Medicine is the
science and
practice
Practice or practise may refer to:
Education and learning
* Practice (learning method), a method of learning by repetition
* Phantom practice, phenomenon in which a person's abilities continue to improve, even without practicing
* Practice-based ...
of caring for a patient, managing the
diagnosis
Diagnosis is the identification of the nature and cause of a certain phenomenon. Diagnosis is used in many different disciplines, with variations in the use of logic, analytics, and experience, to determine "cause and effect". In systems engin ...
,
prognosis,
prevention,
treatment,
palliation of their
injury or
disease, and
promoting their health. Medicine encompasses a variety of
health care practices evolved to maintain and restore
health
Health, according to the World Health Organization, is "a state of complete physical, mental and social well-being and not merely the absence of disease and infirmity".World Health Organization. (2006)''Constitution of the World Health Organ ...
by the
prevention and
treatment of
illness. Contemporary medicine applies
biomedical sciences,
biomedical research,
genetics, and
medical technology to
diagnose
Diagnosis is the identification of the nature and cause of a certain phenomenon. Diagnosis is used in many different disciplines, with variations in the use of logic, analytics, and experience, to determine "cause and effect". In systems enginee ...
, treat, and prevent injury and disease, typically through
pharmaceuticals or
surgery
Surgery ''cheirourgikē'' (composed of χείρ, "hand", and ἔργον, "work"), via la, chirurgiae, meaning "hand work". is a medical specialty that uses operative manual and instrumental techniques on a person to investigate or treat a pa ...
, but also through therapies as diverse as
psychotherapy,
external splints and traction,
medical devices,
biologics
A biopharmaceutical, also known as a biological medical product, or biologic, is any pharmaceutical drug product manufactured in, extracted from, or semisynthesized from biological sources. Different from totally synthesized pharmaceuticals, th ...
, and
ionizing radiation, amongst others.
Medicine has been practiced since
prehistoric times
Prehistory, also known as pre-literary history, is the period of human history between the use of the first stone tools by hominins 3.3 million years ago and the beginning of recorded history with the invention of writing systems. The use ...
, and for most of this time it was an
art (an area of skill and knowledge), frequently having connections to the
religious and
philosophical beliefs of local culture. For example, a
medicine man would apply
herbs and say
prayers for healing, or an ancient
philosopher and
physician would apply
bloodletting
Bloodletting (or blood-letting) is the withdrawal of blood from a patient to prevent or cure illness and disease. Bloodletting, whether by a physician or by leeches, was based on an ancient system of medicine in which blood and other bodily f ...
according to the theories of
humorism. In recent centuries, since the
advent of modern science, most medicine has become a combination of
art and
science (both
basic and
applied, under the
umbrella of medical science). For example, while stitching technique for
sutures is an art learned through practice, the knowledge of what happens at the
cellular and
molecular level in the tissues being stitched arises through science.
Prescientific forms of medicine, now known as
traditional medicine or ''folk medicine'', remain commonly used in the absence of scientific medicine, and are thus called
alternative medicine. Alternative treatments outside of scientific medicine with safety and efficacy concerns are termed
quackery.
Etymology
Medicine (, ) is the
science and practice of the
diagnosis
Diagnosis is the identification of the nature and cause of a certain phenomenon. Diagnosis is used in many different disciplines, with variations in the use of logic, analytics, and experience, to determine "cause and effect". In systems engin ...
,
prognosis,
treatment, and
prevention of
disease. The word "medicine" is derived from
Latin
Latin (, or , ) is a classical language belonging to the Italic languages, Italic branch of the Indo-European languages. Latin was originally a dialect spoken in the lower Tiber area (then known as Latium) around present-day Rome, but through ...
''medicus'', meaning "a physician".
Clinical practice
Medical availability and clinical practice varies across the world due to regional differences in culture and technology. Modern scientific medicine is highly developed in the
Western world, while in
developing countries such as parts of Africa or Asia, the population may rely more heavily on
traditional medicine with limited evidence and efficacy and no required formal training for practitioners.
In the
developed world,
evidence-based medicine is not universally used in clinical practice; for example, a 2007 survey of literature reviews found that about 49% of the interventions lacked sufficient evidence to support either benefit or harm.
In modern clinical practice,
physicians and
physician assistants personally assess patients in order to
diagnose
Diagnosis is the identification of the nature and cause of a certain phenomenon. Diagnosis is used in many different disciplines, with variations in the use of logic, analytics, and experience, to determine "cause and effect". In systems enginee ...
,
prognose, 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 by a medical interview
and a
physical examination. Basic diagnostic
medical devices (e.g.
stethoscope,
tongue depressor
A tongue depressor (sometimes called spatula) is a tool used in medical practice to depress the tongue to allow for examination of the mouth and throat. The most common modern tongue depressors are flat, thin, wooden blades, smoothed and rounde ...
) 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.
Follow-ups may be shorter but follow the same general procedure, and specialists follow a similar process. The diagnosis and treatment may take only a few minutes or a few weeks depending upon the complexity of the issue.
The components of the medical interview
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 'chief concern' or 'presenting complaint'.
* History of present
illness (HPI): the chronological order of events of symptoms and further clarification of each symptom. Distinguishable from history of previous illness, often called past medical history (PMH).
Medical history comprises HPI and PMH.
* Current activity: occupation, hobbies, what the patient actually does.
*
Medications (Rx): what drugs the patient takes including
prescribed,
over-the-counter
Over-the-counter (OTC) drugs are medicines sold directly to a consumer without a requirement for a prescription from a healthcare professional, as opposed to prescription drugs, which may be supplied only to consumers possessing a valid prescr ...
, and
home remedies
Traditional medicine (also known as indigenous medicine or folk medicine) comprises medical aspects of traditional knowledge that developed over generations within the folk beliefs of various societies, including indigenous peoples, before the ...
, as well as alternative and
herbal medicines or remedies.
Allergies are also recorded.
* Past medical history (PMH/PMHx): concurrent medical problems, past hospitalizations and operations, injuries, past
infectious diseases 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
The heart is a muscular Organ (biology), organ in most animals. This organ pumps blood through the blood vessels of the circulatory system. The pumped blood carries oxygen and nutrients to the body, while carrying metabolic waste such as ca ...
,
lungs
The lungs are the primary organs of the respiratory system in humans and most other animals, including some snails and a small number of fish. In mammals and most other vertebrates, two lungs are located near the backbone on either si ...
,
digestive tract,
urinary tract, etc.).
The
physical examination is the examination of the patient for
medical signs of disease, which are objective and observable, in contrast to symptoms that are volunteered by the patient and not necessarily objectively observable. The healthcare provider uses sight, hearing, touch, and sometimes smell (e.g., in infection,
uremia
Uremia is the term for high levels of urea in the blood. Urea is one of the primary components of urine. It can be defined as an excess of amino acid and protein metabolism end products, such as urea and creatinine, in the blood that would be no ...
,
diabetic ketoacidosis). Four actions are the basis of physical examination:
inspection,
palpation (feel),
percussion
A percussion instrument is a musical instrument that is sounded by being struck or scraped by a beater including attached or enclosed beaters or rattles struck, scraped or rubbed by hand or struck against another similar instrument. Exc ...
(tap to determine resonance characteristics), and
auscultation (listen), generally in that order although auscultation occurs prior to percussion and palpation for abdominal assessments.
The clinical examination involves the study of:
* Vital signs including height, weight, body temperature,
blood pressure,
pulse, respiration rate, and hemoglobin
oxygen saturation
* General appearance of the patient and specific indicators of disease (nutritional status, presence of jaundice, pallor or
clubbing)
*
Skin
* Head,
eye,
ear, nose, and throat (
HEENT)
*
Cardiovascular (
heart
The heart is a muscular Organ (biology), organ in most animals. This organ pumps blood through the blood vessels of the circulatory system. The pumped blood carries oxygen and nutrients to the body, while carrying metabolic waste such as ca ...
and
blood vessels)
*
Respiratory (large airways and
lungs
The lungs are the primary organs of the respiratory system in humans and most other animals, including some snails and a small number of fish. In mammals and most other vertebrates, two lungs are located near the backbone on either si ...
