Medicine is a branch of health science concerned with restoring and maintaining health and wellness. Broadly, it is the practical science of preventing and curing diseases. However, medicine often refers more specifically to matters dealt with by physicians and surgeons.
Medicine is both an area of knowledge (a science), and the application of that knowledge (the medical profession). The various specialized branches of the science of medicine correspond to equally specialized medical professions dealing with particular organs or diseases. The science of medicine is the body of knowledge about body systems and diseases, while the profession of medicine refers to the social structure of the group of people formally trained to apply that knowledge to treat disease.
There are traditional and schools of healing which are usually not considered to be part of (Western) medicine in a strict sense (see health science for an overview). The most highly developed systems of medicine outside of the Western or Hippocratic tradition are the Ayurvedic school (of India) and traditional Chinese medicine. The remainder of this article focuses on modern (Western) medicine.
History of medicine
Medicine as it is practiced now is rooted in various traditions, but developed mainly in the late 18th and early 19th century in Germany (Rudolf Virchow) and France (Jean-Martin Charcot and others). The new, "scientific" medicine replaced more traditional views based on the "Four humours". The development of clinical medicine shifted to the United Kingdom and the USA during the early 1900s (Sir William Osler, Harvey Cushing).
Genomics is already having a large influence on medical practice, as most monogenic genetic disorders have now been linked to causative genes, and molecular biological techniques are influencing medical decision-making.
The practice of medicine
The medical encounter or patient-doctor relationship is what medicine is about. A person with a health problem or concern sees a doctor for help. The practice of medicine combines both science and art. Science and technology are the evidence base for many clinical problems for the general population at large. The art of medicine is the application of this medical knowledge in combination with intuition and clinical judgment to determine the proper diagnoses and treatment plan for this unique patient.
The doctor needs to:
The medical encounter is documented in a medical record. One method that is used is called the Problem Oriented Medical Record (POMR), which includes a problem list of diagnoses and a "SOAP" method of documentation for each visit:
The patient-doctor relationship is important to the doctor in order to obtain an accurate medical history and obtain compliance with the treatment plan; respect, understanding, and trust is important. However, too much trust in a spectific doctor can be dangerous. The doctor-patient relationship is important to the patient because the doctor has been given a monopoly on access to the prescription pad, and granted authority status by health insurance programs to act as gatekeeper to other medical procedures and services.
A complete medical evaluation includes a medical history, a physical examination, appropriate laboratory or imaging studies, analysis of data and medical decision making to obtain diagnoses, and treatment plan.
The components of the medical history are:
The physical examination is the examination of the patient from head to toe looking for signs of disease. The doctor uses his senses of sight, hearing, touch, and sometimes smell (taste has been replaced by modern lab tests). Four chief methods are used: inspection, palpation, percussion, and auscultation; smelling may be useful (e.g. infection, uremia, diabetic ketoacidosis).
Medical decision making (MDM) process involves the analysis and synthesis of all the above data to come with a list of possible diagnoses (the differential diagnoses) and what needs to be done to come up with a final diagnosis which would explain the patient's problem.
Treatment plan may include ordering additional labs and studies, starting therapy, referring to a specialist, or watchful observation. Follow-up may be needed.
This process is used by primary care providers and well as specialists. It may take only a few minutes if the problem is simple and straightforward. Or it may take weeks for a patient who has been hospitalized with multiple system problems involving 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.
Medical sciences and health professions
The delivery of modern health care depends, not just on medical practitioners, but on an expanding group of highly trained professionals coming together as an interdisciplinary team. A full list is given on the health profession page. Some examples include: nurses, laboratory scientists, pharmacists, physiotherapists, speech therapists, occupational therapists, dietitians and bioengineers.
The scope and sciences underpinning human medicine overlap many other fields. Dentistry and psychology, while separate disciplines from medicine, are sometimes also considered medical fields. Physician assistants, nurse practitioners and midwives treat patients and prescribe medication in many legal jurisdictions. Veterinary medicine applies similar techniques to the care of animals.
