
Medicine is a branch of health science concerned with maintaining health and restoring it by treating disease. Medicine is both an area of knowledge (a science), and the application of that knowledge (by the medical profession and other health professionals such as nurses). The various specialized branches of the science of medicine correspond to equally specialized medical professions dealing with particular organs or diseases. The science of medicine is the knowledge of body systems and diseases, while the profession of medicine refers to the social structure of the group of people formally trained to apply that knowledge to treat disease. There are traditions and schools of healing which are usually not considered to be part of (Western) medicine in a strict sense (see health science for an overview). The most highly developed systems of medicine outside of the Western or Hippocrates tradition are the Ayurvedic medicine (of India) and traditional Chinese medicine. The remainder of this article focuses on modern (Western) medicine. ==History of medicine== ''Main articles: History of medicine, Timeline of medicine and medical technology''. Medicine as it is practiced now is rooted in various traditions, but developed mainly in the late 18th century and early 19th century in Germany (Rudolf Virchow) and France (Jean-Martin Charcot, Claude Bernard and others). The new, "scientific" medicine replaced more traditional views based on the "four humours". The development of clinical medicine shifted to the United Kingdom and the United States during the early 1900s (William Osler, Harvey Cushing). Evidence-based medicine is the recent movement to link the practice and the science of medicine more closely through the use of the scientific method and modern information science. Genomics is already having a large influence on medical practice, as most monogenic genetic disorders have now been linked to causative genes, and molecular biology techniques are influencing medical decision-making. ==Practice of medicine== The medical encounter or patient-medical doctor relationship is an important part of what medicine is about (there are other relationships between health professionals and patients that are also important, e.g. nurse - patient). A person with a health problem or concern sees a doctor for help. The practice of medicine combines both science and art. Science and technology are the evidence base for many clinical problems for the general population at large. The art of medicine is the application of this medical knowledge in combination with intuition and clinical judgment to determine the proper diagnoses and treatment plan for this unique patient and to treat the patient accordingly. The doctor needs to: *develop a relationship with the patient *gather data (anamnesis and physical examination combined with laboratory or imaging studies) *analyze and synthesize that data (assessment and/or differential diagnosis), and then * develop a treatment plan (more testing, therapy, watchful observation, referral and follow-up) * treat the patient accordingly * assess the progress of treatment and alter the plan as necessary. The medical encounter is documented in a medical record. One method that is used is called the ''problem-oriented medical record'' (POMR), which includes a problem list of diagnoses and a "SOAP" method of documentation for each visit: * ''S'' - Subjective, the medical history of the problem from the point-of-view of the patient. * ''O'' - Objective, the physical examination and any laboratory or imaging studies. * ''A'' - Assessment, is the medical decision-making process including the differential diagnoses and most probable diagnoses. * ''P'' - Plan, the way resolve the problem and monitor progress ===Medical systems=== Medicine is practiced within the medical system of a particular culture or government. Leaving aside tribal cultures, the most significant divide in developed countries is that between universal health care and the market based health care (such as practiced in the US). ===Patient-doctor relationship=== The doctor-patient relationship and interaction is a central process in the practice of medicine. There are many perspectives from which to understand and describe it. An idealized physician's perspective, such as is taught in medical school, sees the core aspects of the process as the physician learning from the patient his symptoms, concerns and values; in response the physician examines the patient, interprets the symptoms, and formulates a diagnosis to explain the symptoms and their cause to the patient and to propose a treatment. In more detail, the patient presents a set of complaints or concerns about his health to the doctor, who then obtains further information about the patient's symptoms, previous state of health, living conditions, and so forth, and then formulates a diagnosis and enlists the patient's agreement to a treatment plan. Importantly, during this process the doctor educates the patient about the causes, progression, outcomes, and possible treatments of his ailments, as well as often providing advice for maintaining health. This teaching relationship is the basis of calling the physician doctor, which originally meant "teacher" in Latin. The patient-doctor relationship is additionally complicated by the patient's suffering (patient comes from the Latin ''patiens'', "suffering") and limited ability to relieve it on his own. The doctor's expertise comes from his knowledge about, or experience with, other people who have suffered similar symptoms, and his presumed ability to relieve it with medicines or other therapies about which the patient may initially have little knowledge. The doctor-patient relationship can be analyzed from the perspective of medical ethics concerns, in terms of how well the goals of non-maleficence, beneficence, autonomy, and justice are achieved. Many other values and ethical issues can be added to these. In different societies, periods, and cultures, different values may be assigned different priorities. For example, in the last 30 years medical care in the Western World has increasingly emphasized patient autonomy in decision making. The relationship and process can also be analyzed in terms of social power relationships (e.g., by Michel Foucault), or economic transactions. Physicians have been accorded gradually higher status and respect over the last century, and they have been entrusted with control of access to prescription medicines as a public health measure. This represents a concentration of power and carries both advantages and disadvantages to particular kinds of patients with particular kinds of conditions. A further twist has occurred in the last 25 years as costs of medical care have risen, and a third party (an insurance company or government agency) now often insists upon a share of decision-making power for a variety of reasons, reducing freedom of choice of both doctors and patients in many ways. The quality of the patient-doctor relationship is important to both parties. The better the relationship in terms of mutual respect, knowledge, trust, shared values and perspectives about disease and life, and time available, the better will be the amount and quality of information about the patient's disease transferred in both directions, enhancing accuracy of diagnosis and increasing the patient's knowledge about the disease. In some settings, e.g. the hospital ward, the patient-doctor relationship is much more complex, and many other people are involved when somebody is ill: relatives, neighbors, rescue specialists, nurses, technical personnel, social workers and others. ===Clinical skills=== ''Main articles: Anamnesis, Physical examination.'' A complete medical evaluation includes a anamnesis, a physical examination, appropriate laboratory or imaging studies, analysis of data and medical decision making to obtain diagnoses, and treatment plan. The components of the medical history are: * Chief complaint (CC) - the reason for the current medical visit. * History of present illness (HPI) - the chronological order of events