Medicine

Template:Two other uses of [http://en.wikipedia.org/wiki/Asclepius, the God|Greek god of medicine, holding the symbolic of Asclepius with its coiled [1]] Medicine is the field of science and the [2] of [3]. It encompasses a variety of care practices evolved to maintain and restore [4] by the (medical)|prevention and [5] of [6] in beings.

Contemporary medicine applies science, research, and technology to (medical)|diagnose and treat injury and disease, typically through medication or [7], but also through therapies as diverse as [8], (medicine)|external splints & traction, [9], medical product|biologics, (medicine)|ionizing radiation and others. The word medicine is derived from the [10] ars medicina, meaning the art of healing.

History

Template:Main of ancient Egyptian physician [http://en.wikipedia.org/wiki/Imhotep, the first physician from antiquity known by name.]

medicine incorporated plants ([11]), animal parts and minerals. In many cases these materials were used ritually as magical substances by priests, [12], or man|medicine men. Well-known spiritual systems include [13] (the notion of inanimate objects having spirits), [14] (an appeal to gods or communion with ancestor spirits); [15] (the vesting of an individual with mystic powers); and [16] (magically obtaining the truth). The field of anthropology examines the ways in which culture and society are organized around or impacted by issues of health, health care and related issues.

aryballos Louvre CA1989-2183.jpg|thumb|200px|right|An ancient Greek patient gets medical treatment: this [http://en.wikipedia.org/wiki/aryballos (circa 480–470 BCE, now in Paris's Museum) probably contained healing oil] [http://en.wikipedia.org/wiki/Ancient Greek medicine|Greek physician [17] (ca. 460 BCE – ca. 370 BCE), considered the father of medicine.] polymath, [http://en.wikipedia.org/wiki/Avicenna, who, along with Imhotep and Hippocrates, has been called the "father of medicine"] Early records on medicine have been discovered from Egyptian medicine, Medicine|Babylonian medicine, [18] medicine (in the subcontinent), Chinese medicine (predecessor to the modern Chinese Medicine), and Greek medicine and in ancient Rome|Roman medicine. The Egyptian [19] (3rd millennium BC) is the first physician in history known by name. Earliest records of dedicated hospitals come from Mihintale in Lanka where evidence of dedicated medicinal treatment facilities for patients are found. The Indian surgeon [20] described numerous surgical operations, including the earliest forms of surgery.Template:Dubious

The Greek medicine|Greek physician [21], the "father of medicine", laid the foundation for a rational approach to medicine. Hippocrates introduced the Oath for physicians, which is still relevant and in use today, and was the first to categorize illnesses as (medical)|acute, (medicine)|chronic, (epidemiology)|endemic and epidemic, and use terms such as, "exacerbation, [22], resolution, crisis, [23], peak, and [24]".

The Greek physician [25] 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 Roman Empire and the onset of the Middle Ages, the Greek tradition of medicine went into decline in Western Europe, although it continued uninterrupted in the Roman Empire|Eastern Roman (Byzantine) Empire.

Most of our knowledge of ancient medicine during the millennium BC|1st millennium BC comes from the [26], i.e. the Five Books of [27], which contain various health related laws and rituals. The Hebrew contribution to the development of modern medicine started in the Era, with the physician the Jew, and has since been tremendous.

After 750 CE, the Muslim world had the works of Hippocrates, Galen and Sushruta translated into Arabic, and medicine|Islamic physicians engaged in some significant medical research. Notable Islamic medical pioneers include the [28], [29], who, along with Imhotep and Hippocrates, has also been called the "father of medicine". He wrote Canon of Medicine, considered one of the most famous books in the history of medicine. Others include al-Qasim al-Zahrawi|Abulcasis, Zuhr|Avenzoar, al-Nafis, and [30]. ibn Zakariya Razi|Rhazes was one of first to question the Greek theory of [31], which nevertheless remained influential in both medieval Western and medieval medicine. The Islamic [32] hospitals were an early example of hospitals.