)
*
Abdomen and
rectum
* Genitalia (and pregnancy if the patient is or could be pregnant)
*
Musculoskeletal (including spine and extremities)
*
Neurological
Neurology (from el, νεῦρον (neûron), "string, nerve" and the suffix -logia, "study of") is the branch of medicine dealing with the diagnosis and treatment of all categories of conditions and disease involving the brain, the spinal c ...
(consciousness, awareness, brain, vision,
cranial nerves, spinal cord and
peripheral nerves)
*
Psychiatric (orientation,
mental state, mood, evidence of abnormal perception or thought).
It is to likely focus on areas of interest highlighted in the medical history and may not include everything listed above.
The treatment plan may include ordering additional
medical laboratory tests and
medical imaging studies, starting therapy, referral to a specialist, or watchful observation. Follow-up may be advised. Depending upon the
health insurance plan and the
managed care system, various forms of "
utilization review", such as prior authorization of tests, may place barriers on accessing expensive services.
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.
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, such as churches. The characteristics of any given health care system have significant impact on the way medical care is provided.
From ancient times, Christian emphasis on practical charity gave rise to the development of systematic nursing and hospitals and the
Catholic Church
The Catholic Church, also known as the Roman Catholic Church, is the List of Christian denominations by number of members, largest Christian church, with 1.3 billion baptized Catholics Catholic Church by country, worldwide . It is am ...
today remains the largest non-government provider of medical services in the world. Advanced industrial countries (with the exception of the
United States
The United States of America (U.S.A. or USA), commonly known as the United States (U.S. or US) or America, is a country Continental United States, primarily located in North America. It consists of 50 U.S. state, states, a Washington, D.C., ...
)
and many
developing countries provide medical services through a system of
universal health care that 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 provide no guarantee of healthcare for the population as a whole. In such societies, healthcare 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.
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 healthcare 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.
The
health professionals who provide care in medicine comprise multiple
professions such as
medics
A medic is a person involved in medicine such as a medical doctor, medical student, paramedic or an emergency medical responder.
Among physicians in the UK, the term "medic" indicates someone who has followed a "medical" career path in postgradu ...
,
nurses,
physio therapists, and
psychologists. These professions will have their own
ethical standards, professional education, and bodies. The medical profession have been conceptualized from a
sociological perspective.
Delivery
Provision of medical care is classified into primary, secondary, and tertiary care categories.
Primary care medical services are provided by
physicians,
physician assistants,
nurse practitioners, or other health professionals who have first contact with a patient seeking medical treatment or care. These occur in physician offices,
clinics,
nursing homes, schools, home visits, and other places close to patients. About 90% of medical visits can be treated by the primary care provider. These include treatment of acute and chronic illnesses,
preventive care and
health education for all ages and both sexes.
Secondary care medical services are provided by
medical specialists in their offices or clinics or at local community hospitals for a patient referred by a primary care provider who first diagnosed or treated the patient. Referrals are made for those patients who required the expertise or procedures performed by specialists. These include both
ambulatory care and
inpatient services,
Emergency departments,
intensive care medicine, surgery services,
physical therapy,
labor and delivery,
endoscopy units, diagnostic
laboratory
A laboratory (; ; colloquially lab) is a facility that provides controlled conditions in which scientific or technological research, experiments, and measurement may be performed. Laboratory services are provided in a variety of settings: physi ...
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.
In low-income countries, modern healthcare is often too expensive for the average person. International healthcare policy researchers have advocated that "user fees" be removed in these areas to ensure access, although even after removal, significant costs and barriers remain.
Separation of prescribing and dispensing Separation of prescribing and dispensing, also called dispensing separation, is a practice in medicine and pharmacy in which the physician who provides a medical prescription is independent from the pharmacist who provides the prescription drug.
I ...
is a practice in medicine and pharmacy in which the
physician who provides a
medical prescription is independent from the
pharmacist who provides the
prescription drug. In the
Western world there are centuries of tradition for separating pharmacists from physicians. In Asian countries, it is traditional for physicians to also provide drugs.
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:
nurse
Nursing is a profession within the health care sector focused on the care of individuals, families, and communities so they may attain, maintain, or recover optimal health and quality of life. Nurses may be differentiated from other health ...
s,
emergency medical technicians and paramedics, laboratory scientists,
pharmacists,
podiatrists,
physiotherapists
Physical therapy (PT), also known as physiotherapy, is one of the allied health professions. It is provided by physical therapists who promote, maintain, or restore health through physical examination, diagnosis, management, prognosis, patient ...
,
respiratory therapists,
speech therapists,
occupational therapists, radiographers,
dietitian
A dietitian, medical dietitian, or dietician is an expert in identifying and treating disease-related malnutrition and in conducting medical nutrition therapy, for example designing an enteral tube feeding regimen or mitigating the effects of ...
s, and
bioengineers,
medical physicists,
surgeons,
surgeon's assistant,
surgical technologist.
The scope and sciences underpinning human medicine overlap many other fields. A patient admitted to the 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 are:
* Basic sciences of medicine; this is what every physician is educated in, and some return to in
biomedical research.
*
Medical specialties
*
Interdisciplinary fields, where different medical specialties are mixed to function in certain occasions.
Basic sciences
* ''
Anatomy
Anatomy () is the branch of biology concerned with the study of the structure of organisms and their parts. Anatomy is a branch of natural science that deals with the structural organization of living things. It is an old science, having i ...
'' is the study of the physical structure of
organism
In biology, an organism () is any living system that functions as an individual entity. All organisms are composed of cells ( cell theory). Organisms are classified by taxonomy into groups such as multicellular animals, plants, and fu ...
s. In contrast to ''macroscopic'' or ''gross anatomy'', ''cytology'' and ''histology'' are concerned with microscopic structures.
* ''
Biochemistry
Biochemistry or biological chemistry is the study of chemical processes within and relating to living organisms. A sub-discipline of both chemistry and biology, biochemistry may be divided into three fields: structural biology, enzymology and ...
'' is the study of the chemistry taking place in living organisms, especially the structure and function of their chemical components.
* ''
Biomechanics'' is the study of the structure and function of biological systems by means of the methods of
Mechanics
Mechanics (from Ancient Greek: μηχανική, ''mēkhanikḗ'', "of machines") is the area of mathematics and physics concerned with the relationships between force, matter, and motion among physical objects. Forces applied to objec ...
.
* ''
Biostatistics'' is the application of statistics to biological fields in the broadest sense. A knowledge of biostatistics is essential in the planning, evaluation, and interpretation of medical research. It is also fundamental to
epidemiology
Epidemiology is the study and analysis of the distribution (who, when, and where), patterns and determinants of health and disease conditions in a defined population.
It is a cornerstone of public health, and shapes policy decisions and evi ...
and evidence-based medicine.
* ''
Biophysics'' is an interdisciplinary science that uses the methods of
physics
Physics is the natural science that studies matter, its fundamental constituents, its motion and behavior through space and time, and the related entities of energy and force. "Physical science is that department of knowledge which ...
and
physical chemistry to study biological systems.
* ''
Cytology'' is the microscopic study of individual
cells
Cell most often refers to:
* Cell (biology), the functional basic unit of life
Cell may also refer to:
Locations
* Monastic cell, a small room, hut, or cave in which a religious recluse lives, alternatively the small precursor of a monastery w ...
.
* ''
Embryology
Embryology (from Greek ἔμβρυον, ''embryon'', "the unborn, embryo"; and -λογία, '' -logia'') is the branch of animal biology that studies the prenatal development of gametes (sex cells), fertilization, and development of embr ...
'' is the study of the early development of organisms.
* ''
Endocrinology'' is the study of hormones and their effect throughout the body of animals.
* ''
Epidemiology
Epidemiology is the study and analysis of the distribution (who, when, and where), patterns and determinants of health and disease conditions in a defined population.
It is a cornerstone of public health, and shapes policy decisions and evi ...
'' is the study of the demographics of disease processes, and includes, but is not limited to, the study of epidemics.
