Medicine Portal
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Of Medicine &
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Ampoules &
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Biomedical Insemination
Health Care Delivery
Patient-Physician-Relationship
Medical history and
Physical examination
Medicine is the science and art of maintaining and/or restoring human
health through the study, diagnosis, and treatment of patients. The term
is derived from the Latin ars medicina meaning the art of healing.The
modern practice of medicine occurs at the many interfaces between the
art of healing and various sciences. Medicine is directly connected to the
health sciences and biomedicine. Broadly speaking, the term 'Medicine'
today refers to the fields of clinical medicine, medical research and
surgery, thereby covering the challenges of disease and injury.The Rod
of Asclepius, with its single snake, is an ancient Greek symbol associated
with medicine. The American Medical Association, the American
Osteopathic Association, the Royal Society of Medicine, the Australian
Medical Association, the British Medical Association, and the World
Health Organization display the Rod of Asclepius in their logos or
emblems.The Rod of Asclepius, with its single snake, is an ancient Greek
symbol associated with medicine. The American Medical Association,
the American Osteopathic Association, the Royal Society of Medicine,
the Australian Medical Association, the British Medical Association,
and the World Health Organization display the Rod of Asclepius in their
logos or emblems.
Since the 19th century, only those with a medical degree have been
considered worthy to practice medicine. Clinicians licensed
professionals who deal with patients can be physicians, physical
therapists, physician assistants, nurses or others. The medical profession
is the social and occupational structure of the group of people formally
trained and authorized to apply medical knowledge. Many countries and
legal jurisdictions have legal limitations on who may practice
medicine.Medicine comprises various specialized sub-branches, such as
cardiology, pulmonology, neurology, or other fields such as sports
medicine, research or public health.Human societies have had various
different systems of health care practice since at least the beginning of
recorded history. Medicine, in the modern period, is the mainstream
scientific tradition which developed in the Western world since the early
Renaissance around 1450. Many other traditions of health care are still
practiced throughout the world; most of these are separate from
Western medicine, which is also called biomedicine, allopathic medicine
or the Hippocratic tradition. The most highly developed of these are
traditional Chinese medicine, Traditional Tibetan medicine and the
Ayurvedic traditions of India and Sri Lanka. Various non-mainstream
traditions of health care have also developed in the Western world.
These systems are sometimes considered companions to Hippocratic
medicine, and sometimes are seen as competition to the Western
tradition. Few of them have any scientific confirmation of their tenets,
because if they did they would be brought into the fold of Western
medicine.Medicine is also often used amongst medical professionals as
shorthand for internal medicine. Veterinary medicine is the practice of
health care in animal species other than human beings.
The earliest type of medicine in most cultures was the use of plants
Herbalism and animal parts. This was usually in concert with 'magic' of
various kinds in which: animism the notion of inanimate objects having
spirits; spiritualism here meaning an appeal to gods or communion with
ancestor spirits; shamanism the vesting of an individual with mystic
powers; and divination the supposed obtaining of truth by magic means,
played a major role.The practice of medicine developed gradually, and
separately, in Ancient Egypt, Ancient India, Ancient China, Ancient
Greece, Ancient Persia and elsewhere. Medicine as it is practiced now
developed largely in the late eighteenth century and early nineteenth
century in England William Harvey, seventeenth century, Germany
Rudolf Virchow and France Jean-Martin Charcot, Claude Bernard and
others. The new, scientific medicine where results are testable and
repeatable replaced early Western traditions of medicine, based on
herbalism, the Greek four humours and other pre-modern
theories.[citation needed] The focal points of development of clinical
medicine shifted to the United Kingdom and the USA by the early 1900s
Canadian-born Sir William Osler, Harvey Cushing. Possibly the major
shift in medical thinking was the gradual rejection in the 1400s during
the Black Death 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.
People like Vesalius led the way in improving upon or indeed rejecting
the theories of great authorities from the past such as Galen,
Hippocrates, and Avicenna/Ibn Sina, all of whose theories were in time
almost totally discredited. Such new attitudes were also only made
possible by the weakening of the Roman Catholic church's power in
society, especially in the Republic of Venice.Evidence-based medicine is
a recent movement to establish the most effective algorithms of practice
ways of doing things through the use of the scientific method and modern
global information science by collating all the evidence and developing
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.