Medical doctors have many specializations and subspecializations which are listed below. Within the profession, the differences between medical specialties are a frequent source of humor. There is an adage that goes, "The internist knows everything and does nothing, the surgeon knows nothing and does everything, and the pathologist knows everything and does everything, but it's too late."
Basic, supplementary, and related sciences
Diagnostic and imaging specialties
Disciplines of clinical medicine
Interdisciplinary medical fields
Interdisciplinary sub-specialties of medicine are:
Settings where medical care is delivered
Medicine is a diverse field and the provision of medical care is therefore provided in a variety of locations.
Primary care medical services are provided by physicians or other health professionals who has first contact with a patient seeking medical treatment or care. These occur in physician's office, 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 sex.
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.
Teaching of medicine
Medical training involves several years of university study followed by several more years of residential practice at a hospital. Entry to a medical degree in some countries (such as the United States) requires the completion of another degree first, while in other countries (such as the United Kingdom) medical training can be commenced as an undergraduate degree immediately after secondary education. Once graduated from medical school most physicians begin their residency training, where skills in a speciality of medicine are learned, supervised by more experienced doctors. The first year of residency is known as the "intern" year. The duration of residency training depends on the speciality.
In the USA, physician training generally follows the following timeline (with age of completion):
The name of the medical degree gained at the end varies: some countries (e.g. the US) call it "Doctor of Medicine" (abbreviated 'M.D.'), while other countries (mostly following the British Oxbridge system) call it "Medicinæ Baccalaureus & Baccalaureus Chirurgiæ" (Latin for "Bachelor of Medicine/Bachelor of Surgery", French: "Chirurgie"); this is technically a double degree, frequently abbreviated 'MB BChir', 'MB ChB', 'MB BS' (or variations thereof), dependent on the medical school. In either case graduates of a medical degree may call themselves physician. In the US and some other contries there is a parallel system of medicine called "osteopathy" which awards the degree D.O. (doctor of osteopathy). In many countries, a doctorate of medicine does not require original research as does, in distinction, a PhD.
A medical graduate can then enter general practice and become a general practitioner (or primary care internist in the USA); training for these is generally shorter, while specialist training is typically longer.
In most countries, it is prohibited to practice medicine without a proper degree in that field and doctors must be licensed by a medical board or some other equivalent organization. This is meant as a safeguard against charlatans. These laws are obstacles to those who would want to pretend to training and expertise they have not earned, such as practitioners of alternative medicine or faith healing.
Criticism against medicine has a long history. In the Middle Ages, it was not considered a profession suitable for Christians, as disease was considered Godsent, and interfering with the process a form of blasphemy. Barber-surgeons generally had a bad reputation that was not to improve until the development of academic surgery as a specialism of medicine, rather than an accessory field.
Through the course of the twentieth century, doctors naturally focused increasingly on the technology that was enabling them to make dramatic improvements in patients' health. This resulted in criticism for the loss of compassion and mechanistic, detached treatment. This issue started to reach collective professional consciousness in the 1970s and the profession had begun to respond by the 1980 and 1990s.
Perhaps the most devastating criticism came from Ivan Illich in his 1976 work Medical Nemesis. In his view, modern medicine only medicalises disease, causing loss of health and wellness, while generally failing to restore health by eliminating disease. The human being thus becomes a lifelong patient. Other less radical philosophers have voiced similar views, but none were as virulent as Illich. (Another example can be found in Technopoly: The Surrender of Culture to Technology by Neil Postman, 1992, which criticises overreliance on technological means in medicine.)
Criticism against modern medicine has led to some improvements in the curricula of medical schools, which now teach students systematically on medical ethics, holistic approaches to medicine, the biopsychosocial model and similar concepts.
The inability of modern medicine to properly address many common complaints continues to prompt many people to seek support from alternative medicine. Although a large number of alternative approaches to health await scientific validation, many report improvement of symptoms after obtaining alternative therapies.
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