* ''
Genetics'' is the study of genes, and their role in
biological inheritance.
* ''
Histology
Histology,
also known as microscopic anatomy or microanatomy, is the branch of biology which studies the microscopic anatomy of biological tissues. Histology is the microscopic counterpart to gross anatomy, which looks at larger structures v ...
'' is the study of the structures of
biological tissues by light
microscopy,
electron microscopy and
immunohistochemistry.
* ''
Immunology'' is the study of the
immune system
The immune system is a network of biological processes that protects an organism from diseases. It detects and responds to a wide variety of pathogens, from viruses to parasitic worms, as well as cancer cells and objects such as wood splinte ...
, which includes the innate and adaptive immune system in humans, for example.
* ''
Lifestyle medicine'' is the study of the
chronic conditions
A chronic condition is a health condition or disease that is persistent or otherwise long-lasting in its effects or a disease that comes with time. The term ''chronic'' is often applied when the course of the disease lasts for more than three mo ...
, and how to prevent, treat and reverse them.
* ''
Medical physics
Medical physics deals with the application of the concepts and methods of physics to the prevention, diagnosis and treatment of human diseases with a specific goal of improving human health and well-being. Since 2008, medical physics has been incl ...
'' is the study of the applications of physics principles in medicine.
* ''
Microbiology'' is the study of
microorganisms, including
protozoa,
bacteria,
fungi
A fungus ( : fungi or funguses) is any member of the group of eukaryotic organisms that includes microorganisms such as yeasts and molds, as well as the more familiar mushrooms. These organisms are classified as a kingdom, separately fr ...
, and
virus
A virus is a submicroscopic infectious agent that replicates only inside the living cells of an organism. Viruses infect all life forms, from animals and plants to microorganisms, including bacteria and archaea.
Since Dmitri Ivanovsk ...
es.
* ''
Molecular biology'' is the study of molecular underpinnings of the process of
replication,
transcription and
translation
Translation is the communication of the meaning of a source-language text by means of an equivalent target-language text. The English language draws a terminological distinction (which does not exist in every language) between ''transla ...
of the genetic material.
* ''
Neuroscience'' includes those disciplines of science that are related to the study of the
nervous system. A main focus of neuroscience is the
biology and physiology of the human brain and
spinal cord. Some related clinical specialties include
neurology,
neurosurgery and
psychiatry.
* ''
Nutrition science'' (theoretical focus) and ''
dietetics'' (practical focus) is the study of the relationship of food and drink to health and disease, especially in determining an optimal diet. Medical nutrition therapy is done by dietitians and is prescribed for
diabetes,
cardiovascular diseases, weight and eating
disorders, allergies,
malnutrition, and
neoplastic diseases.
* ''
Pathology as a science'' is the study of disease—the causes, course, progression and resolution thereof.
* ''
Pharmacology'' is the study of drugs and their actions.
* ''
Gynecology'' is the study of female reproductive system.
* ''
Photobiology Photobiology is the scientific study of the beneficial and harmful interactions of light (technically, non-ionizing radiation) in living organisms. The field includes the study of photophysics, photochemistry, photosynthesis, photomorphogenesis, ...
'' is the study of the interactions between
non-ionizing radiation and living organisms.
* ''
Physiology
Physiology (; ) is the scientific study of functions and mechanisms in a living system. As a sub-discipline of biology, physiology focuses on how organisms, organ systems, individual organs, cells, and biomolecules carry out the chemic ...
'' is the study of the normal functioning of the body and the underlying regulatory mechanisms.
* ''
Radiobiology'' is the study of the interactions between
ionizing radiation and living organisms.
* ''
Toxicology'' is the study of hazardous effects of drugs and
poisons.
Specialties
In the broadest meaning of "medicine", there are many different specialties. In the UK, most specialities have their own body or college, which has its own entrance examination. These are collectively known as the Royal Colleges, although not all currently use the term "Royal". The development of a speciality is often driven by new technology (such as the development of effective anaesthetics) or ways of working (such as emergency departments); the new specialty leads to the formation of a unifying body of doctors and the prestige of administering their own examination.
Within medical circles, specialities usually fit into one of two broad categories: "Medicine" and "Surgery". "Medicine" refers to the practice of non-operative medicine, and most of its subspecialties require preliminary training in Internal Medicine. In the UK, this was traditionally evidenced by passing the examination for the Membership of the
Royal College of Physicians (MRCP) or the equivalent college in Scotland or Ireland. "Surgery" refers to the practice of operative medicine, and most subspecialties in this area require preliminary training in General Surgery, which in the UK leads to membership of the
Royal College of Surgeons of England (MRCS). At present, some specialties of medicine do not fit easily into either of these categories, such as radiology, pathology, or anesthesia. Most of these have branched from one or other of the two camps above; for example anaesthesia developed first as a
faculty
Faculty may refer to:
* Faculty (academic staff), the academic staff of a university (North American usage)
* Faculty (division)
A faculty is a division within a university or college comprising one subject area or a group of related subject ...
of the Royal College of Surgeons (for which MRCS/FRCS would have been required) before becoming the
Royal College of Anaesthetists
The Royal College of Anaesthetists (RCoA) is the professional body responsible for the specialty of anaesthesia throughout the United Kingdom. It sets standards in anaesthesia, critical care, pain management, and for the training of anaesthe ...
and membership of the college is attained by sitting for the examination of the Fellowship of the Royal College of Anesthetists (FRCA).
Surgical specialty
Surgery is an ancient medical specialty that uses operative manual and instrumental techniques on a patient to investigate or treat a
pathological condition such as
disease or
injury, to help improve bodily function or appearance or to repair unwanted ruptured areas (for example,
a perforated ear drum). Surgeons must also manage pre-operative, post-operative, and potential surgical candidates on the hospital wards. In some centers,
anesthesiology
Anesthesiology, anaesthesiology, or anaesthesia is the medical specialty concerned with the total perioperative care of patients before, during and after surgery. It encompasses anesthesia, intensive care medicine, critical emergency medicine, ...
is part of the division of surgery (for historical and logistical reasons), although it is not a surgical discipline. Other medical specialties may employ surgical procedures, such as
ophthalmology
Ophthalmology ( ) is a surgical subspecialty within medicine that deals with the diagnosis and treatment of eye disorders.
An ophthalmologist is a physician who undergoes subspecialty training in medical and surgical eye care. Following a me ...
and
dermatology, but are not considered surgical sub-specialties per se.
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.
Surgical subspecialties include those a physician may specialize in after undergoing general surgery residency training as well as several surgical fields with separate residency training. Surgical subspecialties that one may pursue following general surgery residency training: ''
''
*
General surgery
*
Bariatric surgery
*
Cardiovascular surgery
Cardiac surgery, or cardiovascular surgery, is surgery on the heart or great vessels performed by cardiac surgeons. It is often used to treat complications of ischemic heart disease (for example, with coronary artery bypass grafting); to corr ...
- may also be pursued through a separate cardiovascular surgery residency track
*
Colorectal surgery
*
Endocrine surgery
*
Hand surgery
* Hepatico-Pancreatico-Biliary Surgery
*
Minimally invasive surgery
Minimally invasive procedures (also known as minimally invasive surgeries) encompass surgical techniques that limit the size of incisions needed, thereby reducing wound healing time, associated pain, and risk of infection. Surgery by definitio ...
*
Surgical oncology
*
Pediatric surgery
*
Plastic surgery - may also be pursued through a separate plastic surgery residency track
* Surgical critical care
*
Transplant surgery
Organ transplantation is a medical procedure in which an organ is removed from one body and placed in the body of a recipient, to replace a damaged or missing organ. The donor and recipient may be at the same location, or organs may be transpo ...
*
Trauma surgery
*
Vascular surgery - may also be pursued through a separate vascular surgery residency track
Other surgical specialties within medicine with their own individual residency training:
*
Dermatology
*
Neurosurgery
*
Ophthalmology
Ophthalmology ( ) is a surgical subspecialty within medicine that deals with the diagnosis and treatment of eye disorders.