However, the fourteenth and fifteenth century Death was just as devastating to the Middle East as to Europe, and it has even been argued that Western Europe was generally more effective in recovering from the pandemic than the Middle East. In the early modern period, important early figures in medicine and anatomy emerged in Europe, including Falloppio and Harvey.

The major shift in medical thinking was the gradual rejection, especially during the 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|Copernicus's rejection of [33]'s theories on astronomy). Physicians like [34] improved upon or disproved some of the theories from the past.

Vesalius was an author of one of the most influential books on anatomy, humani corporis fabrica. French surgeon Paré is considered as one of the fathers of [35]. Bacteria and microorganisms were first observed with a microscope by van Leeuwenhoek in 1676, initiating the scientific field [36]. Partly based on the works by the Italian surgeon and anatomist Realdo Colombo the English physician Harvey described the system. Boerhaave is sometimes referred to as a "father of physiology" due to his exemplary teaching in Leiden and textbook 'Institutiones medicae' (1708). It is said that the 17th century French physician Fauchard started [37] science as we know it today, and he has been named "the father of modern dentistry".

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 research (where results are testable and [38]) began to replace early Western traditions based on herbalism, the Greek "humours" and other such pre-modern notions. The modern era really began with Jenner's discovery of the vaccine at the end of the 18th century (inspired by the method of [39] earlier practiced in Asia), Koch's discoveries around 1880 of the transmission of disease by bacteria, and then the discovery of [40]s around 1900.

The post-18th century [41] period brought more groundbreaking researchers from Europe. From [42] and Austria, doctors Virchow, Conrad Röntgen, Landsteiner and Loewi made notable contributions. In the United Kingdom, Fleming, Lister, 1st Baron Lister|Joseph Lister, Crick and Nightingale are considered important. [43] doctor Ramón y Cajal is considered the father of modern [44].

From New Zealand and Australia came Wilkins, Florey, Baron Florey|Howard Florey, and Macfarlane Burnet.

In the United States, Williams Keen, Coley, D. Watson, Italy (Luria), Switzerland (Yersin), Japan (Shibasaburo), and France (Charcot, Bernard, Broca and others did significant work). Russian Korotkov also did significant work, as did Osler|Sir William Osler and Cushing.

As science and technology developed, medicine became more reliant upon [45]s. 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. [46] developed from [47] and many drugs are still derived from plants (atropine, ephedrine, warfarin, [48], digoxin, vinca alkaloids, taxol, hyoscine, etc.). [49]s were discovered by Jenner and Pasteur.

The first antibiotic was [50] / [51] discovered by Ehrlich in 1908 after he observed that bacteria took up toxic dyes that human cells did not. The first major class of [52]s was the (medicine)|sulfa drugs, derived by French chemists originally from compound|azo dyes.

Pharmacology has become increasingly sophisticated; modern [53] allows drugs targeted towards specific physiological processes to be developed, sometimes designed for compatibility with the body to reduce effect|side-effects. [54] and knowledge of genetics is having some influence on medicine, as the causative [55]s of most monogenic disorders have now been identified, and the development of techniques in biology and genetics are influencing medical technology, practice and decision-making.

medicine is a contemporary movement to establish the most effective [56] of practice (ways of doing things) through the use of reviews and [57]. The movement is facilitated by modern global science, 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 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.

Clinical practice

Template:Merge from Doctor Luke Fildes crop.jpg|thumb|250px|The Doctor, by [http://en.wikipedia.org/wiki/Sir Luke Fildes (1891)] In clinical practice, doctors personally assess patients in order to diagnosis|diagnose, treat, and prevent disease using clinical judgment. The relationship typically begins an interaction with an examination of the patient's history and record, followed a medical interview and a examination. Basic diagnostic devices (e.g. [58], depressor) are typically used. After examination for (medical)|signs and interviewing for [59], the doctor may order tests (e.g. tests), take a [60], or prescribe drugs or other therapies. 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. Followups may be shorter but follow the same general procedure.