of symptoms. A mnemonic PQRST is sometimes helpful in obtaining the history: ** Provocative-palliative factors - what makes a symptom worse or better. ** Quality - description of the symptom ** Region - which part of the body is affected ** Severity - what is the intensity of the symptom; using a scale of 0-10 (10 worst) ** Timing - what is the course of the symptom * Current activity - occupation, hobbies, what the patient actually does. * Medications - what drugs including OTCs, and home remedies, as well as herbal medicine remedies such as St. John's Wort. Allergy are recorded. * Past medical history (PMH/PMHx) - other medical diagnoses, past hospitalizations and surgerys, injuries, past infectious diseases and/or vaccinations * Review of systems (ROS) - an outline of additional symptoms to ask which may be missed on HPI, generally following the body's main organ systems (heart, lungs, digestive tract, urinary tract, etc.) * Social history (SH) - birthplace, residences, marital history, social and economic status, habits including diet (nutrition), drugs, tobacco, alcohol * Family history (FH) - listing of diseases in the family that may impact the patient. A family tree is sometimes used. The physical examination is the examination of the patient looking for signs of disease. The doctor uses his senses of sight, hearing, touch, and sometimes smell (taste has been replaced by modern lab tests). Four chief methods are used: inspection, palpation, percussion, and auscultation; smelling may be useful (e.g. infection, uremia, diabetic ketoacidosis). * Vital signs include height, weight, body temperature, blood pressure, pulse, respiration rate, hemoglobin oxygen saturation * General appearance of the patient * Skin * Head, eye, ear, nose, and throat (HEENT) * Cardiovascular - heart and blood vessels * Respiratory - lungs * Abdomen and rectosigmoid * Genitalia * Spine and extremities - musculoskeletal * Neuropsychiatric Medical laboratory and Medical imaging results, if any. Medical decision making (MDM) process involves the analysis and synthesis of all the above data to come with a list of possible diagnoses (the differential diagnosis) and what needs to be done to come up with a final diagnosis which would explain the patient's problem. Treatment plan may include ordering additional labs and studies, starting therapy, referring to a specialist, or watchful observation. Follow-up may be needed. This process is used by primary care providers as well as specialists. It may take only a few minutes if the problem is simple and straightforward. Or it may take weeks for a patient who has been hospitalized with multiple system problems involving several specialists. On subsequent visits, the process may be repeated in an abbreviated manner to obtain any new history, symptoms, physical findings, and lab or imaging results or specialist consultations. ==Settings where medical care is delivered== ''See also clinic, hospital, and hospice'' Medicine is a diverse field and the provision of medical care is therefore provided in a variety of locations. Primary care medical services are provided by physicians or other health professionals who has first contact with a patient seeking medical treatment or care. These occur in physician's office, clinics, nursing homes, schools, home visits and other places close to patients. About 90% of medical visits can be treated by the primary care provider. These include treatment of acute and chronic illnesses, preventive care and health education for all ages and both sex. Secondary care medical services are provided by medical specialists in their offices or clinics or at local community hospitals for a patient referred by a primary care provider who first diagnosed or treated the patient. Referrals are made for those patients who required the expertise or procedures performed by specialists. These include both ambulatory care and inpatient services, emergency rooms, intensive care medicine, surgery services, physical therapy, childbirth, endoscopy units, diagnostic laboratory and medical imaging services, hospice centers, etc. Some primary care providers may also take care of hospitalized patients and deliver babies in a secondary care setting. Tertiary care medical services are provided by specialist hospitals or regional centers equipped with diagnostic and treatment facilities not generally available at local hospitals. These include trauma centers, burn (injury) treatment centers, advanced neonatology unit services, organ transplants, high-risk pregnancy, radiation therapy oncology, etc. Modern medical care also depends on information - still delivered in many health care settings on paper records, but increasingly nowadays by electronic means. ==Branches of medicine== The delivery of modern health care depends, not just on medical practitioners, but on an expanding group of highly trained profession coming together as an interdisciplinary team. A full list is given on the health profession page. Some examples include: nurse, laboratory scientists, pharmacy, physiotherapy, speech therapy, occupational therapy, dietitians and bioengineering. The scope and sciences underpinning human medicine overlap many other fields. Dentistry and clinical psychology, while separate disciplines from medicine, are sometimes also considered medical fields. Physician assistants, nurse practitioners and midwives treat patients and prescribe medication in many legal jurisdictions. Veterinary medicine applies similar techniques to the care of animals. Medical doctors have many specializations and subspecializations which are listed below. ===Basic sciences=== *''Anatomy'' is the study of the physical structure of organisms. In contrast to ''macroscopic'' or ''gross anatomy'', ''cytology'' and ''histology'' are concerned with microscopic structures. *''Biochemistry'' is the study of the chemistry taking place in living organisms, especially the structure and function of their chemical components. *''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 and evidence-based medicine. *''Cytology'' is the microscopic study of individual cell (biology). *''Embryology'' is the study of the early development of organisms. *''Epidemiology'' 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'' is the study of the structures of biological tissues by light microscopy, electron microscopy and histochemistry. *''Immunology'' is the study of the immune system, which includes the innate and adaptive immune system in human, for example. *''Microbiology'' is the study of microorganisms, including protozoa, bacterium, fungus, and viruses. *''Neuroscience'' is a comprehensive term for 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. *''Nutrition'' 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 neoplasia diseases. *''Pathology'' is the study of disease - the causes, course, progression and resolution thereof. *''Pharmacology'' is the study of drugs and their actions. *''Physiology'' is the study of the normal functioning of the body and the underlying regulatory mechanisms. *''Toxicology'' is the study of hazardous effects of drugs and poisons. ===Diagnostic specialties=== *''Clinical laboratory sciences'' are the clinical diagnostic services which 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, each of whom usually hold a medical technology degree, who actually perform the medical tests, assays, and procedures needed for providing the specific services. **''Transfusion medicine'' is concerned with the transfusion of blood and blood component, including the maintenance of a "''blood bank''". **''Cellular pathology'' is concerned with diagnosis using samples from patients taken as tissues and cells using histology and cytology. **''Chemical pathology'' is concerned with diagnosis by making biochemical analysis of blood, body fluids and tissues. **''Hematology'' is concerned with diagnosis by looking at changes in the cellular composition of the blood and bone marrow as well as the coagulation system in the blood. **''Clinical microbiology'' is concerned with the ''in vitro'' diagnosis of diseases caused