An ophthalmologist is a physician who undergoes subspecialty training in medical and surgical eye care. Following a me ...
*
Oral and Maxillofacial surgery
*
Orthopedic surgery
*
Otorhinolaryngology
*
Podiatric surgery - do not undergo medical school training, but rather separate training in podiatry school
*
Urology
Internal medicine specialty
Internal medicine is the
medical specialty dealing with the prevention, diagnosis, and treatment of adult diseases. According to some sources, an emphasis on internal structures is implied. In North America, specialists in internal medicine are commonly called "internists". Elsewhere, especially in
Commonwealth nations, such specialists are often called
physicians.
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
Nephrology (from Greek'' nephros'' "kidney", combined with the suffix ''-logy'', "the study of") is a specialty of adult internal medicine and pediatric medicine that concerns the study of the kidneys, specifically normal kidney function (ren ...
specialize respectively in diseases of the gut and the kidneys.
In the
Commonwealth of Nations
The Commonwealth of Nations, simply referred to as the Commonwealth, is a political association of 56 member states, the vast majority of which are former territories of the British Empire. The chief institutions of the organisation are the C ...
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:
:*''
Angiology/Vascular Medicine''
:*''
Bariatrics''
:*''
Cardiology''
:*''
Critical care medicine''
:*''
Endocrinology''
:*''
Gastroenterology''
:*''
Geriatrics''
:*''
Hematology''
:*''
Hepatology
Hepatology is the branch of medicine that incorporates the study of liver, gallbladder, biliary tree, and pancreas as well as management of their disorders. Although traditionally considered a sub-specialty of gastroenterology, rapid expansi ...
''
:*''
Infectious disease''
:*''
Nephrology''
:*''
Neurology''
:*''
Oncology''
:*''
Pediatrics''
:*''
Pulmonology/Pneumology/Respirology/chest medicine''
:*''
Rheumatology''
:*''
Sports 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 US. This difference does not apply in the UK where all doctors are now required by law to work less than 48 hours per week on average.
Diagnostic specialties
* ''
Clinical laboratory sciences'' are the clinical diagnostic services that apply laboratory techniques to diagnosis and management of patients. In the United States, these services are supervised by a pathologist. The personnel that work in these
medical laboratory departments are technically trained staff who do not hold medical degrees, but who usually hold an undergraduate
medical technology degree, who actually perform the
tests
Test(s), testing, or TEST may refer to:
* Test (assessment), an educational assessment intended to measure the respondents' knowledge or other abilities
Arts and entertainment
* ''Test'' (2013 film), an American film
* ''Test'' (2014 film), ...
,
assays, and procedures needed for providing the specific services. Subspecialties include
transfusion medicine
Transfusion medicine (or transfusiology) is the branch of medicine that encompasses all aspects of the transfusion of blood and blood components including aspects related to hemovigilance. It includes issues of blood donation, immunohematology ...
,
cellular pathology,
clinical chemistry,
hematology,
clinical microbiology
Medical microbiology, the large subset of microbiology that is applied to medicine, is a branch of medical science concerned with the prevention, diagnosis and treatment of infectious diseases. In addition, this field of science studies vario ...
and
clinical immunology
Immunology is a branch of medicineImmunology for Medical Students, Roderick Nairn, Matthew Helbert, Mosby, 2007 and biology that covers the medical study of immune systems in humans, animals, plants and sapient species. In such we can see there ...
.
* ''
Pathology as a medical specialty'' is the branch of medicine that deals with the study of diseases and the morphologic, physiologic changes produced by them. As a diagnostic specialty, pathology can be considered the basis of modern scientific medical knowledge and plays a large role in
evidence-based medicine. Many modern molecular tests such as
flow cytometry,
polymerase chain reaction (PCR),
immunohistochemistry,
cytogenetics, gene rearrangements studies and
fluorescent in situ hybridization (FISH) fall within the territory of pathology.
* ''Diagnostic
radiology'' is concerned with imaging of the body, e.g. by
x-rays, x-ray
computed tomography,
ultrasonography, and
nuclear magnetic resonance tomography. Interventional radiologists can access areas in the body under imaging for an intervention or diagnostic sampling.
* ''
Nuclear medicine
Nuclear medicine or nucleology is a medical specialty involving the application of radioactive substances in the diagnosis and treatment of disease. Nuclear imaging, in a sense, is " radiology done inside out" because it records radiation emi ...
'' is concerned with studying human organ systems by administering radiolabelled substances (radiopharmaceuticals) to the body, which can then be imaged outside the body by a
gamma camera
A gamma camera (γ-camera), also called a scintillation camera or Anger camera, is a device used to image gamma radiation emitting radioisotopes, a technique known as scintigraphy. The applications of scintigraphy include early drug development ...
or a PET scanner. Each radiopharmaceutical consists of two parts: a tracer that is specific for the function under study (e.g., neurotransmitter pathway, metabolic pathway, blood flow, or other), and a radionuclide (usually either a gamma-emitter or a positron emitter). There is a degree of overlap between nuclear medicine and radiology, as evidenced by the emergence of combined devices such as the PET/CT scanner.
* ''
Clinical neurophysiology'' is concerned with testing the physiology or function of the central and peripheral aspects of the nervous system. These kinds of tests can be divided into recordings of: (1) spontaneous or continuously running electrical activity, or (2) stimulus evoked responses. Subspecialties include
electroencephalography,
electromyography,
evoked potential,
nerve conduction study and
polysomnography. Sometimes these tests are performed by techs without a medical degree, but the interpretation of these tests is done by a medical professional.
Other major specialties
The following are some major medical specialties that do not directly fit into any of the above-mentioned groups:
* ''
Anesthesiology
Anesthesiology, anaesthesiology, or anaesthesia is the medical specialty concerned with the total perioperative care of patients before, during and after surgery. It encompasses anesthesia, intensive care medicine, critical emergency medicine, ...
'' (also known as ''anaesthetics''): concerned with the perioperative management of the surgical patient. The anesthesiologist's role during surgery is to prevent derangement in the vital organs' (i.e. brain, heart, kidneys) functions and postoperative pain. Outside of the operating room, the anesthesiology physician also serves the same function in the labor and delivery ward, and some are specialized in critical medicine.
* ''
Emergency medicine'' is concerned with the diagnosis and treatment of acute or life-threatening conditions, including
trauma
Trauma most often refers to:
*Major trauma, in physical medicine, severe physical injury caused by an external source
*Psychological trauma, a type of damage to the psyche that occurs as a result of a severely distressing event
*Traumatic inju ...
, surgical, medical, pediatric, and psychiatric emergencies.
* ''
Family medicine'', ''
family practice'', ''
general practice'' or ''primary care'' is, in many countries, the first port-of-call for patients with non-emergency medical problems. Family physicians often provide services across a broad range of settings including office based practices, emergency department coverage, inpatient care, and nursing home care.
* ''
Obstetrics and
gynecology'' (often abbreviated as ''
OB/GYN'' (American English) or ''Obs & Gynae'' (British English)) are concerned respectively with childbirth and the female reproductive and associated organs.
Reproductive medicine and
fertility medicine
Reproductive endocrinology and infertility (REI) is a surgical subspecialty of obstetrics and gynecology that trains physicians in reproductive medicine addressing hormonal functioning as it pertains to reproduction as well as the issue of infert ...
are generally practiced by gynecological specialists.
* ''
Medical genetics'' is concerned with the diagnosis and management of hereditary disorders.
* ''
Neurology'' is concerned with diseases of the nervous system. In the UK, neurology is a subspecialty of general medicine.
* ''
Pediatrics'' (AE) or ''paediatrics'' (BE) is devoted to the care of infants, children, and adolescents. Like internal medicine, there are many pediatric subspecialties for specific age ranges, organ systems, disease classes, and sites of care delivery.
* ''
Pharmaceutical medicine'' is the medical scientific discipline concerned with the discovery, development, evaluation, registration, monitoring and medical aspects of marketing of medicines for the benefit of patients and public health.