Genomics and knowledge of human genetics is already 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 practice and
decision-making.Pharmacology has developed from herbalism and many
drugs are still derived from plants atropine, ephedrine, warfarin,
aspirin, digoxin, vinca alkaloids, taxol, hyoscine, etc. The modern era
began with Robert Koch's discoveries around 1880 of the transmission of
disease by bacteria, and then the discovery of antibiotics shortly
thereafter around 1900. 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. The first major class of
antibiotics was the sulfa drugs, derived by French chemists originally
from azo dyes. Throughout the twentieth century, major advances in the
treatment of infectious diseases were observable in Western societies.
The medical establishment is now developing drugs targeted towards
one particular disease process. Thus drugs are being developed to
minimise the side effects of prescribed drugs, to treat cancer, geriatric
problems, long-term problems such as high cholesterol, chronic diseases
type 2 diabetes, lifestyle and degenerative diseases such as arthritis and
Alzheimer's disease.
The practice of medicine combines both science as the evidence base and
art in the application of this medical knowledge in combination with
intuition and clinical judgment to determine the treatment plan for each
patient.Central to medicine is the patient-physician relationship
established when a person with a health concern seeks a physician's
help; the 'medical encounter'. Other health professionals similarly
establish a relationship with a patient and may perform various
interventions, e.g. nurses, radiographers and therapists.Medicine is
practiced within the medical system, which is a legal, credentialing and
financing framework, established by a particular culture or government.
The characteristics of a health care system have significant effect on the
way medical care is delivered.Financing has a great influence as it
defines who pays the costs. Aside from tribal cultures, the most
significant divide in developed countries is between universal health care
and market-based health care such as practiced in the U.S.. Universal
health care might allow or ban a parallel private market. The latter is
described as single-payer system.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
US health care system has come under fire for lack of openness, 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.
Medical care delivery is classified into primary, secondary and tertiary
care.Primary care medical services are provided by physicians 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.
This kind of relationship and interaction is a central process in the
practice of medicine. There are many perspectives from which to
understand and describe it.An idealized physician's perspective, such as
is taught in medical school, sees the core aspects of the process as the
physician learning the patient's symptoms, concerns and values; in
response the physician examines the patient, interprets the symptoms,
and formulates a diagnosis to explain the symptoms and their cause to
the patient and to propose a treatment. The job of a physician is similar
to a human biologist: that is, to know the human frame and situation in
terms of normality. Once the physician knows what is normal and can
measure the patient against those norms, he or she can then determine
the particular departure from the normal and the degree of departure.
This is called the diagnosis.The four great cornerstones of diagnostic
medicine are anatomy structure: what is there, physiology how the
structure/s work, pathology what goes wrong with the anatomy and
physiology and psychology mind and behavior. In addition, the physician
should consider the patient in their 'well' context rather than simply as
a walking medical condition. This means the socio-political context of
the patient family, work, stress, beliefs should be assessed as it often
offers vital clues to the patient's condition and further management. In
more detail, the patient presents a set of complaints the symptoms to the
physician, who then obtains further information about the patient's
symptoms, previous state of health, living conditions, and so forth. The
physician then makes a review of systems ROS or systems inquiry, which
is a set of ordered questions about each major body system in order:
general such as weight loss, endocrine, cardio-respiratory, etc. Next
comes the actual physical examination; the findings are recorded,
leading to a list of possible diagnoses. These will be in order of
probability. The next task is to enlist the patient's agreement to a
management plan, which will include treatment as well as plans for
follow-up. Importantly, during this process the healthcare provider
educates the patient about the causes, progression, outcomes, and
possible treatments of his ailments, as well as often providing advice for
maintaining health. This teaching relationship is the basis of calling the
physician doctor, which originally meant teacher in Latin. The
patient-physician relationship is additionally complicated by the
patient's suffering patient derives from the Latin patior, suffer and
limited ability to relieve it on his/her own. The physician's expertise
comes from his knowledge of what is healthy and normal contrasted with
knowledge and experience of other people who have suffered similar
symptoms unhealthy and abnormal, and the proven ability to relieve it
with medicines pharmacology or other therapies about which the patient
may initially have little knowledge.