by bacterium, viruses, fungus, and parasites. **''Clinical immunology'' is concerned with disorders of the immune system and related body defenses. It also deals with diagnosis of allergy. *''Radiology'' is concerned with imaging of the human body, e.g. by x-rays, x-ray computed tomography, ultrasonography, and nuclear magnetic resonance tomography. **''Interventional radiology'' is concerned with using imaging of the human body, usually from CT, ultrasound, or fluoroscopy, to do biopsy, place certain tubes, and perform intravascular procedures. **''Nuclear Medicine'' uses radioactive substances for ''in vivo'' and ''in vitro'' diagnosis using either imaging of the location of radioactive substances placed into a patient, or using ''in vitro'' diagnostic tests utilizing radioactive substances. ===Clinical disciplines=== *''Anesthesiology'' (American English), ''Anaesthesia'' (British English), is the clinical discipline concerned with providing anesthesia. Pain medicine is often practiced by specialised anesthesiologists. *''Dermatology'' is concerned with the skin and its diseases. *''Emergency medicine'' is concerned with the diagnosis and treatment of acute or life-threatening conditions, including trauma, surgical, medical, pediatric, and psychiatric emergencies. *''General practice'' or ''family medicine'' or ''primary care'' is, in many countries, the first port-of-call for patients with non-emergency medical problems. Family doctors are usually able to treat over 90% of all complaints without referring to specialists. *''Geriatrics'' is concerned with medical care of the elderly. *''Hospital medicine'' is the general medical care of hospitalized patients. Doctors whose primary professional focus is hospital medicine are called hospitalists. *''Intensive care medicine'' is concerned with the therapy of patients with serious and life-threatening disease or injury. Intensive care medicine employs invasive diagnostic techniques and (temporary) replacement of organ functions by technical means. *''Internal medicine'' is concerned with diseases of inner organs and systemic dieseases of adults, i.e. such that affect the body as a whole. There are several subdisciplines of internal medicine: **''Cardiology'' is concerned with the heart and cardiovascular system and their diseases. **''Gastroenterology'' is concerned with the organs of digestion. **''Endocrinology'' is concerned with the endocrine system, i.e. endocrine glands and hormones. **''Hematology'' (or ''haematology'') is concerned with the blood and its diseases. **''Infectious diseases'' is concerned with the study, diagnosis and treatment of diseases caused by biological agents. **''Nephrology'' is concerned with diseases of the kidneys. **''Oncology'' is devoted to the study, diagnosis and treatment of cancer and other malignant diseases. **''Pulmonology'' (or ''chest medicine'', ''respiratory medicine'' or ''lung medicine'') is concerned with diseases of the lungs and the respiratory system. **''Rheumatology'' is devoted to the diagnosis and treatment of inflammatory diseases of the joints and other organ systems. *''Neurology'' is concerned with the diagnosis and treatment of nervous system diseases. *''Obstetrics and Gynecology'' (often abbreviated as Obstetrics and Gynaecology) are concerned respectively with childbirth and the female reproductive and associated organs. Reproductive medicine and fertility medicine is generally practiced by gynecological specialists. *''Palliative care'' is a relatively modern branch of clinical medicine that deals with pain and symptom relief and emotional support in patients with terminal diseases (cancer, heart failure). *''Pediatrics'' (or ''paediatrics'') is devoted to the care of children, and adolescents. Like internal medicine, there are many pediatric subspecialities for specific age ranges, organ systems, disease classes and sites of care delivery. Most subspecialities of adult medicine have a pediatric equivalent such as pediatric cardiology, pediatric endocrinology, pediatric gastroenterology, pediatric hematology, and pediatric oncology. *''Physical medicine and rehabilitation'' (or ''physiatry'') is concerned with functional improvement after injury, illness, or congenital abnormality. *''Preventive medicine'' is the branch of medicine concerned with preventing disease. **''Community health care'' or ''public health'' is an aspect of health services concerned with threats to the overall health of a community based on population health analysis. **''Occupational medicine'''s principal role is the provision of health advice to organisations and individuals to ensure that the highest standards of health and safety at work can be achieved and maintained. *''Psychiatry'' is a branch of medicine that studies and treats mental disorders. Related non-medical fields are psychotherapy and clinical psychology. There are several subdisciplines of Psychiatry: **''Child & adolescent psychiatry'' focuses on the care of children and adolescents with mental/emotional/learning problems (i.e., ADHD, Autism, family conflicts). **''Geriatric psychiatry'' focuses on the care of elderly people with mental illnesses (i.e., dementias, post stroke cognitive changes, depression). **''Addiction psychiatry'' focuses on substance abuse and its treatment. **''Forensic psychiatry'' focuses on the interface of psychiatry and the Law. *''Radiation therapy'' is concerned with the therapeutic use of ionizing radiation and high energy elementary particle beams in patient treatment. *''Surgical specialties'' - there are many medical disciplines that employ operative treatment. Some of these are highly specialized and are often not considered subdisciplines of surgery, although their naming might suggest so. **''General surgery'' is traditionally defined as the specialty of surgery of the skin, endocrine glands, and abdomen (and, sometimes, the mammary glands). In some countries, it is still deemed a pre-requisite training prior to progression to training in certain sub-specialties, but lately has evolved into its own sub-specialty. **''Cardiovascular surgery'' is the surgical specialty that is concerned with the heart and major blood vessels of the chest. **''Neurosurgery'' is concerned with the operative treatment of diseases of the nervous system. **''Maxillofacial surgery'' (technically a subspeciality of dentistry) **''Ophthalmology'' deals with the diseases of the eyes and their treatment. **''Orthopedic surgery'' consists on surgery of the locomotor system. **''Otolaryngology'' (or ''otorhinolaryngology'' or ''ENT''/ear-nose-throat) is concerned with treatment of ear, nose and throat disorders. The term head and neck surgery defines a closely related specialty which is concerned mainly with surgical oncology of the same anatomical structures. **''Pediatric surgery'' treats a wide variety of chest and abdominal (and sometimes urology) diseases of childhood. **''Plastic surgery'' includes aesthetic surgery (operations that are done for other than medical purposes) as well as reconstructive surgery (operations to restore function and/or appearance after traumatic or operative mutilation). **''Surgical oncology'' is concerned with curative and palliative surgical approaches to cancer treatment. **''Urology'' focuses on the urinary tracts of males and females, and on the male reproductive system. It is often practiced together with andrology ("men's health"). **''Vascular surgery'' is surgery of "peripheral" blood vessels, i.e. those outside of the chest (usually operated on by cardiovascular surgery) and of the central nervous system (treated by neurosurgery). *''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. ===Interdisciplinary fields=== Interdisciplinary sub-specialties of medicine are: *''Aerospace medicine'' deals with medical problems related to flying and space travel. *''Bioethics'' is a field of study which concerns the relationship between biology, science, medicine and ethics, philosophy and theology. *''Clinical pharmacology'' 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, or medical geology. *''Diving