* ''
Physical medicine and rehabilitation
Physical medicine and rehabilitation, also known as physiatry, is a branch of medicine that aims to enhance and restore functional ability and quality of life to people with physical impairments or disabilities. This can include conditions s ...
'' (or ''physiatry'') is concerned with functional improvement after injury, illness, or
congenital disorder
A birth defect, also known as a congenital disorder, is an abnormal condition that is present at birth regardless of its cause. Birth defects may result in disabilities that may be physical, intellectual, or developmental. The disabilities c ...
s.
* ''
Podiatric medicine
Podiatry () or podiatric medicine () is a branch of medicine devoted to the study, diagnosis, medical and surgical treatment of disorders of the foot, ankle, and leg.
A Doctor of Podiatric Medicine (DPM), or a podiatrist, is a healthcare p ...
'' is the study of, diagnosis, and medical & surgical treatment of disorders of the foot, ankle, lower limb, hip and lower back.
* ''
Psychiatry'' is the branch of medicine concerned with the
bio-psycho-social study of the
etiology, diagnosis, treatment and prevention of
cognitive,
perceptual
Perception () is the organization, identification, and interpretation of sensory information in order to represent and understand the presented information or environment. All perception involves signals that go through the nervous syste ...
,
emotional and
behavioral disorders. Related fields include
psychotherapy and
clinical psychology.
* ''
Preventive medicine'' is the branch of medicine concerned with preventing disease.
** ''
Community health'' or ''
public health'' is an aspect of health services concerned with threats to the overall health of a community based on
population health analysis.
Interdisciplinary fields
Some interdisciplinary sub-specialties of medicine include:
* ''
Aerospace medicine
Aviation medicine, also called flight medicine or aerospace medicine, is a preventive or occupational medicine in which the patients/subjects are pilots, aircrews, or astronauts. The specialty strives to treat or prevent conditions to which aircr ...
'' deals with medical problems related to flying and
space travel.
* ''
Addiction medicine'' deals with the treatment of addiction.
* ''
Medical ethics'' deals with
ethical and
moral principles that apply values and judgments to the practice of medicine.
* ''
Biomedical Engineering
Biomedical engineering (BME) or medical engineering is the application of engineering principles and design concepts to medicine and biology for healthcare purposes (e.g., diagnostic or therapeutic). BME is also traditionally logical sciences ...
'' is a field dealing with the application of
engineering
Engineering is the use of scientific principles to design and build machines, structures, and other items, including bridges, tunnels, roads, vehicles, and buildings. The discipline of engineering encompasses a broad range of more speciali ...
principles to medical practice.
* ''
Clinical pharmacology
Clinical pharmacology has been defined as "that discipline that teaches, does research, frames policy, gives information and advice about the actions and proper uses of medicines in humans and implements that knowledge in clinical practice". Clinic ...
'' is concerned with how systems of
therapeutics interact with patients.
* ''
Conservation medicine'' studies the relationship between human and animal health, and environmental conditions. Also known as ecological medicine,
environmental medicine
Environmental medicine is a multidisciplinary field involving medicine, environmental science, chemistry and others, overlapping with environmental pathology. It can be viewed as the medical branch of the broader field of environmental health. T ...
, or
medical geology.
* ''
Disaster medicine'' deals with medical aspects of emergency preparedness, disaster mitigation and management.
* ''
Diving medicine'' (or
hyperbaric medicine) is the prevention and treatment of diving-related problems.
* ''
Evolutionary medicine
Evolutionary medicine or Darwinian medicine is the application of modern evolutionary theory to understanding health and disease. Modern biomedical research and practice have focused on the molecular and physiological mechanisms underlying he ...
'' is a perspective on medicine derived through applying
evolutionary theory.
* ''
Forensic medicine'' deals with medical questions in
legal context, such as determination of the time and cause of death, type of weapon used to inflict trauma, reconstruction of the facial features using remains of deceased (skull) thus aiding identification.
* ''
Gender-based medicine'' studies the biological and physiological differences between the human sexes and how that affects differences in disease.
* ''
Hospice and Palliative Medicine'' is a relatively modern branch of clinical medicine that deals with pain and symptom relief and emotional support in patients with
terminal illnesses including cancer and
heart failure.
* ''
Hospital medicine'' is the general medical care of hospitalized patients. Physicians whose primary professional focus is hospital medicine are called
hospitalists in the United States and
Canada
Canada is a country in North America. Its ten provinces and three territories extend from the Atlantic Ocean to the Pacific Ocean and northward into the Arctic Ocean, covering over , making it the world's second-largest country by to ...
. The term Most Responsible Physician (MRP) or attending physician is also used interchangeably to describe this role.
* ''
Laser medicine'' involves the use of lasers in the diagnostics or treatment of various conditions.
* ''
Medical humanities
''Medical Humanities'' is a quarterly peer-reviewed academic journal covering the field of medical humanities. The journal presents the international conversation around medicine and its engagement with the humanities and arts, social sciences, ...
'' includes the
humanities (
literature
Literature is any collection of Writing, written work, but it is also used more narrowly for writings specifically considered to be an art form, especially prose fiction, drama, and poetry. In recent centuries, the definition has expanded to ...
,
philosophy
Philosophy (from , ) is the systematized study of general and fundamental questions, such as those about existence, reason, knowledge, values, mind, and language. Such questions are often posed as problems to be studied or resolved. ...
,
ethics
Ethics or moral philosophy is a branch of philosophy that "involves systematizing, defending, and recommending concepts of right and wrong behavior".''Internet Encyclopedia of Philosophy'' The field of ethics, along with aesthetics, concer ...
, history and religion),
social science (
anthropology,
cultural studies,
psychology,
sociology), and the arts (
literature
Literature is any collection of Writing, written work, but it is also used more narrowly for writings specifically considered to be an art form, especially prose fiction, drama, and poetry. In recent centuries, the definition has expanded to ...
, theater, film, and
visual arts) and their application to
medical education and practice.
* ''
Health informatics'' is a relatively recent field that deal with the application of computers and
information technology
Information technology (IT) is the use of computers to create, process, store, retrieve, and exchange all kinds of data . and information. IT forms part of information and communications technology (ICT). An information technology syste ...
to medicine.
* ''
Nosology'' is the classification of diseases for various purposes.
* ''
Nosokinetics'' is the science/subject of measuring and modelling the process of care in health and social care systems.
* ''
Occupational medicine
Occupational medicine, until 1960 called industrial medicine, is the branch of medicine which is concerned with the maintenance of health in the workplace, including prevention and treatment of diseases and injuries, with secondary objective ...
'' is the provision of health advice to organizations and individuals to ensure that the highest standards of health and safety at work can be achieved and maintained.
* ''
Pain management'' (also called ''
pain medicine
Pain management is an aspect of medicine and health care involving relief of pain (pain relief, analgesia, pain control) in various dimensions, from acute and simple to chronic and challenging. Most physicians and other health professional ...
'', or ''algiatry'') is the medical discipline concerned with the relief of pain.
* ''
Pharmacogenomics'' is a form of ''individualized medicine''.
* ''
Podiatric medicine
Podiatry () or podiatric medicine () is a branch of medicine devoted to the study, diagnosis, medical and surgical treatment of disorders of the foot, ankle, and leg.
A Doctor of Podiatric Medicine (DPM), or a podiatrist, is a healthcare p ...
'' is the study of, diagnosis, and medical treatment of disorders of the foot, ankle, lower limb, hip and lower back.
* ''
Sexual medicine'' is concerned with diagnosing, assessing and treating all disorders related to sexuality.
* ''
Sports medicine'' deals with the treatment and prevention and rehabilitation of sports/exercise injuries such as
muscle spasm
A spasm is a sudden involuntary contraction of a muscle, a group of muscles, or a hollow organ such as the bladder.
A spasmodic muscle contraction may be caused by many medical conditions, including dystonia. Most commonly, it is a muscle ...
s,
muscle tear
A strain is an acute or chronic soft tissue injury that occurs to a muscle, tendon, or both. The equivalent injury to a ligament is a sprain. Generally, the muscle or tendon overstretches and partially tears, under more physical stress than i ...
s, injuries to ligaments (ligament tears or ruptures) and their repair in
athletes
An athlete (also sportsman or sportswoman) is a person who competes in one or more sports that involve physical strength, speed, or endurance.
