; a shaman. -- Medicine seal, a small gem or paste engraved with reversed characters, to serve as a seal. Such seals were used by Roman physicians to stamp the names of their medicines.

Med·i·cine
v. t.

To give medicine to; to affect as a medicine does; to remedy; to cure. «Medicine thee to that sweet sleep.» Shak.

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US History Companion: Medicine
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Until the early decades of the twentieth century, methods of treating disease were rooted in local customs and beliefs, not in a professional or scientific consensus. The medicine practiced in one area or by one group was often quite different from medicine elsewhere.

In rural America, laypeople combined local folk custom with information gleaned from medical dictionaries and popular texts to treat injuries and illnesses. Similarly, doctors, not yet an elite professional group, were usually trained through a combination of schooling and apprenticeship. A large number of medical schools were business institutions organized for the profit of local practitioners. Students, often from lower-middle- or working-class backgrounds, paid to attend lectures of dubious worth. Formal medical education, largely unregulated, could vary in length, content, and structure, and after 1847, when the American Medical Association (ama) was formed, its lack of standardization was much criticized.

Few during the nineteenth century agreed on what constituted appropriate practice. Furthermore, most doctors and educated people were skeptical of those who sought to unify medicine under any one therapeutic umbrella. Calls for uniformity were perceived as little more than a political ploy to gain a measure of legitimacy for a particular medical interest group. Throughout much of the century, the disparate demands of different groups created a diverse body of therapeutic knowledge and practice. Accordingly, training differed for rural doctors, urban doctors, homeopaths, allopaths, eclectics, Thomsonians, and a host of others. Those treating different classes and ethnic groups were forced by the realities of the medical marketplace to adjust their practice.

Each group of practitioners identified with a particular "school" or "sect" of medicine. Rural doctors depended mostly on herbal treatments. Thomsonians and later the eclectics were among the botanical schools that developed throughout rural New England, the South, and the Midwest; these groups incorporated local folk customs into their therapeutics. In cities regular practitioners, homeopaths, and many others competed with one another for patients. Thus, unlike today, when patients have little control over the types of therapies used, patients in nineteenth-century America could choose among a wide variety of therapies.

Doctors, by and large, were "family" or "community" practitioners engaged in general medicine; only a small number specialized in surgery, ophthalmology, or other areas. Family doctors, the bulk of the profession, lived in the communities where they practiced, making house calls or treating patients in offices located in their homes. Often they and their patients were members of the same church or club. The family doctor would preside at the significant events in people's lives, tending to births as well as deaths. He saw it as his role to comfort the family, and it was not unusual for him to move into a patient's house for the duration of an illness.

This relationship between doctors and patients was not necessarily a product of a deep-seated belief in democracy or in the importance of trust and understanding in the therapeutic process. Rather, it was an outgrowth of the professional environment. These doctors were working in an era of great uncertainty concerning medical procedures and outcomes, and they were in severe competition with one another for clients. A large number of medical schools combined with loose licensure requirements produced an oversupply of practitioners. Without the options of research positions in universities, hospitals, or institutes, and without specialized forms of practice, doctors depended on the goodwill of their patients for their economic survival. Competition for patients was fierce by the end of the century, and familiarity, a pleasant demeanor, courteousness, and understanding were essential qualities for the successful doctor.

Because medical knowledge was sketchy and doctors depended on their patients for a living, they tended to practice in familiar ways that were accepted by their patients. This does not mean that they did not believe in their treatments, but that in many ways their knowledge was not much more sophisticated than that of their patients. Most doctors employed bleeding, cupping, purging, and other seemingly draconian measures to treat their patients. Because illness was often equated with moral failings, what we see as cruelty was viewed then as an appropriate consequence of transgressions.

Those who rejected regular therapeutics could turn to other, milder forms of practice. Appealing to merchants and other urban groups, homeopathy provided milder therapies and perhaps more elegant rationales. What might have been lacking in scientific rigor was made up for by the intimacy of practice itself. The authority of the practitioner rested as much on his social relationship to his patient as it did upon scientific fact.

Around the turn of the century a significant movement arose devoted to reforming medical education. By standardizing the training of physicians and controlling entry into the profession through licensure, reformers hoped to make medical practice itself more uniform. The movement culminated in the now-classic Carnegie Bulletin Number Four, or the "Flexner Report," which called for the reorganization of medical school curricula.

The report, named for its author, Abraham Flexner, illustrates some of the divisions within the medical community during these years and the centrality of arguments regarding standardization to those who sought to influence the health system. First, it called for the establishment of a common medical education built around laboratory science and two years of clinical experience as well as lectures. Second, it asserted that the guiding principles of professional behavior should be determined by the "science" of medical practice rather than the "art" of individual attention. Like the busy machine shops and industrial factories that were proving so successful in turning the country into an industrial power, medicine would be turned into a technically exact scientific enterprise. Finally, it called for the exclusion of women, blacks, and the poor from practice.