medicine'' (or hyperbaric medicine) is the prevention and treatment of diving-related problems. * ''Evolutionary medicine'' 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. *''Medical humanities'' includes the humanities (literature, philosophy, ethics, history and religion), social science (anthropology, cultural studies, psychology, sociology), and the arts (literature, theater, film, and visual arts) and their application to medical education and practice. *''Medical informatics'' and ''medical computer science'' are relatively recent fields that deal with the application of computers and information technology to medicine. *''Nosology'' is the classification of diseases for various purposes. *''Sports medicine'' deals with the treatment and preventive care of athletics, amateur and professional. The team includes specialty physicians and surgeons, athletic trainers, physical therapists, Coach (sport)es, other personnel, and, of course, the athlete. ==Medical education== ''See also the main article, Medical doctor (British English) or Physician (American English)'' Medical training involves several years of university study followed by several more years of residential practice at a hospital. Entry to a medical degree in some countries (such as the United States) requires the completion of another degree first, while in other countries (such as the United Kingdom, Australia and New Zealand) medical training can be commenced as an undergraduate degree immediately after secondary education. The name of the medical academic degree gained at the end varies: some countries (e.g. the US) call it "Doctor of Medicine" (abbreviated 'M.D.'), while other countries (mostly following the British Oxbridge system) call it "''Medicinæ Baccalaureus & Baccalaureus Chirurgiæ''" (Latin for "Bachelors of Medicine and Surgery", Old English: "''Chirurgie''"); this is technically a double degree, frequently abbreviated 'MB BChir', 'MB ChB', 'MB BS' (or variations thereof), dependent on the medical school. In either case, graduates of a medical degree may call themselves physician. In the US and some other countries there is a parallel system of medicine called "osteopathy" which awards the degree D.O. (doctor of osteopathy). In many countries, a doctorate of medicine does not require original research as does, in distinction, a Doctor of Philosophy. Once graduated from medical school most physicians begin their residency/house post training, where skills in a speciality of medicine are learned, supervised by more experienced doctors. The first year of residency is known as the "intern" year (USA) or "junior/pre-registration house officer" year (UK). The duration of residency training depends on the speciality. A medical graduate can then enter general practice and become a general practitioner (or primary care internist in the United States); training for these is generally shorter, while specialist training is typically longer. ==Medical devices== ''See also the main articles: implant (medicine), artificial limbs, corrective lenses, cochlear implants, ocular prosthetics, facial prosthetics, somato prosthetics, surgical prosthetics, maxillo-facial prosthetics and dental implants'' Medical devices are devices used by health professionals as tools in diagnosis, treatment or other aspects of patient care. ==Legal restrictions== In most countries, it is a legal requirement for medical doctors 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 doctors 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 and healing, such as alternative medicine or faith healing. ==Criticism== Criticism against medicine has a long history. In the Middle Ages, it was not considered a profession suitable for Christians, as disease was considered Godsent, and interfering with the process a form of blasphemy. Barber surgeon generally had a bad reputation that was not to improve until the development of academic surgery as a specialism of medicine, rather than an accessory field. Through the course of the twentieth century, doctors naturally focused increasingly on the technology that was enabling them to make dramatic improvements in patients' health. This resulted in criticism for the loss of compassion and mechanistic, detached treatment. This issue started to reach collective professional consciousness in the 1970s and the profession had begun to respond by the 1980 and 1990s. Perhaps the most devastating criticism came from Ivan Illich in his 1976 work ''Medical Nemesis''. In his view, modern medicine only ''medicalises'' disease, causing loss of health and wellness, while generally failing to restore health by eliminating disease. The human being thus becomes a lifelong ''patient''. Other less radical philosophers have voiced similar views, but none were as virulent as Illich. (Another example can be found in ''Technopoly: The Surrender of Culture to Technology'' by Neil Postman, 1992, which criticises overreliance on technological means in medicine.) Criticism of modern medicine has led to some improvements in the curricula of medical schools, which now teach students systematically on medical ethics, holistic medicine to medicine, the biopsychosocial model and similar concepts. The inability of modern medicine to properly address many common complaints continues to prompt many people to seek support from alternative medicine. Although most alternative approaches lack scientific validation, many report improvement of symptoms after obtaining alternative therapies. Medical errors are the focus of many complaints and negative coverage. In many ways the prevention of error in medicine is thought by many practitioners of human factors engineering to be similar yet far behind aviation safety, where it was long ago realized that it is dangerous to place too much responsibility on one "superhuman" individual and expect him or her not to make errors. Reporting systems and checking mechanisms are becoming more common in identifying sources of error and improving practice. ==See also== *Big killers *Complementary and alternative medicine *Health profession *Healthcare system *Iatrogenesis (ill health caused by medical treatment) *List of biomedical terms: | List of biomedical topics (numbers) | List of biomedical topics, A | List of biomedical topics, B | List of biomedical topics, C | List of biomedical topics, D | List of biomedical topics, E | List of biomedical topics, F | List of biomedical topics, G | List of biomedical topics, H | List of biomedical topics, I | List of biomedical topics, J | List of biomedical topics, K | List of biomedical topics, L | List of biomedical topics, M | List of biomedical topics, N | List of biomedical topics, O | List of biomedical topics, P | List of biomedical topics, Q | List of biomedical topics, R | List of biomedical topics, S | List of biomedical topics, T | List of biomedical topics, U | List of biomedical topics, V | List of biomedical topics, W | List of biomedical topics, X | List of biomedical topics, Y | List of biomedical topics, Z *List of diseases *List of medical abbreviations *List of medical schools *Medical equipment *Rare diseases *List of publications in medicine ==External links== *[http://www.nlm.nih.gov NLM] (United States National Library of Medicine, contains resources for patients and healthcare professionals) *[http://www.vh.org Virtual Hospital] (digital health sciences library by the University of Iowa) *[http://cancerweb.ncl.ac.uk/omd/index.html Online Medical Dictionary] *[http://www.wikimd.org/index.php?title=Free_Medical_Resources Collection of links to free medical resources] Medicine Health bn:ঔষধ fa:پزشکی ga:Leigheas iu:ᐊᓐᓂᐊᒥ ᖃᐅᔨᓴᕐᓂᖅ la:Medicina li:Genaeskónde nds:Medizin simple:Medicine sw:Utibabi th:แพทยศาสตร์ vi:Y khoa minnan:I-ha̍k