Athletes may be professionals or amateurs. Most professional athletes have particularly well-develo ...
,
amateur and
professional.
* ''
Therapeutics'' is the field, more commonly referenced in earlier periods of history, of the various remedies that can be used to treat disease and promote health.
* ''
Travel medicine
Travel medicine or emporiatrics is the branch of medicine that deals with the prevention and management of health problems of international travelers.
Globalization and travel
Globalization facilitates the spread of disease and increases the n ...
'' or ''emporiatrics'' deals with health problems of international travelers or travelers across highly different environments.
* ''
Tropical medicine'' deals with the prevention and treatment of tropical diseases. It is studied separately in temperate climates where those diseases are quite unfamiliar to medical practitioners and their local clinical needs.
* ''
Urgent care'' focuses on delivery of unscheduled, walk-in care outside of the hospital emergency department for injuries and illnesses that are not severe enough to require care in an emergency department. In some jurisdictions this function is combined with the emergency department.
*
Veterinary medicine;
veterinarians apply similar techniques as physicians to the care of animals.
* ''
Wilderness medicine
Wilderness medicine is a rapidly evolving field and is of increasing importance as more people engage in hiking, climbing, kayaking, and other potentially hazardous activities in the backcountry. The modern definition of wilderness medicine is "m ...
'' entails the practice of medicine in the wild, where conventional medical facilities may not be available.
* Many other
health science fields, e.g.
dietetics
Education and legal controls
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, or
residency
Residency may refer to:
* Domicile (law), the act of establishing or maintaining a residence in a given place
** Permanent residency, indefinite residence within a country despite not having citizenship
* Residency (medicine), a stage of postgrad ...
. 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. In Canada and the United States of America, a
Doctor of Medicine degree, often abbreviated M.D., or a
Doctor of Osteopathic Medicine degree, often abbreviated as D.O. and unique to the United States, must be completed in and delivered from a recognized university.
Since knowledge, techniques, and medical technology continue to evolve at a rapid rate, many regulatory authorities require
continuing medical education. Medical practitioners upgrade their knowledge in various ways, including
medical journals, seminars, conferences, and online programs. A database of objectives covering medical knowledge, as suggested by national societies across the United States, can be searched at http://data.medobjectives.marian.edu/.
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.
In the European Union, the profession of doctor of medicine is regulated. A profession is said to be regulated when access and exercise is subject to the possession of a specific professional qualification.
The regulated professions database contains a list of regulated professions for doctor of medicine in the EU member states, EEA countries and Switzerland. This list is covered by the Directive 2005/36/EC.
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.
Medical ethics
Medical ethics is a system of moral principles that apply values and judgments to the practice of 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. Six of the values that commonly apply to medical ethics discussions are:
*
autonomy – the patient has the right to refuse or choose their treatment. (''Voluntas aegroti suprema lex''.)
*
beneficence – a practitioner should act in the best interest of the patient. (''Salus aegroti suprema lex''.)
*
justice – concerns the distribution of scarce health resources, and the decision of who gets what treatment (fairness and equality).
*
non-maleficence
' () is a Latin phrase that means "first, do no harm". The phrase is sometimes recorded as '.
Non-maleficence, which is derived from the maxim, is one of the principal precepts of bioethics that all students in healthcare are taught in school a ...
– "first, do no harm" (''primum non-nocere'').
*
respect for persons
Respect for persons is the concept that all people deserve the right to fully exercise their autonomy. Showing respect for persons is a system for interaction in which one entity ensures that another has agency to be able to make a choice.
This c ...
– the patient (and the person treating the patient) have the right to be treated with dignity.
*
truthfulness and
honesty
Honesty or truthfulness is a facet of moral character that connotes positive and virtuous attributes such as integrity, truthfulness, straightforwardness, including straightforwardness of conduct, along with the absence of lying, cheating, th ...
– the concept of
informed consent has increased in importance since the historical events of the
Doctors' Trial of the Nuremberg trials,
Tuskegee syphilis experiment
The Tuskegee Study of Untreated Syphilis in the Negro Male (informally referred to as the Tuskegee Experiment or Tuskegee Syphilis Study) was a study conducted between 1932 and 1972 by the United States Public Health Service (PHS) and the Cent ...
, and others.
Values such as these do not give answers as to how to handle a particular situation, but provide a useful framework for understanding conflicts. When moral values are in conflict, the result may be an ethical
dilemma
A dilemma ( grc-gre, δίλημμα "double proposition") is a problem offering two possibilities, neither of which is unambiguously acceptable or preferable. The possibilities are termed the ''horns'' of the dilemma, a clichéd usage, but dis ...
or crisis. Sometimes, no good solution to a dilemma in medical ethics exists, and occasionally, the values of the medical community (i.e., the hospital and its staff) conflict with the values of the individual patient, family, or larger non-medical community. Conflicts can also arise between health care providers, or among family members. For example, some argue that the principles of autonomy and beneficence clash when patients refuse
blood transfusions, considering them life-saving; and truth-telling was not emphasized to a large extent before the HIV era.
History
Ancient world
Prehistoric medicine incorporated plants (
herbalism), animal parts, and minerals. In many cases these materials were used ritually as magical substances by priests,
shamans
Shamanism is a religious practice that involves a practitioner (shaman) interacting with what they believe to be a spirit world through altered states of consciousness, such as trance. The goal of this is usually to direct spirits or spirit ...
, or
medicine men. Well-known spiritual systems include
animism
Animism (from Latin: ' meaning ' breath, spirit, life') is the belief that objects, places, and creatures all possess a distinct spiritual essence. Potentially, animism perceives all things— animals, plants, rocks, rivers, weather syst ...
(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 examines the ways in which culture and society are organized around or impacted by issues of health, health care and related issues.
Early records on medicine have been discovered from
ancient Egyptian medicine
The medicine of the ancient Egyptians is some of the oldest documented. From the beginnings of the civilization in the late fourth millennium BC until the Persian invasion of 525 BC, Egyptian medical practice went largely unchanged and include ...
,
Babylonian Medicine
Babylonia (; Akkadian: , ''māt Akkadī'') was an ancient Akkadian-speaking state and cultural area based in the city of Babylon in central-southern Mesopotamia (present-day Iraq and parts of Syria). It emerged as an Amorite-ruled state c. ...
,
Ayurvedic medicine (in the
Indian subcontinent
The Indian subcontinent is a physiographical region in Southern Asia. It is situated on the Indian Plate, projecting southwards into the Indian Ocean from the Himalayas. Geopolitically, it includes the countries of Bangladesh, Bhutan, In ...
),
classical Chinese medicine
Traditional Chinese medicine (TCM) is an alternative medical practice drawn from traditional medicine in China. It has been described as "fraught with pseudoscience", with the majority of its treatments having no logical mechanism of action ...
(predecessor to the modern
traditional Chinese medicine), and
ancient Greek medicine and
Roman medicine.
In Egypt,
Imhotep (3rd millennium BCE) is the first physician in history known by name. The oldest
Egyptian medical text is the ''
Kahun Gynaecological Papyrus'' from around 2000 BCE, which describes gynaecological diseases. The ''
Edwin Smith Papyrus'' dating back to 1600 BCE is an early work on surgery, while the ''
Ebers Papyrus'' dating back to 1500 BCE is akin to a textbook on medicine.
In China, archaeological evidence of medicine in Chinese dates back to the
Bronze Age
The Bronze Age is a historic period, lasting approximately from 3300 BC to 1200 BC, characterized by the use of bronze, the presence of writing in some areas, and other early features of urban civilization. The Bronze Age is the second pri ...
Shang Dynasty, based on seeds for herbalism and tools presumed to have been used for surgery. The ''
Huangdi Neijing'', the progenitor of Chinese medicine, is a medical text written beginning in the 2nd century BCE and compiled in the 3rd century.
In India, the surgeon
Sushruta described numerous surgical operations, including the earliest forms of
plastic surgery.