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 'presenting complaint.'
• History of present illness / complaint (HPI): the chronological order of events of symptoms and further clarification of each symptom.
• Current activity: occupation, hobbies, what the patient actually does.
• [61]s (Rx): what drugs the patient takes including prescribed, drug|over-the-counter, and remedy|home remedies, as well as alternative and medicines/herbal remedies. [62] are also recorded.
• Past medical history (PMH/PMHx): concurrent medical problems, past hospitalizations and operations, injuries, past diseases and/or [63]s, history of known allergies.
• Social history (SH): birthplace, residences, marital history, social and economic status, habits (including (nutrition)|diet, medications, smoking|tobacco, alcohol).
• history (medicine)|Family history (FH): listing of diseases in the family that may impact the patient. A 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 loss, change in sleep quality, fevers, lumps and bumps? etc.), followed by questions on the body's main organ systems (heart|heart, lung|lungs, tract|digestive tract, system|urinary tract, etc.).

The 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 (e.g., in infection, [64], ketoacidosis). Taste has been made redundant by the availability of modern lab tests. Four actions are taught as the basis of physical examination: (medicine)|inspection, [65] (feel), (medicine)|percussion (tap to determine resonance characteristics), and [66] (listen). This order may be modified depending on the main focus of the examination (e.g., a joint may be examined by simply "look, feel, move". Having this set order is an educational tool that encourages practitioners to be systematic in their approach and refrain from using tools such as the [67] before they have fully evaluated the other modalities).

The clinical examination involves study of:

• Vital signs including height, weight, body temperature, pressure, [68], respiration rate, hemoglobin saturation
• General appearance of the patient and specific indicators of disease (nutritional status, presence of jaundice, pallor or clubbing|clubbing)
• skin|Skin
• Head, eye, [69], nose, and throat (HEENT)
• [70] ([71] and vessels)
• [72] (large airways and [73])
• [74] and [75]
• Genitalia (and pregnancy if the patient is or could be pregnant)
• [76] (including spine and extremities)
• [77] (consciousness, awareness, brain, vision, nerves, spinal cord and nervous system|peripheral nerves)
• [78] (orientation, state examination|mental state, 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.

laboratory|Laboratory and imaging|imaging studies results may be obtained, if necessary.

The medical decision-making (MDM) process involves analysis and synthesis of all the above data to come up with a list of possible diagnoses (the diagnosis|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 [79] tests and studies, starting therapy, referral to a specialist, or watchful observation. Follow-up may be advised.

This process is used by primary care providers as well as specialists. It may take only a few minutes if the problem is simple and straightforward. On the other hand, it may take weeks in a patient who has been hospitalized with bizarre symptoms or multi-system problems, with involvement by several specialists.

On subsequent visits, the process may be repeated in an abbreviated manner to obtain any new history, symptoms, physical findings, and lab or imaging results or specialist consultations.

Institutions

Santa Maria della Scala n5.jpg|thumb|The Hospital of [http://en.wikipedia.org/wiki/Santa Maria della Scala (Siena)|Santa Maria della Scala, fresco by di Bartolo, 1441–1442] Contemporary medicine is in general conducted within care systems. Legal, [80]ing and financing frameworks are established by individual governments, augmented on occasion by international organizations. The characteristics of any given health care system have significant impact on the way medical care is provided.

Advanced industrial countries (with the exception of the United States) and many country|developing countries provide medical services through a system of health care that aims to guarantee care for all through a health care system, or compulsory private or co-operative 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 [81] societies, and the United States, 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.

ampoule JPN.jpg|thumb|Modern drug [http://en.wikipedia.org/wiki/ampoules]

Transparency of information is another factor defining a delivery system. Access to information on conditions, treatments, quality, and pricing greatly affects the choice by patients/consumers and, therefore, the incentives of medical professionals. While the US 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.