Old talk: * /Archive 1 and /Archive 2 Feel free to visit the Wikipedia_talk:WikiProject_Clinical_medicine where topics related to medicine are discussed. == Criticism of medicine sections seems short and weak == The practice of modern medicine has been criticised for many other things than listed here. Its tendency to use government to establish monopoly control over procedures and chemicals. Its tendency to substitute the values of the practitions for those of patient, withholding information (more common in Japan), making decisions about what quality of life is worthwhile, discrimination against the elderly, making cost effective decisions instead of lowest risk ones, other the other hand practicing expensive "defensive" medicine, assuming patients are lying and order unnecessary tests as when ER patient with urinary tract infection reports no extra marital sexual relations, substituting their own assessment of the facts such as when Thomas Morris was denied access to anti-biotics because he suspected he had been exposed to anthrax (he had been and subsequently died) denying patients a basic right to self defense, etc.--User:Silverback 20:23, 11 Oct 2004 (UTC) Please amplify in the article then. I don't think anyone considered it complete. User:Alteripse 20:35, 11 Oct 2004 (UTC) I think Silverback is attempting to start a conversation about this important subject, before making the article itself a forum for the debate, which is my understanding is how this is meant to work. I agree there is enough (just in MY experience) for an entire article about this, but that does not mean as exhaustive a summary as possible does not belong here. I will try to add to the list of criticisms in this space in the near future, but for now wanted to point out there should be more support for the expansion of this section than 4 months of silence. -Jonathan Stone 2 Jan 05 You might want to consider at least 3 things. First, there are a zillion potential medical topics. No contributor has any more "obligation" or "duty" to write about any particular topic than you do. Second, remember that a general overview article such as Medicine should avoid a U.S. bias; a detailed treatment of the advantages and shortcomings of the American healthcare system probably belongs in its own separate article. Third, if you stick to generalities and complain that sometimes doctors fail to do all the things they should or sometimes do some things they shouldn't, it becomes pretty banal unless you actually want to describe and analyze the forces and influences involved. User:Alteripse 04:28, 2 Jan 2005 (UTC) Hey Alteripse!! happy new year!! hope all is well. I aggree that the criticism section is weak and short.. so is the section (there isn't one) on what is to be a doc... the way medicine can take over your life... the 24/24 on call... the fact you can be walking down the street and suddenly find yourself administering first aid... the family and emothional stress (confronting your own limitations, and fighting death and loosing) ... the enormous rewards (respect, $$, choice)... It'd be nice to expand this especially for the 18 year olds considering the vocation. User:Erich gasboy 08:12, 2 Jan 2005 (UTC) ==recent removal of link== JD, that link you removed is spam in a sense, but does contain a useful collection of links. I thought about deleting it a couple weeks ago when first posted but decided to let it stay after I looked at it. I wish the poster would discuss here, but I vote for retention. (and I have no connection whatsover with the site) User:Alteripse 13:37, 20 Feb 2005 (UTC) :Although it is spam, I find this link extremely useful and believe it should be put back. --User:Eleassar777 13:43, 20 Feb 2005 (UTC) Okay, I'll put it back. Mr Spammer also removed an interlanguage link; I wonder why. Please promise me that WikiMD will get no more links in other articles. It's a messy wiki that has spammed this site numerous times. User:Jfdwolff | User_talk:Jfdwolff 19:51, 20 Feb 2005 (UTC) :Sure, boss. I agree it's worth nothing but the links. (smile) User:Alteripse 20:07, 20 Feb 2005 (UTC) BOSS? C'mon, we're not getting hierarchical on this site that runs on anarchy, are we? User:Jfdwolff | User_talk:Jfdwolff 21:55, 20 Feb 2005 (UTC) It just seemed the appropriate tone. Joke. User:Alteripse 00:48, 21 Feb 2005 (UTC) == Eleassar777, please discuss and document == Why are you deleting the important information about importance of the doctor/patient relationship to the patient, and replacing it with unfounded overgeneralizations such as the relationship being "central" to medicine, and introducing a novel "teaching" role. I don't know what country you have experienced medicine in, but most doctors have little to no time to "teach", and in many cultures they jealously guard their knowledge and withhold information from patients.--User:Silverback 13:21, 28 Feb 2005 (UTC) : Alteripse presented the arguments very well, so read below. --User:Eleassar777 13:56, 28 Feb 2005 (UTC) ::No she didn't, perhaps you can do better?--User:Silverback 15:33, 28 Feb 2005 (UTC) :::Silverback, if one patient going to a doctor and saying, "Doc, I hurt. Make it better." isn't the core of medicine, please tell us all what is. "Doctor" literally means "teacher" and has been the title of physicians in English speaking societies for several centuries now--there is nothing "novel" about the physician as teacher. Furthermore, the "important information" about the doctor patient relationship you are so desperately clinging to was a poorly written paragraph that mentioned 1) a physician's relationship with his medicines, which he must compel a patient to take, and 2) a patient's relationship with his government and his insurer, but did NOT mention the physician and patient relating to each other. --User:Matdaddy 23:27, 1 Mar 2005 (UTC) ::Well said. I hadn't realised the etymology of "doctor", but now I understand why I love teaching as well. (Is "indoctrination" an influx of physicians in a busy bar?) User:Jfdwolff | User_talk:Jfdwolff 13:03, 7 Mar 2005 (UTC) ==patient-doctor relationship section== Silverback, a few gentle reminders. #Don't you think your viewpoint might be a bit too "American-centric"? The ER phenomenon you are complaining about is a relatively contemporary American problem that still applies to a minority of the doctor-patient interactions even today in the US. Step back and take a bigger look at the process of "doctoring" across history and cultures. An intro to an article like this should be broadly applicable. ::No is isn't uniquely American, ERs have always had to deal with unconscious or severely ill patients who are unable to make their own medical decisions and for whom the MD/patient relationship is irrelevant.--User:Silverback 15:32, 28 Feb 2005 (UTC) #Please read more carefully, or at least match your reasons to the text you are editing. Your comment about the ER doesn't really contradict the description you removed. I agree it degrades the process by removing prior acquaintance (makes every interaction a first one), reducing the time, and requiring attention only to immediate problems rather than chronic ones. But if you re-read what you removed, it made no claims about any of these three issues. ::It did make claims about what was "central". The ER is more central and especially in this internet and college educated age, MDs are having to deal with informed patients with strong opinions about their care.--User:Silverback 15:32, 28 Feb 2005 (UTC) #I know you don't like it when someone suggests your assertion might be a bit POV, but this is such an example. WP has thousands of articles describing human service relationships. Nearly all start off with a description of what service gets provided in a general ideal way. We don't start the intro to an article about air travel by complaining about how expensive tickets are or how pilots make mistakes and crash the plane sometimes or how unfair it is that you have to get government approval to start a new airline. Your edit justifications might strike some as sounding like this. You might not get multiple people reverting you if you put your opinions in the criticism section of this article and label them more clearly as such, and applicable to current US healthcare system. Note I am not disputing the validity of your opinions here, just asking you to recognize that they are not quite at the level of the most fundamental indisputable fact about this topic for most of us. ::Look whose talking about POV, when did you suddenly take an interest in the medical article and start deleting the previous text wholesale.