The physician-patient relationship can be analyzed from the perspective
of ethical concerns, in terms of how well the goals of non-maleficence,
beneficence, autonomy, and justice are achieved. Many other values and
ethical issues can be added to these. In different societies, periods, and
cultures, different values may be assigned different priorities. For
example, in the last 30 years medical care in the Western World has
increasingly emphasized patient autonomy in decision making.The
relationship and process can also be analyzed in terms of social power
relationships e.g., by Michel Foucault, or economic transactions.
Physicians have been accorded gradually higher status and respect over
the last century, and they have been entrusted with control of access to
prescription medicines as a public health measure. This represents a
concentration of power and carries both advantages and disadvantages
to particular kinds of patients with particular kinds of conditions. A
further twist has occurred in the last 25 years as costs of medical care
have risen, and a third party an insurance company or government
agency now often insists upon a share of decision-making power for a
variety of reasons, reducing freedom of choice of healthcare providers
and patients in many ways.
The quality of the patient-physician relationship is important to both
parties. The better the relationship in terms of mutual respect,
knowledge, trust, shared values and perspectives about disease and life,
and time available, the better will be the amount and quality of
information about the patient's disease transferred in both directions,
enhancing accuracy of diagnosis and increasing the patient's knowledge
about the disease. Where such a relationship is poor the physician's
ability to make a full assessment is compromised and the patient is more
likely to distrust the diagnosis and proposed treatment. In these
circumstances and also in cases where there is genuine divergence of
medical opinions, a second opinion from another physician may be
sought.In some settings, e.g. the hospital ward, the patient-physician
relationship is much more complex, and many other people are involved
when somebody is ill: relatives, neighbors, rescue specialists, nurses,
technical personnel, social workers and others.
A complete medical evaluation includes a medical history, a systems
enquiry, a physical examination, appropriate laboratory or imaging
studies, analysis of data and medical decision making to obtain
diagnoses, and a treatment plan.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: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.
Working together as an interdisciplinary team, many highly trained
health profession also besides medical practitioners are involved in the
delivery of modern health care. Some 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 and psychology, while
separate disciplines from medicine, are considered medical fields.
Veterinarians apply similar techniques as physicians to the care of
animals. The original focus of veterinary medicine was primarily the
health care of domestic animals. In recent years the discipline has
broadened to include all vertebrate animals and even some of the more
economically valuable or scientifically interesting invertebrates.
Veterinary and human medicine had similar origins but diverged in the
West largely under the influence of Christian doctrine which
emphasized a fundamental difference between humans and all other
species. The two disciplines re-converged to some degree after the
Renaissance when scientific study of anatomy and physiology revealed
undeniable similarities between humans and other animals. The
similarities further extend into pathology and disease control leading the
early pioneer in scientific pathology Rudolph Virchow to proclaim the
doctrine of one medicine.Physicians have many specializations and
subspecializations which are listed below. There are variations from
country to country regarding which specialties certain subspecialities
are in.
Criticism of medicine has a long history. In the Middle Ages, some
people did not consider it a profession suitable for Christians, as disease
was often considered God-sent. God was considered to be the 'divine
physician' who sent illness or healing depending on his will. However
many monastic orders, particularly the Benedictines, considered the
care of the sick as their chief work of mercy. Barber-surgeons generally
had a bad reputation that was not to improve until the development of
academic surgery as a speciality of medicine, rather than an accessory
field.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 further criticisms. This issue started to reach collective
professional consciousness in the 1970s and the profession had begun to
respond by the 1980s and 1990s.
The noted anarchist Ivan Illich heavily criticized modern medicine. In
his 1976 work Medical Nemesis, Illich stated that modern medicine only
medicalises disease and causes loss of health and wellness, while
generally failing to restore health by eliminating disease. This
medicalisation of disease forces the human to become a lifelong
patient.[5]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 of 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 some common complaints continues to prompt many
people to seek support from alternative medicine. Although most
alternative approaches lack scientific validation, some may be effective
in individual cases. Some physicians combine alternative medicine with
orthodox approaches.Medical errors and overmedication are also the
focus of many 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 was long
ago realized 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.