Delivery

Provision of medical care is classified into primary, secondary, and tertiary care categories.

care medical services are provided by [82], assistants, practitioners, or other health professionals who have first contact with a patient seeking medical treatment or care. These occur in physician offices, [83]s, 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, care and education for all ages and both sexes.

care medical services are provided by 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 care and [84] services, department|emergency rooms, care medicine, surgery services, therapy, and delivery, [85] units, diagnostic laboratory|laboratory and imaging services, care|hospice centers, etc. Some primary care providers may also take care of hospitalized patients and deliver babies in a secondary care setting.

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 centers, (injury)|burn treatment centers, advanced [86] unit services, transplants, high-risk pregnancy, therapy|radiation [87], etc.

Modern medical care also depends on information – still delivered in many health care settings on paper records, but increasingly nowadays by electronic means.

Branches

Working together as an team, many highly trained professionals besides medical practitioners are involved in the delivery of modern health care. Examples include: [88]s, medical technicians and paramedics, laboratory scientists, [89], assistants, [90], therapists, therapy|speech therapists, therapy|occupational therapists, radiographers, [91]s, and [92].

The scope and sciences underpinning human medicine overlap many other fields. [93], while considered by some a separate discipline from medicine, is a medical field.

A patient admitted to hospital is usually under the care of a specific team based on their main presenting problem, e.g., the Cardiology team, who then may interact with other specialties, e.g., surgical, radiology, to help diagnose or treat the main problem or any subsequent complications/developments.

Physicians have many specializations and subspecializations into certain branches of medicine, which are listed below. There are variations from country to country regarding which specialties certain subspecialties are in.

The main branches of medicine are:

• Basic sciences of medicine; this is what every physician is educated in, and some return to in research#Preclinical research|biomedical research.
• specialties
• sub-specialties of medicine|Interdisciplinary fields, where different medical specialties are mixed to function in certain occasions.

Basic sciences

• [94] is the study of the physical structure of [95]s. In contrast to macroscopic or gross anatomy, cytology and histology are concerned with microscopic structures.
• [96] is the study of the chemistry taking place in living organisms, especially the structure and function of their chemical components.
• [97] is the study of the structure and function of biological systems by means of the methods of [98].
• [99] 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 [100] and evidence-based medicine.
• [101] is an interdisciplinary science that uses the methods of [102] and chemistry to study biological systems.
• biology|Cytology is the microscopic study of individual (biology)|cells.Louis Pasteur.jpg|thumb|200px|[http://en.wikipedia.org/wiki/Louis Pasteur in his laboratory, 1885]
• [103] is the study of the early development of organisms.
• [104] is the study of hormones and their effect throughout the body of animals.
• [105] is the study of the demographics of disease processes, and includes, but is not limited to, the study of epidemics.
• [106] is the study of genes, and their role in inheritance.
• [107] is the study of the structures of tissues by light [108], microscope|electron microscopy and [109].
• [110] is the study of the system, which includes the innate and adaptive immune system in humans, for example.
• physics is the study of the applications of physics principles in medicine.
• [111] is the study of [112]s, including [113], [114], [115], and [116]es.
• biology is the study of molecular underpinnings of the process of replication|replication, (genetics)|transcription and [117] of the genetic material.
• [118] includes those disciplines of science that are related to the study of the system. A main focus of neuroscience is the [119] and physiology of the human brain and cord. Some related clinical specialties include [120], [121] and [122].
• science (theoretical focus) and [123] (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 [124], diseases, weight and eating illness|disorders, allergies, [125], and [126] diseases.
• as a science is the study of disease—the causes, course, progression and resolution thereof.
• [127] is the study of drugs and their actions.
• [128] is the study of the interactions between radiation and living organisms.
• [129] is the study of the normal functioning of the body and the underlying regulatory mechanisms.
• [130] is the study of the interactions between radiation and living organisms.
• [131] is the study of hazardous effects of drugs and [132]s.

Specialties

Template:Main In the broadest meaning of "medicine", there are many different specialties. In the UK, most specialities will have their own body or college (collectively known as the Royal Colleges, although currently not all use the term "Royal"), which have their own entrance exam. The development of a speciality is often driven by new technology (such as the development of effective anaesthetics) or ways of working (e.g., emergency departments), which leads to the desire to form a unifying body of doctors and thence the prestige of administering their own exam.