Earliest records of dedicated hospitals come from Mihintale in
Sri Lanka
Sri Lanka (, ; si, ශ්රී ලංකා, Śrī Laṅkā, translit-std=ISO (); ta, இலங்கை, Ilaṅkai, translit-std=ISO ()), formerly known as Ceylon and officially the Democratic Socialist Republic of Sri Lanka, is an ...
where evidence of dedicated medicinal treatment facilities for patients are found.
In Greece, the
Greek physician Hippocrates, the "father of modern medicine",
[The father of modern medicine: the first research of the physical factor of tetanus](_blank)
, European Society of Clinical Microbiology and Infectious Diseases laid the foundation for a rational approach to medicine. Hippocrates introduced the
Hippocratic Oath for physicians, which is still relevant and in use today, and was the first to categorize illnesses as
acute
Acute may refer to:
Science and technology
* Acute angle
** Acute triangle
** Acute, a leaf shape in the glossary of leaf morphology
* Acute (medicine), a disease that it is of short duration and of recent onset.
** Acute toxicity, the adverse ef ...
,
chronic,
endemic
Endemism is the state of a species being found in a single defined geographic location, such as an island, state, nation, country or other defined zone; organisms that are indigenous to a place are not endemic to it if they are also found else ...
and epidemic, and use terms such as, "exacerbation,
relapse, resolution, crisis,
paroxysm, peak, and
convalescence
Convalescence is the gradual recovery of health and strength after illness or injury. It refers to the later stage of an infectious disease or illness when the patient recovers and returns to previous health, but may continue to be a source of ...
".
The Greek physician
Galen was also one of the greatest surgeons of the ancient world and performed many audacious operations, including brain and eye surgeries. After the fall of the
Western Roman Empire
The Western Roman Empire comprised the western provinces of the Roman Empire at any time during which they were administered by a separate independent Imperial court; in particular, this term is used in historiography to describe the period ...
and the onset of the
Early Middle Ages, the Greek tradition of medicine went into decline in Western Europe, although it continued uninterrupted in the
Eastern Roman (Byzantine) Empire
The Byzantine Empire, also referred to as the Eastern Roman Empire or Byzantium, was the continuation of the Roman Empire primarily in its eastern provinces during Late Antiquity and the Middle Ages, when its capital city was Constantinopl ...
.
Most of our knowledge of ancient
Hebrew medicine Jewish medicine is medical practice of the Jewish people, including writing in the languages of both Hebrew and Arabic. 28% of Nobel Prize winners in medicine have been Jewish, although Jews comprise less than 0.2% of the world's population.
Hist ...
during the
1st millennium BC comes from the
Torah, i.e. the Five Books of
Moses, which contain various health related laws and rituals. The Hebrew contribution to the development of modern medicine started in the
Byzantine Era
The Byzantine calendar, also called the Roman calendar, the Creation Era of Constantinople or the Era of the World ( grc, Ἔτη Γενέσεως Κόσμου κατὰ Ῥωμαίους, also or , abbreviated as ε.Κ.; literal translation of ...
, with the physician
Asaph the Jew.
Middle Ages
The concept of hospital as institution to offer medical care and possibility of a cure for the patients due to the ideals of Christian charity, rather than just merely a place to die, appeared in the
Byzantine Empire
The Byzantine Empire, also referred to as the Eastern Roman Empire or Byzantium, was the continuation of the Roman Empire primarily in its eastern provinces during Late Antiquity and the Middle Ages, when its capital city was Constantinopl ...
.
Although the concept of
uroscopy was known to Galen, he did not see the importance of using it to localize the disease. It was under the Byzantines with physicians such of
Theophilus Protospatharius that they realized the potential in uroscopy to determine disease in a time when no microscope or stethoscope existed. That practice eventually spread to the rest of Europe.
After 750 CE, the Muslim world had the works of Hippocrates, Galen and Sushruta translated into
Arabic
Arabic (, ' ; , ' or ) is a Semitic language spoken primarily across the Arab world.Semitic languages: an international handbook / edited by Stefan Weninger; in collaboration with Geoffrey Khan, Michael P. Streck, Janet C. E.Watson; Walter ...
, and
Islamic physicians engaged in some significant medical research. Notable Islamic medical pioneers include the
Persian polymath,
Avicenna, who, along with Imhotep and Hippocrates, has also been called the "father of medicine". He wrote ''
The Canon of Medicine'' which became a standard medical text at many medieval European
universities, considered one of the most famous books in the history of medicine. Others include
Abulcasis,
Avenzoar
Abū Marwān ‘Abd al-Malik ibn Zuhr ( ar, أبو مروان عبد الملك بن زهر), traditionally known by his Latinized name Avenzoar (; 1094–1162), was an Arab physician, surgeon, and poet. He was born at Seville in medieval And ...
,
Ibn al-Nafis, and
Averroes. Persian physician
Rhazes[copy]
was one of the first to question the Greek theory of
humorism, which nevertheless remained influential in both medieval Western and medieval
Islamic medicine. Some volumes of
Rhazes's work ''Al-Mansuri'', namely "On Surgery" and "A General Book on Therapy", became part of the medical curriculum in European universities. Additionally, he has been described as a doctor's doctor, the father of
pediatrics,
and a pioneer of
ophthalmology
Ophthalmology ( ) is a surgical subspecialty within medicine that deals with the diagnosis and treatment of eye disorders.
An ophthalmologist is a physician who undergoes subspecialty training in medical and surgical eye care. Following a me ...
. For example, he was the first to recognize the reaction of the eye's pupil to light.
The Persian
Bimaristan hospitals were an early example of
public hospitals.
In Europe,
Charlemagne decreed that a hospital should be attached to each cathedral and monastery and the historian
Geoffrey Blainey likened the
activities of the Catholic Church in health care during the Middle Ages to an early version of a welfare state: "It conducted hospitals for the old and orphanages for the young; hospices for the sick of all ages; places for the lepers; and hostels or inns where pilgrims could buy a cheap bed and meal". It supplied food to the population during famine and distributed food to the poor. This welfare system the church funded through collecting taxes on a large scale and possessing large farmlands and estates. The
Benedictine order was noted for setting up hospitals and infirmaries in their monasteries, growing medical herbs and becoming the chief medical care givers of their districts, as at the great
Abbey of Cluny. The Church also established a network of
cathedral schools and universities where medicine was studied. The
Schola Medica Salernitana in Salerno, looking to the learning of
Greek and
Arab
The Arabs (singular: Arab; singular ar, عَرَبِيٌّ, DIN 31635: , , plural ar, عَرَب, DIN 31635: , Arabic pronunciation: ), also known as the Arab people, are an ethnic group mainly inhabiting the Arab world in Western Asia, ...
physicians, grew to be the finest medical school in Medieval Europe.
However, the fourteenth and fifteenth century
Black Death devastated both the Middle East and Europe, and it has even been argued that Western Europe was generally more effective in recovering from the pandemic than the Middle East. In the early modern period, important early figures in medicine and anatomy emerged in Europe, including
Gabriele Falloppio and
William Harvey.
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
Claudius Ptolemy (; grc-gre, Πτολεμαῖος, ; la, Claudius Ptolemaeus; AD) was a mathematician, astronomer, astrologer, geographer, and music theorist, who wrote about a dozen scientific treatises, three of which were of importanc ...
's theories on astronomy). Physicians like
Vesalius improved upon or disproved some of the theories from the past. The main tomes used both by medicine students and expert physicians were
Materia Medica and
Pharmacopoeia.
Andreas Vesalius was the author of ''
De humani corporis fabrica
''De Humani Corporis Fabrica Libri Septem'' (Latin, lit. "On the fabric of the human body in seven books") is a set of books on human anatomy written by Andreas Vesalius (1514–1564) and published in 1543. It was a major advance in the history ...
'', an important book on
human anatomy. Bacteria and microorganisms were first observed with a microscope by
Antonie van Leeuwenhoek in 1676, initiating the scientific field
microbiology.