--User:Silverback 15:32, 28 Feb 2005 (UTC) I am open to your suggestions, but please don't revert any more. Thanks. User:Alteripse 13:37, 28 Feb 2005 (UTC) PS: I wrote this before you entered the note above. Thanks for elaborating your opinion. I like the intro and consider it preferable for reasons stated above. User:Alteripse 13:45, 28 Feb 2005 (UTC) :A good compromise would be just to add this new text to the existing text rather than deleting valid information? --User:Silverback 15:36, 28 Feb 2005 (UTC) :PS: I didn't revert the "intro".--User:Silverback 15:39, 28 Feb 2005 (UTC) First you are correct, it isn't the intro. My mistake. Second, I am generally in favor of adding rather than removing. I hadn't noticed much was removed but I will look again. I am certainly open to compromise and suggestion. I have a terribly slow connection right now and it takes several minutes to go between pages and versions. User:Alteripse 17:17, 28 Feb 2005 (UTC) I probably owe you at least a partial apology. There was no reason for Mattdaddy to replace what was originally there (about gatekeeper responsibility etc) and I missed that it wasn't just an addition. I responded to your edit summaries and removal and didn't understand your point about what was prev removed. Let's keep both in the same section; they are both valid points. Do you want to re-integrate or shall I? I will not try until I have a better connection later today. User:Alteripse 17:29, 28 Feb 2005 (UTC) My graf was attempt to describe the interaction between one patient and one doctor in an exam room which is the heart of medicine. In place of a discussion of the complicated exchange between doctor and patient, the previous graf portrays the doctor as an obstruction/intermediate between the patient and the government or an insurance company, as if healing results from an interaction between a patient and the gov't or between a patient and his insurer. There is an enormous imbalance of power and knowledge between patient and physician. A patient walks into a doctor's office apprehensive and scared because he often has little idea why he is in pain or can't get his breath or what have you, and he may not be able to tell if the cause is something benign, that will soon relent, or something that will permanently disable him. At the same time, the patient has first hand knowledge about this suffering, and only the patient can decide exactly how great a risk he will take to rid himself of it. Many educated and resourceful patients do some research on their ailments before presenting to a doctor, especially with common diseases, but few if any can present their doctor with a list of likely causes of their ailment, a check list of tests that should be performed to rule out the most dangerous and confirm the most likely, and first line therapy for more than the most common cause. And I doubt that there is anyone anywhere who has gone to his doctor having correctly diagnosed himself with myeloma and asked for his doctor's signature allowing him to treat himself with thalidomide plus dexamethasone every week for three months with bisphosphonate adjunctive therapy and prophylactic allopurinol. The doctor does not usually have first hand knowledge of the suffering the patient's disease causes, but does have experience and knowledge to consider alternate causes and suggest how likely it is that the disease will respond to conventional therapy given any modifying factors in the patient's history. Of course, some patients have researched non-conventional therapies, which the doctor hopefully then researches himself and compares with conventional means for the benefit of the patient. Anyway, I would refer anyone interested in the doctor-patient relationship to the opening chapters of Harrison's Internal Medicine, at least, or even better Ed Pellegrino's work. And think about all this yourself the next time you go see your doctor. --User:Matdaddy 22:15, 28 Feb 2005 (UTC) :Some patients have researched conventional therapies as well, as someone who follows the medical literature, I have educated my physicians about the latest research on ACE inhibitors, ARBs, matrix-metalloprotease inhibitors, thalidomide, beta blockers, melatonin, naltrexone the latest medical tests for novel risk factors, etc. I would not have had to go to this trouble if physicians had not lobbied the government so hard to gain and their maintain their monopoly powers. But because they are coercively in the loop with this government imposed monopoly, the patient doctor relationship is important to the patient. This fact should not be left out.--User:Silverback 08:54, 2 Mar 2005 (UTC) OK, I wasn't trying to leave anything out, but I don't follow your argument here. You would have to educate your doctors far more about medicines they ''don't'' have a prescription power over. That is one ofthe complaints of patients who want all doctors to know about all manner of alternative treatments. As much more as we might like doctors to know about ''prescription'' medications, they have far less access to information about'' non-prescription'' treatments. This fact seems to directly contradict your point, unless I am misunderstanding it? User:Alteripse 05:05, 3 Mar 2005 (UTC) :Of those I mentioned, only melatonin is non-prescription and that may change because a scientist has a use patent, and is trying to get it FDA approved. So, overall it is prescription medications I was educating the doctors about. --User:Silverback 05:51, 3 Mar 2005 (UTC) Exactly. You seemed to be making the point that information would be ''easier'' to get about drugs if they were non-prescription and I think you are incorrect, because there is almost no good source of information for consumers or doctors about non-prescription drugs (melatonin being an example). In fact, I can give you some other powerful arguments ''against'' "do-it-yourself" prescribing: #as imperfect as the current system is, abolishing it would make it far less possible to track rare side effects (e.g., the Vioxx & Rezulin recalls) once it was marketed; ::We are protected too much from "rare" side effects, recall that Contact contained a decongestant, that was withdrawn due to increased risk of stroke. Several studies were done before one with enough statistical power showed that it increased the risk of stroke in women. The increased risk was about twice as much as from caffiene. The same study showed it was PROTECTIVE against stroke in men. It was the only decongestant the worked for my daughter, and when she was suffering should would probably have been willing to drive 20+ miles to get it rather than use pseudoephedrine HCL. Her risk of death or serious injury was probably much greater on the drive than from the medicine. patients should be allowed to make their own decisions about the risks if they want to. #there is already an enormous controlled trial going on of consumer prescribing power-- the non-prescription "dietary supplement" industry, which makes drugs in all but name. Would you want Lilly and Merck acting like the companies that make non-prescription drugs-- a huge industry that provides almost ''zero'' public information about how to use them or potential risks, and wards off regulatory scrutiny in the name of "health freedom" with false and dishonest claims to consumers that someone is trying to take their vitamins away, and by contributing money to politicians (e.g., the ephedra scandal)? Think of the public knowledge about what works or doesn't work published by the NCCAM-- which was set up by public demand to provide reliable information on non-prescription treatments, and after nearly 10 years and hundreds of millions of dollars, has not reported that a SINGLE alt med treatment works or doesn't work, and has even rewritten the mission statement on their website so that people will stop expecting that type of information any time soon. ::I have no problem with you using ephedra if you want.