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 subspecialties in this area require preliminary training in "Internal Medicine". In the UK, this would traditionally have been evidenced by obtaining the MRCP (An exam allowing Membership of the College of Physicians 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." (In the UK: Membership of the College of Surgeons of England (MRCS).)There are some specialties of medicine that at the present time 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 (teaching staff)|faculty of the Royal College of Surgeons (for which MRCS/FRCS would have been required) before becoming the College of Anaesthetists and membership of the college is by sitting the FRCA (Fellowship of the Royal College of Anesthetists).

Surgery

Template:Main at Work.jpg|thumb|Surgeons in an [http://en.wikipedia.org/wiki/operating room] Surgical specialties employ operative treatment. In addition, surgeons must decide when an operation is necessary, and also treat many non-surgical issues, particularly in the surgical intensive care unit (SICU), where a variety of critical issues arise. Surgeons must also manage pre-operative, post-operative, and potential surgical candidates on the hospital wards. Surgery has many sub-specialties, including surgery, surgery, surgery, [133], surgery, surgery, surgery, [134], surgery, surgery, surgery, surgery, [135], surgery, and surgery. In some centers, [136] 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 [137] and [138], 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.

'Medicine' as a specialty

Template:Main Internal medicine is the medical (medicine)|specialty concerned with the diagnosis, management and nonsurgical treatment of unusual or serious diseases, either of one particular organ system or of the body as a whole. According to some sources, an emphasis on internal structures is implied. In North America, specialists in internal medicine are commonly called "internists". Elsewhere, especially in of Nations|Commonwealth nations, such specialists are often called [139]s. 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, [140]s and [141]s specialize respectively in diseases of the gut and the kidneys.

In the of Nations and some other countries, specialist [142] and [143] 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 care physician|Primary care.

There are many subspecialities (or subdisciplines) of medicine:

• [144]
• care medicine
• [145]
• [146]
• [147]
• [148]
• [149]
• diseases
• [150]
• [151]
• [152]
• [153]
• [154]
• medicine.

Training in internal medicine (as opposed to surgical training), varies considerably across the world: see the articles on education and [155] for more details. In North America, it requires at least three years of residency training after medical school, which can then be followed by a one to three year fellowship in the subspecialties listed above. In general, resident work hours in medicine are less than those in surgery, averaging about 60 hours per week in the USA. 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

• 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 laboratory departments are technically trained staff who do not hold medical degrees, but who usually hold an undergraduate technology degree, who actually perform the test|tests, [156]s, and procedures needed for providing the specific services. Subspecialties include medicine, pathology, chemistry, [157], microbiology and immunology.
• 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 medicine. Many modern molecular tests such as cytometry, chain reaction (PCR), [158], [159], gene rearrangements studies and in situ hybridization (FISH) fall within the territory of pathology.
• [160] is concerned with imaging of the human body, e.g. by [161]s, x-ray tomography, [162], and magnetic resonance [163].
• medicine 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 camera 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.
• 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 [164], [165], potential, conduction study and [166]. 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 followings are some major medical specialties that do not directly fit into any of the above mentioned groups.