Independently from
Ibn al-Nafis,
Michael Servetus rediscovered the
pulmonary circulation, but this discovery did not reach the public because it was written down for the first time in the "Manuscript of Paris" in 1546, and later published in the theological work for which he paid with his life in 1553. Later this was described by
Renaldus Columbus
Matteo Realdo Colombo (c. 1515 – 1559) was an Italian professor of anatomy and a surgeon at the University of Padua between 1544 and 1559.
Early life and education
Matteo Realdo Colombo or Realdus Columbus, was born in Cremona, Lombardy, the ...
and
Andrea Cesalpino
Andrea Cesalpino ( Latinized as Andreas Cæsalpinus) (6 June 1524 – 23 February 1603) was a Florentine physician, philosopher and botanist.
In his works he classified plants according to their fruits and seeds, rather than alphabetically o ...
.
Herman Boerhaave is sometimes referred to as a "father of physiology" due to his exemplary teaching in Leiden and textbook 'Institutiones medicae' (1708).
Pierre Fauchard has been called "the father of modern dentistry".
Modern
Veterinary medicine was, for the first time, truly separated from human medicine in 1761, when the French veterinarian
Claude Bourgelat founded the world's first veterinary school in Lyon, France. Before this, medical doctors treated both humans and other animals.
Modern scientific
biomedical research (where results are testable and
reproducible
Reproducibility, also known as replicability and repeatability, is a major principle underpinning the scientific method. For the findings of a study to be reproducible means that results obtained by an experiment or an observational study or in a ...
) began to replace early Western traditions based on herbalism, the Greek "
four humours" and other such pre-modern notions. The modern era really began with
Edward Jenner's discovery of the
smallpox vaccine at the end of the 18th century (inspired by the method of
inoculation earlier practiced in Asia),
Robert Koch's discoveries around 1880 of the transmission of disease by bacteria, and then the discovery of
antibiotics around 1900.
The post-18th century
modernity period brought more groundbreaking researchers from Europe. From
Germany
Germany,, officially the Federal Republic of Germany, is a country in Central Europe. It is the second most populous country in Europe after Russia, and the most populous member state of the European Union. Germany is situated betwee ...
and Austria, doctors
Rudolf Virchow,
Wilhelm Conrad Röntgen,
Karl Landsteiner
Karl Landsteiner (; 14 June 1868 – 26 June 1943) was an Austrian-born American biologist, physician, and immunologist. He distinguished the main blood groups in 1900, having developed the modern system of classification of blood groups from ...
and
Otto Loewi
Otto Loewi (; 3 June 1873 – 25 December 1961) was a German-born pharmacologist and psychobiologist who discovered the role of acetylcholine as an endogenous neurotransmitter. For his discovery he was awarded the Nobel Prize in Physiology or M ...
made notable contributions. In the
United Kingdom
The United Kingdom of Great Britain and Northern Ireland, commonly known as the United Kingdom (UK) or Britain, is a country in Europe, off the north-western coast of the continental mainland. It comprises England, Scotland, Wales and ...
,
Alexander Fleming,
Joseph Lister
Joseph Lister, 1st Baron Lister, (5 April 182710 February 1912) was a British surgeon, medical scientist, experimental pathologist and a pioneer of antiseptic surgery and preventative medicine. Joseph Lister revolutionised the craft of ...
,
Francis Crick and
Florence Nightingale
Florence Nightingale (; 12 May 1820 – 13 August 1910) was an English social reformer, statistician and the founder of modern nursing. Nightingale came to prominence while serving as a manager and trainer of nurses during the Crimean War ...
are considered important.
Spanish doctor
Santiago Ramón y Cajal
Santiago Ramón y Cajal (; 1 May 1852 – 17 October 1934) was a Spanish neuroscientist, pathologist, and histologist specializing in neuroanatomy and the central nervous system. He and Camillo Golgi received the Nobel Prize in Physiology or M ...
is considered the father of modern
neuroscience.
From New Zealand and Australia came
Maurice Wilkins,
Howard Florey, and
Frank Macfarlane Burnet.
Others that did significant work include
William Williams Keen,
William Coley
William Bradley Coley (January 12, 1862 – April 16, 1936) was an American bone surgeon and cancer researcher best known for his early contributions to the study of cancer immunotherapy. Although his work was not proven effective in his lifeti ...
,
James D. Watson (United States);
Salvador Luria (Italy);
Alexandre Yersin
Alexandre Emile Jean Yersin (22 September 1863 – 1 March 1943) was a Swiss-French physician and bacteriologist. He is remembered as the co-discoverer of the bacillus responsible for the bubonic plague or pest, which was later named in his ...
(Switzerland);
Kitasato Shibasaburō
Baron was a Japanese physician and bacteriologist. He is remembered as the co-discoverer of the infectious agent of bubonic plague in Hong Kong during an outbreak in 1894, almost simultaneously with Alexandre Yersin.
Kitasato was nominat ...
(Japan);
Jean-Martin Charcot,
Claude Bernard,
Paul Broca (France);
Adolfo Lutz
Adolfo Lutz (6 October 1855 – 18 December 1940) was a Brazilian physician, father of tropical medicine and medical zoology in Brazil, and a pioneer epidemiologist and researcher in infectious diseases.
Life
Lutz was born in Rio de Janeiro, ...
(Brazil);
Nikolai Korotkov (Russia);
Sir William Osler (Canada); and
Harvey Cushing
Harvey Williams Cushing (April 8, 1869 – October 7, 1939) was an American neurosurgeon, pathologist, writer, and draftsman. A pioneer of brain surgery, he was the first exclusive neurosurgeon and the first person to describe Cushing's disease ...
(United States).
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.
Pharmacology developed in part from
herbalism and some drugs are still derived from plants (
atropine,
ephedrine,
warfarin,
aspirin,
digoxin,
''vinca'' alkaloids,
taxol,
hyoscine
Scopolamine, also known as hyoscine, or Devil's Breath, is a natural or synthetically produced tropane alkaloid and anticholinergic drug that is formally used as a medication for treating motion sickness and postoperative nausea and vomi ...
, etc.).
Vaccines were discovered by
Edward Jenner and
Louis Pasteur.
The first antibiotic 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
Sulfonamide is a functional group (a part of a molecule) that is the basis of several groups of drugs, which are called sulphonamides, sulfa drugs or sulpha drugs. The original antibacterial sulfonamides are synthetic (nonantibiotic) ant ...
, derived by German chemists originally from
azo dyes.
Pharmacology 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 and
human evolution
Human evolution is the evolutionary process within the history of primates that led to the emergence of '' Homo sapiens'' as a distinct species of the hominid family, which includes the great apes. This process involved the gradual developmen ...
is having increasingly significant influence on medicine, as the causative
gene
In biology, the word gene (from , ; "...Wilhelm Johannsen coined the word gene to describe the Mendelian units of heredity..." meaning ''generation'' or ''birth'' or ''gender'') can have several different meanings. The Mendelian gene is a b ...
s of most monogenic
genetic disorders have now been identified, and the development of techniques in
molecular biology,
evolution, and
genetics are influencing medical technology, practice and decision-making.
Evidence-based medicine is a contemporary movement to establish the most effective
algorithms of practice (ways of doing things) through the use of
systematic reviews and
meta-analysis. The movement is facilitated by modern global
information science
Information science (also known as information studies) is an academic field which is primarily concerned with analysis, collection, classification, manipulation, storage, retrieval, movement, dissemination, and protection of information. ...
, which allows as much of the available evidence as possible to be collected and analyzed according to standard protocols that are then disseminated to healthcare providers. 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.
Quality, efficiency, and access
Evidence-based medicine, prevention of medical error (and other "iatrogenesis"), and avoidance of unnecessary health care are a priority in modern medical systems. These topics generate significant political and public policy attention, particularly in the United States where healthcare is regarded as excessively costly but
population health metrics lag similar nations.
Globally, many
developing countries lack access to care and access to medicines. As of 2015, most wealthy developed countries provide Universal health care, health care to all citizens, with a few exceptions such as the United States where lack of
health insurance coverage may limit access.
See also
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References
{{Authority control
Medicine,
new:चिकित्सा