The Flexner Report, the product of a long, rancorous struggle among educators on the ama's Council on Medical Education, achieved only some of its aims. Medical practice would remain a field filled with uncertainties and nonstandardized procedures, but the standardization of the social background of doctors would be realized. By the end of the nineteenth century, the eclectic nature of medical practice and the unregulated environment in which it had developed had created a large, diverse set of educational institutions that catered to women, black, and poorer students. In fact, there were sixteen women's medical schools by 1900 and ten black medical colleges, primarily in the southern states, by the same year. Also, the majority of students attending the various medical colleges were lower or lower middle class. But, by 1916, only two female women's colleges and two black schools remained in existence, and many of the proprietary institutions that had catered to part-time and working students had closed.

Reformers saw little need to protect these poorly endowed institutions in part because they believed that the future of scientific medicine would make social diversity within its ranks unimportant. If the physician of the future was to be a scientist treating patients regardless of social class or race, then there was little need to protect certain groups in medicine; doctors were to treat organs rather than people. In Flexner's model, white upper-middle-class male physicians would add to the social status of the profession without sacrificing the quality of care. Flexner's discussion of the future of the "Poor Boy," "Women," and "Negros" in medicine showed a simplistic, naive belief in the ability of medical science to resolve the issues of equity and equality that became the central concerns of health planners in the 1960s and 1970s.

Although the effect of the reform movement had profound implications for the social characteristics of American physicians, it had less of an impact on their practices. By and large, doctors were still tied to their private offices and were very defensive about "interference" from those seeking to standardize or evaluate their treatments. With no central organization capable of oversight, doctors adopted the mantle of science and the aura of scientists while maintaining their autonomy over treatment and procedure.

In recent years, however, the medical profession has faced a series of crises that have undermined its autonomy and undercut its authority. The staggering increase in the costs of basic health services and the growing skepticism of Americans with regard to professional dominance have produced a variety of movements to find alternatives to traditional forms of care. The 1960s saw a critique of medicine that emphasized the maldistribution of physicians, their extraordinary incomes, and the elitist, conservative nature of the ama. Further, the dearth of hospital and physicians' services for the nation's poor added an obvious political dimension to the arguments over the medical profession.

These critiques spurred broad efforts to reform the health system. First, the long-standing struggle to enact a national health insurance plan culminated in the 1965 passage of Medicaid for the poor and disabled and Medicare for the elderly. Second, the argument that there were too few physicians provided a rationale for rapidly expanding the number of medical schools. Third, the argument that existing services were badly distributed and unable to address the pressing needs of the nation's poor led the Office of Economic Opportunity (oeo) within the Department of Health, Education, and Welfare to organize innovative programs to provide services to the urban poor. The oeo, for example, funded such efforts as the Urban Corps, which awarded scholarships to medical students in return for a commitment to serve poor communities and neighborhood health centers.

Another criticism during the 1960s and 1970s grew out of the women's movement. Critics attacked the male dominance of the profession and pressed for greater participation of women. As a result, the numbers of women entering the medical profession increased dramatically.

All these complaints reflected a growing sense that medicine had become far too removed from the population it served and that the sensitivity of medical practice to patient needs had been sacrificed on the altar of science and technology. By the late 1960s, some had begun to question the efficacy of medicine itself; critics contended that despite its increased costliness, it had done little or nothing to improve the overall health of the nation. Some even argued that medicine could be harmful--that it could cause iatrogenic (physician-caused) diseases. By the 1980s, the negative perceptions of medicine and its practitioners had had a strong impact: malpractice lawsuits skyrocketed in number and more restrictions were placed on educational subsidies for specialist training and undergraduate medical education.

Moreover, in the 1980s, lawyers, courts, ethicists, and philosophers began to explore questions that had previously been the preserve of the medical community alone. When should medical procedures be used to terminate pregnancies? Should physicians be allowed to use technology indefinitely to prolong life? Who should provide care and what type of care should be provided for the terminally ill? Only twenty years before, the general critique of medicine had argued that there were too few physicians and that more services were needed. The assumption was that medicine was a universal good that should be readily available to everyone. But the deep questioning of the efficacy of medicine and of the system had led to profound ethical and political debates that are still being argued.

Bibliography:

Charles Rosenberg, The Care of Strangers (1987); David Rosner, A Once Charitable Enterprise: Hospitals and Health Care in Brooklyn and New York (1981); Rosemary Stevens, In Sickness and in Wealth (1988).

Author:

David Rosner

See also Abortion; Birth Control; Birthrate and Mortality; Epidemics; Medicaid; Medicare; Midwives; Sanitary Commission.