• [167] (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 served the same function in the labor & delivery ward, and some are specialized in critical medicine.
• [168] is concerned with the skin and its diseases. In the UK, dermatology is a subspecialty of general medicine.
• medicine is concerned with the diagnosis and treatment of acute or life-threatening conditions, including trauma|trauma, surgical, medical, pediatric, and psychiatric emergencies.
• medicine, practice, 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 room coverage, inpatient care, and nursing home care.
• [169] and [170] (often abbreviated as [171] (American English) or Obs & Gynae (British English)) are concerned respectively with childbirth and the female reproductive and associated organs. medicine and medicine are generally practiced by gynecological specialists.
• Genetics is concerned with the diagnosis and management of hereditary disorders.
• [172] is concerned with diseases of the nervous system. In the UK, neurology is a subspecialty of general medicine.
• [173] exclusively concerned with the eye and ocular adnexa, combining conservative and surgical therapy.
• [174] (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.
• medicine and rehabilitation (or physiatry) is concerned with functional improvement after injury, illness, or disorders.
• [175] is the branch of medicine concerned with the [176] study of the [177], diagnosis, treatment and prevention of [178], [179], [180] and [181] disorders. Related non-medical fields include [182] and psychology.
• medicine is the branch of medicine concerned with preventing disease.
  • health or health is an aspect of health services concerned with threats to the overall health of a community based on health analysis.
  • medicine's principal role 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.
  • medicine deals with medical problems related to flying and spaceflight|space travel.

Interdisciplinary fields

Some interdisciplinary sub-specialties of medicine include:

• medicine deals with the treatment of addiction.
• ethics deals with [183]al and [184] principles that apply values and judgments to the practice of medicine.
• Engineering is a field dealing with the application of [185] principles to medical practice.
• pharmacology is concerned with how systems of [186] interact with patients.
• medicine studies the relationship between human and animal health, and environmental conditions. Also known as ecological medicine, medicine, or geology.
• medicine deals with medical aspects of emergency preparedness, disaster mitigation and management.
• medicine (or medicine) is the prevention and treatment of diving-related problems.
• medicine is a perspective on medicine derived through applying theory.
• medicine deals with medical questions in [187] context, such as determination of the time and cause of death.
• medicine studies the biological and physiological differences between the human sexes and how that affects differences in disease.
• and Palliative Medicine is a relatively modern branch of clinical medicine that deals with pain and symptom relief and emotional support in patients with illnesses including cancer and failure.
• medicine is the general medical care of hospitalized patients. Physicians whose primary professional focus is hospital medicine are called [188]s in the USA and Canada. The term Most Responsible Physician (MRP) or attending physician is also used interchangeably to describe this role.
• medicine involves the use of lasers in the diagnostics and/or treatment of various conditions.
• humanities includes the [189] ([190], [191], [192], history and religion), science ([193], studies, [194], [195]), and the arts ([196], theater, film, and arts) and their application to education and practice.
• informatics, computer science, information and [197] are relatively recent fields that deal with the application of computers and technology to medicine.
• [198] is the classification of diseases for various purposes.
• [199] is the science/subject of measuring and modelling the process of care in health and social care systems.
• management (also called medicine, or algiatry) is the medical discipline concerned with the relief of pain.
• [200] is a form of individualized medicine.
• medicine is concerned with diagnosing, assessing and treating all disorders related to sexuality.
• medicine deals with the treatment and preventive care of [201], [202] and [203]. The team includes specialty physicians and surgeons, athletic trainers, physical therapists, (sport)|coaches, other personnel, and, of course, the athlete.
• [204] 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.
• medicine or emporiatrics deals with health problems of international travelers or travelers across highly different environments.
• 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 room.
• medicine; [205] apply similar techniques as physicians to the care of animals.
• medicine (practice)|Wilderness medicine entails the practice of medicine in the wild, where conventional medical facilities may not be available.
• Many other science fields, e.g. [206]

Education

Template:Main lautrec 1901 examination at faculty of medicine.jpg|thumb|Painted by [http://en.wikipedia.org/wiki/Henri de Toulouse-Lautrec|Toulouse-Lautrec in the year of his own death: an examination in the Paris faculty of medicine, 1901]

Medical education and training varies around the world. It typically involves entry level education at a university school, followed by a period of supervised practice or intern|internship, and/or (medicine)|residency. This can be followed by postgraduate vocational training. A variety of teaching methods have been employed in medical education, still itself a focus of active research.

Many regulatory authorities require medical education, since knowledge, techniques and medical technology continue to evolve at a rapid rate.