-- [User:Silverback|Silverback]] 03:54, 4 Mar 2005 (UTC) ::That's generous of you. My problem with it was twofold-- first, it was a perfect example of false and incomplete advertising-- no info about risks was available to the consumer because the manufacturers were hiding behind the dietary supplement laws and (2) even as a few children and a young adults died each year a consortium of the companies was giving money to the legislators in Texas, Florida, and elsewhere to stop dead an attempt by regulatory agencies to publicly examine the risks. No honesty, no honor, just deceit and greed behind the "health freedom" movement. #if you took prescribing power away from physicians, the folks who would immediately take it from you would be the insurance companies, who would quickly publish (as they try do now to some extent) lists of what drugs they would pay for and for what conditions, and would require that doctors or some other third party confirm that you had that condition. #we already have problems with overuse of certain antibiotics and are trying to tighten rules on which doctors can prescribe them so we can hold on to something to which the increasingly scary bugs out there don't quickly get resistant; I wouldn't want to go the other direction and let people go to the local convenience store for over-the-counter Megastompacillin for their colds. ::::Historically antibiotics have also been under prescribed, it took over a decade before the medical community finally accepted that H pylori caused most stomach ulcers. There are currently bacterial theories of atherosclerosis and kidney stones and a role for fungal infections in chronic sinusitis although current antifungals damage the kidneys. Recall that postal worker Thomas Morris was denied access to Cipro by a physician before he died of anthrax. Chemical freedom should be as basic a right as self defense. Over 1,000,000 are estimate to have died as a result of FDA delays in approving beta blockers and clot busters. Most americans who unthinkingly step into voting booths an pull the lever for some politician who supports the FDA are mass murderers, I know, I was one. Makes al Qaeda look like they were playing pattycake.--User:Silverback 03:54, 4 Mar 2005 (UTC) ::::Bearing in mind the weakness of the series of one, I would point out that no one "denied" ciprofloxacin to Morris--they did fail to diagnose anthrax in him and so did not treat anthrax in him. One might as well say that you are presently being denied treatment for diseases you are not yet known to have. Along those lines, since you seem to have known for years before everyone else that H pylori caused gastric ulcers, why didn't you tell anyone else? Granted, you would have been laughed at at first, but once a few doctors became curious about the little buggers and started looking for them in the ulcers of their patients, those patients taught us all about H pylori and the pathogenesis of most ulcers. --User:Matdaddy 02:29, 5 Mar 2005 (UTC) :::::Morris informed the doctor of the white powder he had been exposed to, and that he wanted Cipro, the MD substituted his judgement and assessment of the risks for Morris. I DID tell people and doctors about the researcher in Austrailia, just not under the name "Silverback", I wasn't the first, but I was an early adopter.--User:Silverback 11:13, 5 Mar 2005 (UTC) :::The best argument against self-prescribing is that it is no safer than performing surgery on oneself. Pseudoephedrine for nasal congestion and the like are about as safe as popping pimples (ahem, incising and draining lesions of acne vulgaris) and the risks of interventions (pharmaceutical or surgical) rise from there. --User:Matdaddy 01:49, 4 Mar 2005 (UTC) ::::That probably is the best argument, and it is wrong of course. --User:Silverback 03:54, 4 Mar 2005 (UTC) ::::On what grounds? Becuase you said so? --User:Matdaddy 02:29, 5 Mar 2005 (UTC) :::::I certainly can't think of a better argument than this wrong one. Many medicines are safer than performing surgery on oneself, although I don't think there is much about self surgery in the literature. I couple of amputations. The safety of most of the anti-hypertensives, statins, and short term use of NSAIDs are all generally safer than performing surgery on oneself.--User:Silverback 11:13, 5 Mar 2005 (UTC) :::::You are naive about self-surgery, Silverback. Look around on the internet and find all the websites about trepanning (sometimes spelled trephining). You can also find plenty of case reports in the medical literature of various self-surgery attempts, mostly castrations, but the one that sticks in my mind was the college student who tried to do an adrenalectomy on himself in his dorm room. That was, I think, in JAMA in the early 80s. Oh, and how about that murderous C-section in Missouri a couple of months ago? User:Alteripse 17:03, 5 Mar 2005 (UTC) Please don't accuse me of claiming doctors are perfect or there is no downside to the current system or of trying to exclude anything negative from this article. It's just that there were lots of good reasons that precribing laws were established, and they were the same reasons that clean food laws were passed: the average knowledge of consumers and prescribers about "drugs" being used a century ago was far worse than it is today, the kind of situation that brings to mind a cliche like, "those who don't know history are condemned to repeat it". I may not change your mind but it seemed worthwhile reminding people exactly why prescribing and licensing laws exist. :I have no objection to someone insisting on only FDA approved drugs, and on only taking them if they are prescribed by a physician. But those benefits could be available voluntarily. Everyone complains about the drug companies and the cost of drugs, hwoever, the largest component of the cost of obtaining drugs for most people is the cut that the physician gets. The point about the information I want retained in the article is not whether it is negative or positive, but whether it is true, and it is.--User:Silverback 03:54, 4 Mar 2005 (UTC) Finally I thought I was supporting your point about power and dependence by expanding it into a paragraph. Did I make it even broader than you wanted, or less clear? How do you suggest we modify it?User:Alteripse 12:30, 3 Mar 2005 (UTC) :Hmmm, all said, that was pretty good. Not as blunt as I would like, but pretty good.--User:Silverback 04:00, 4 Mar 2005 (UTC) Silverback, Eleassar, Matdaddy, please check to see that the new "melded" version contains all the points you each thought was important. User:Alteripse 04:05, 1 Mar 2005 (UTC) :Much has been said about the p-d relationship in these posts and the new version surely is more neutral. However, it is not evident (or at least not clearly explained) what relationships between patient and doctor prevail in different circumstances. I mean, I believe that usually this is the idealized relationship, however in some cases it is also the "ER relationship". It should be specifically written where different kinds of relationship apply. However, we could even argue that in the case of ER there is no relationship. :The other thing I wish to call attention to refers to semantics. Perhaps it would be better to use the phrase ''patient-doctor relationship'' instead of ''doctor-patient relationship''. I mean, it is usually the patient who establishes contact with doctor so the patient should be written first. We could go even further and replace ''doctor'' with ''physician'', because the physician is not always a doctor, according to the Latin meaning of the word. --User:Eleassar777 18:12, 3 Mar 2005 (UTC) ::The literature in the fields of medicine and medical ethics have traditionally used the phrase doctor-patient relationship, although a quick Google search found 50k hits for ''"patient-doctor" relationship'' (compared with 300k for ''"doctor-patient" relationship''). Beauchamp, Pellegrino, Childress, and Thomasma all use doctor-patient relationship, although in some essays Pellegrino has used physician-patient. A reviewed criticism of these authors, who began cultivating medical