Quotes About: Medicine
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Quotes:

"Chemotherapy and radiotherapy will make the ancient method of drilling holes in a patient's head to permit the escape of demons look relatively advanced. Toxic chemotherapy is a hoax. The doctors who use it are guilty of pre-meditated murder, and the use of cobalt and other methods of cancer treatment popular today effectively closes the door on cure." - Jr., Ernst T. Krebs

"Modern medicine is a negation of health. It isn't organized to serve human health, but only itself, as an institution. It makes more people sick than it heals." - Ivan Illich

"Vaccination is the medical sacrament corresponding to baptism." - Samuel Butler

"Walking is a man's best medicine." - Hippocrates

"He is the best physician who is the most ingenious inspirer of hope." - Samuel Taylor Coleridge

"The whole imposing edifice of modern medicine is like the celebrated tower of Pisa --slightly off balance." - Prince Of Wales Charles

See more famous quotes about Medicine

Wikipedia: Medicine
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For chemical substances, see Medication. For other uses, see Medicine (disambiguation).
A statue of Asclepius, the Greek God of medicine, holding a staff which depicts the symbol associated with medicine: the Rod of Asclepius with its single coiled serpent.

Medicine is the art and science of healing. It encompasses a range of health care practices evolved to maintain and restore health by the prevention and treatment of illness.

Contemporary medicine applies health science, biomedical research, and medical technology to diagnose and treat injury and disease, typically through medication, surgery, or some other form of therapy. The word medicine is derived from the Latin 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 continues to require the application of ordinary human feeling and compassion, known in English as bedside manner.[3]

The Rod of Asclepius is the symbol associated with medicine, which comes from the Greek God of medicine and healing, Asclepius. The Caduceus is sometimes wrongly used for this purpose, though this practice is mainly seen in North America.

Contents

History

Main article: History of medicine
The ancient Sumerian god Ningishzida, the patron of medicine, accompanied by two gryphons.

Prehistoric medicine incorporated plants (herbalism), animal parts and minerals. In many cases these materials were used ritually as magical substances by priests, shamans, or medicine men. Well-known spiritual systems include animism (the notion of inanimate objects having spirits), spiritualism (an appeal to gods or communion with ancestor spirits); shamanism (the vesting of an individual with mystic powers); and divination (magically obtaining the truth). The field of medical anthropology studies the various prehistoric medical systems and their interaction with society.

Early records on medicine have been discovered from early Ayurvedic medicine in the Indian subcontinent, ancient Egyptian medicine, traditional Chinese medicine and ancient Greek medicine. Earliest records of dedicated hospitals come from Mihintale in Sri Lanka where evidence of dedicated medicinal treatment facilities for patients are found.[4][5] Early Greek doctor Hippocrates, who is called the Father of Medicine,[6][7] and Galen laid a foundation for later developments in a rational approach to medicine. 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 Easern Roman Empire (Byzantium). After 750, the Muslim Arab world had Hippocrates' and Galen's works translated into Arabic, and Islamic physicians engaged in some significant medical research. Notable Islamic medical pioneers include polymath Avicenna, who, along with Hippocrates, has also been called the Father of Medicine,[8][9] Abulcasis, the father of surgery, Avenzoar, the father of experimental surgery, Ibn al-Nafis, the father of circulatory physiology, and Averroes.[10] Rhazes, who is called the father of pediatrics, was one of first to question the Greek theory of humorism, which nevertheless remained influential in both medieval Western and medieval Islamic medicine [11] During the Crusades, one Muslim observer famously expressed a dim view of contemporary Western medicine.[12] However, overall mortality and mordibity levels in the medieval Middle East and medieval Europe did not significantly differ one from the other, which indicates that there was no major medical "breakthrough" to modern medicine in either region in this period. 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.[13] 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 indeed rejected the theories of great authorities from the past (such as Hippocrates, and Galen), many of whose theories were in time discredited.

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 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.[14] 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 the modern global information science, which allows all evidence 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. 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.[15]

Clinical practice

Girl having her head bandaged, as depicted by the portraitist Henriette Browne (1829-1901)

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[16] 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.[17] Followups may be shorter but follow the same general procedure.