Medical ethics

Template:Main 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:

• [207] - the patient has the right to refuse or choose their treatment. (Voluntas aegroti suprema lex.)
• (ethics)|beneficence - a practitioner should act in the best interest of the patient. (Salus aegroti suprema lex.)
• (ethics)|justice - concerns the distribution of scarce health resources, and the decision of who gets what treatment (fairness and equality).
• non nocere|non-maleficence - "first, do no harm" (primum non nocere).
• for persons - the patient (and the person treating the patient) have the right to be treated with dignity.
• [208]fulness and [209] - the concept of consent has increased in importance since the historical events of the Trial of the Nuremberg trials and syphilis experiment.

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 [210] 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. Some argue for example, that the principles of autonomy and beneficence clash when patients refuse transfusions, considering them life-saving; and truth-telling was not emphasized to a large extent before the HIV era.

Legal controls

In most countries, it is a legal requirement for a medical doctor to be licensed or registered. In general, this entails a medical degree from a university and accreditation by a 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 [211]s that practice inadequate medicine for personal gain. While the laws generally require medical doctors to be trained in "evidence based", Western, or [212] Medicine, they are not intended to discourage different paradigms of health.

Doctors who are negligent or intentionally harmful in their care of patients can face charges of malpractice and be subject to civil, criminal, or professional sanctions.

Criticism of modern medicine

The Catholic social theorist Illich subjected contemporary western medicine to detailed attack in his Medical Nemesis, first published in 1975. He argued that the [213] in recent decades of so many of life's vicissitudes — birth and death, for example — frequently caused more harm than good and rendered many people in effect lifelong patients. He marshalled a body of statistics to show what he considered the shocking extent of post-operative side-effects and drug-induced illness in advanced society. He was the first to introduce to a wider public the notion of [214]. Others have since voiced similar views, but none so trenchantly, perhaps, as Illich.

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 model of health, led to criticisms that medicine was neglecting a [215] model.Template:Citation needed The inability of modern medicine to properly address some common complaints continues to prompt many people to seek support from medicine. Although most alternative approaches lack scientific validation, some, notably acupuncture for some conditions and certain herbs, are backed by evidence.

errors and [216] are also the focus of complaints and negative coverage. Practitioners of factors [217] believe that there is much that medicine may usefully gain by emulating concepts in safety, where it is recognized that it is dangerous to place too much responsibility on one "superhuman" individual and expect him or her not to make [218]s. Reporting systems and checking mechanisms are becoming more common in identifying sources of error and improving practice. Clinical versus statistical, [219] diagnostic methods were famously examined in psychiatric practice in a 1954 book by E. Meehl, which found statistical methods superior. A 2000 [220] comparing these methods in both psychology and medicine found that statistical or "mechanical" diagnostic methods were, in general, although not always, superior.

Disparities in quality of care given are often an additional cause of controversy. For example, elderly mentally ill patients received poorer care during hospitalization in a 2008 study. Rural poor African-American men were used in a Study of Untreated Syphilis in the Negro Male|study of syphilis that denied them basic medical care.

Honors and awards

The highest honor awarded in medicine is the Prize in Medicine, awarded since 1901 by the Assembly at Karolinska Institutet.

Patron saints

There are a number of saints of occupations and activities|patron saints for physicians, the most important of whom are Luke the Evangelist the physician and disciple of [221], Cosmas and Damian (3rd-century physicians from [222]), and Pantaleon (4th-century physician from [223]). Raphael is also considered a patron saint of physicians. In India and in [224], [225], a form of Lord [226] and "Vaidyanatha" meaning 'Lord of Medicine', a form of Lord [227] are the patron dieties of medicine.

The saints of occupations and activities|patron saints for surgeons are Luke the Evangelist, the physician and disciple of [228], Cosmas and Damian (3rd-century physicians from [229]), Quentin (3rd-century saint from France), Foillan (7th-century saint from [230]), and Roch (14th-century saint from France).

See also

• of causes of death by rate
• of diseases
• of disorders
• of important publications in medicine
• encyclopedia
• equipment
• literature
• psychology
• sociology
• medicine

External links

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