The components of the medical interview[16] and encounter are:

  • Chief complaint (cc): the reason for the current medical visit. These are the 'symptoms.' They are in the patient's own words and are recorded along with the duration of each one. Also called 'presenting complaint.'
  • History of present illness / complaint (HPI): the chronological order of events of symptoms and further clarification of each symptom.
  • Current activity: occupation, hobbies, what the patient actually does.
  • Medications (Rx): what drugs the patient takes including prescribed, over-the-counter, and home remedies, as well as alternative and herbal medicines/herbal remedies. Allergies are also recorded.
  • Past medical history (PMH/PMHx): concurrent medical problems, past hospitalizations and operations, injuries, past infectious diseases and/or vaccinations, history of known allergies.
  • Social history (SH): birthplace, residences, marital history, social and economic status, habits (including diet, medications, tobacco, alcohol).
  • Family history (FH): listing of diseases in the family that may impact the patient. A family tree is sometimes used.
  • Review of systems (ROS) or systems inquiry: a set of additional questions to ask which may be missed on HPI: a general enquiry (have you noticed any weight loss, change in sleep quality, fevers, lumps and bumps? etc), followed by questions on the body's main organ systems (heart, lungs, digestive tract, urinary tract, etc).

The physical examination is the examination of the patient 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 (taste has been made redundant by the availability of modern lab tests). Four chief methods are used: inspection, palpation (feel), percussion (tap to determine resonance characteristics), and auscultation (listen); smelling may be useful (e.g. infection, uremia, diabetic ketoacidosis). The clinical examination involves study of:

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) [18][19] and many developing countries provide medical services though 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,[18][19] 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,[20] 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 Practioners, 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, (pharmacy, pharmacists), (physiotherapy,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. However, within medical circles, there are 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". "Surgery" refers to the practice of operative medicine, and most subspecialties in this area require preliminary training in "General Surgery." There are some specialties of medicine that do not fit into either of these categories, such as radiology, pathology, or anesthesia, and those are also discussed further below.

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, transplant surgery, trauma surgery, cardiovascular surgery, neurosurgery, maxillofacial surgery, orthopedic surgery, otolaryngology, plastic surgery, oncologic surgery, vascular surgery, and pediatric surgery. In some centers, anesthesiology is part of the division of surgery (for logistical and planning purposes), 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.[21] In North America, specialists in internal medicine are commonly called "internists". Elsewhere, especially in Commonwealth nations, such specialists are often called physicians.[22] 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.[23]

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.

Diagnostic specialties

Other

Following are some selected fields of medical specialties that don't directly fit into any of the above mentioned groups.

Interdisciplinary fields

Interdisciplinary sub-specialties of medicine are:

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.[24] Others have since voiced similar views, but none so trenchantly, perhaps, as Illich.[25]

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.[26]

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.[27] 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.[27]

Disparities in quality of care given are often an additional cause of controversy.[28] For example, elderly mentally ill patients received poorer care during hospitalization in a 2008 study.[29] Rural poor African-American men were used in a study of syphilis that denied them basic medical care.

See also

Main article: Outline of medicine
Portal.svg 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. ^ Useful known and unknown views of the father of modern medicine, Hippocrates and his teacher Democritus., U.S. National Library of Medicine
  7. ^ The father of modern medicine: the first research of the physical factor of tetanus, European Society of Clinical Microbiology and Infectious Diseases
  8. ^ 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. 
  9. ^ Medical Practitioners
  10. ^ 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. 
  11. ^ 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.
  12. ^ "Medieval Sourcebook: Usmah Ibn Munqidh (1095-1188): Autobiography, excerpts on the Franks". Fordham.edu. http://www.fordham.edu/halsall/source/usamah2.html. Retrieved 2009-05-04. 
  13. ^ 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.
  14. ^ 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
  15. ^ 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. 
  16. ^ 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. 
  17. ^ 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. 
  18. ^ a b Insuring America's Health: Principles and Recommendations, Institute of Medicine at the National Academies of Science, 2004-01-14
  19. ^ 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. 
  20. ^ Martin Sipkoff (January 2004). "Transparency called key to uniting cost control, quality improvement". Managed Care. http://www.managedcaremag.com/archives/0401/0401.forum.html. 
  21. ^ internal medicine at Dorland's Medical Dictionary
  22. ^ H.W. Fowler. (1994). A Dictionary of Modern English Usage (Wordsworth Collection) (Wordsworth Collection). NTC/Contemporary Publishing Company. ISBN 1853263184. 
  23. ^ "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. 
  24. ^ Illich Ivan (1974). Medical Nemesis. London: Calder & Boyars. ISBN 0714510963. OCLC 224760852. 
  25. ^ [[Neil Postman |Postman Neil]] (1992). Technopoly: The Surrender of Culture to Technology. New York: Knopf. OCLC 24694343. 
  26. ^ The HealthWatch Award 2005: Prof. Edzard Ernst, Complementary medicine: the good the bad and the ugly. Retrieved 5 August 2006.
  27. ^ 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. http://www.psych.umn.edu/faculty/grove/096clinicalversusmechanicalprediction.pdf. 
  28. ^ "Eliminating Health Disparities". American Medical Association. http://www.ama-assn.org/ama/pub/physician-resources/public-health/eliminating-health-disparities.shtml. 
  29. ^ "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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