ethics as a field in itself and promulgated the virtue-based model of ethics (non-maleficence, beneficence, autonomy, and justice) 30-40 years ago, would be the appropriate place to challenge this terminology and suggest alternatives, not an encyclopedia entry. ::The terms physician and doctor should be uniformly used thoughout the medicine section with clearly stated definitions near the beginning of this entry, or they should be used interchangeably. Some associate physician with practitioners of internal medicine and its subspecialties to the exclusion of surgeons, for example, while in other countries, only practitioners in internal medicine are called "Doctor" and surgeons are addressed as "Mister". The present day usage of the terms are very imprecise, as in most countries following the Oxbridge system, doctors do not hold a doctoral degree, making the salutation honorary or conventional but not technically accurate. And even in countries where "doctors" hold doctoral degrees, they do not research or defend theses, so their doctorate is largely titular anyway. (Law, the other profession that awards titular doctoral degrees, does not ask that holders of the Juris Doctor be addressed as "doctor.") ::I agree that the terminology is imprecise and generally unsatisfactory, but an important function of reference material is to introduce the reader to a field and its idiosyncracies, so I would present the norms. --User:Matdaddy 01:32, 4 Mar 2005 (UTC) :That's great if you will (don't take this as being hustled, it's only that probably you can do this better than me because you know more about this topic). I mean, what is really important here is not whether we use one term or another, but that the usage of these terms is explained in the article and that it is grounded in some facts. For example, it should be explained, what is the difference between ''doctor'' and ''physician'' (it is to some degree but not at all so thoroughly as in your post here) and why it is more common to use the phrase ''doctor-patient relationship'' instead of ''patient-doctor relationship''. Also, we should strive after consistence. :The other thing is that it should be explained in what circumstances different doctor-patient relationships develop and what influences them. It does not suffice if it is just written that some kind of it is "ideal" and "taught in school" but not said where it appears in practice. :I also see that the facts that belong together are scattered throughout the article. It will be my pleasure to correct this when you (or someone else) add the missing ones and this discussion finally ends. --User:Eleassar777 23:33, 4 Mar 2005 (UTC) Silverback, the basic reason that what others have written don't include your points in the way you want to make them is that we are talking about different topics. Mattdaddy's original description of the ''structure'' of the the basic doctor-patient relationship was as unexceptionable as beginning a discussion of English sentence structure by saying, "a basic English sentence includes a subject and predicate." We all know that some meaningful utterances don't follow the paradigm, but it's still the starting point. Your point about ERs and prescription monopoly was perfectly true and perfectly irrelevant to an explanation of the structure of the basic doctor-patient interaction. Your point about it being "more important now because doctors have prescription monopoly" is a failure to understand the other points. The basic interactional structure of the relationship has not changed in 2500 years. Different aspects get distorted by local customs or circumstances (e.g., the old Chinese practice of a patient describing symptoms on a doll instead of allowing a direct visual inspection of an important person), but it is basically and usually: ''patient describes problem, doctor gathers info, doctor interprets info from professional knowledge perspective, doctor explains diagnosis to patient with treatment recommendation''. In this context, it ''doesn't matter'' who can prescribe-- that is an irrelevant piece of local circumstance. The process is the same if the doctor is a Greek slave, shaman, chiropractor, or an ER doc. Your 3 important points, if I recall, were that in ER interactions the doctor and patient don't know each other, that in critical care situations the doctor doesn't explain much to the patient, and that when government licenses prescription power it changes the potential advantages and disadvantages to the patient. These are perfect examples of modification of way the interaction operates by special circumstances or particular social rules but none of them replace or invalidate the basic interaction structure. Your points are both valid and deserve to be in this article, but not in the same paragraph and not as a "contradiction" or "more accurate view", which is how it seemed you were offering them. I am sorry you thought my attempt to generalize your points into something less specific and place-bound was "namby-pamby." I wasn't trying to exclude your points, nor get into a conflict, just to put them in a context that didn't make it look so much like you just didn't get the point of the section. User:Alteripse 18:21, 6 Mar 2005 (UTC) :It wasn't you attempt to generalize my points that I considered namby pamby, it was what was done to the whole section, it was the touchy feely bs that I generally skip over when I read looking for straight forward information content. Perhaps it is because we live in a literate age, where MDs are more in the way of the informed patient, and if they are too obstinate or insecure then we have to either cleverly work them, or feign deference, or doctor shop to get what we want.--User:Silverback 21:44, 6 Mar 2005 (UTC) Silverback, the version you are pushing suggests that the patient-doctor relationship is all about power. I vehemently disagree. While there is obviously an element of power (governments have entrusted doctors with the prescription pad, not just doctors themselves), the patient-doctor relationship is primarily that of someone in need of "health", which the doctor provides as a healthcare provider (horrible term, but it's true). To paint this relationship as one of power is very much WP:NPOV, and it seems consensus is against it. Of course it should be mentioned that doctors determine access to treatment, but that is their ''professional judgment'' and should be mentioned ''last'', not ''first'' in the paragraph on the patient-doctor relationship. User:Jfdwolff | User_talk:Jfdwolff 00:38, 7 Mar 2005 (UTC) ==power, statistics, and lying== :No my version is NOT all about power, please note that it INCLUDES your version. You also seem to be implying that power is somehow wrong, but your part is partially about paternalism and that is a more benevolent face of power, but power nonetheless. I just state the facts more boldly, and certainly in a more subdued and defensible manner than I state my opinion here. Some people don't want paternalism. NPOV is obscured by not laying out the power aspects of the relationship plainly. I've just thought of a way that your version is POV. It doesn't reflect how patients are treated like statistics. Consider an adult male seeking treatment for a UTI (urinary tract infection), most MDs will order a test for STDs even if the patient doesn't want them and assures the MD that there is no possibility of that, because the MDs have been trained that statistically a significant number of men will be lying about this. How does treating the patient like a statistic and assuming your patient is lying fit in with your version of the "relationship"?--User:Silverback 09:00, 7 Mar 2005 (UTC) "My" version already makes good mention of the "power of the prescription pad" with more references. There is no need to state the facts more boldly. An intelligent reader will get the message without you shouting at him. About paternalism: patients are treated like statistics because statistics is the only thing that really matters in the final analysis. Most heart attacks are due to atherosclerosis. Many post-MI patients undergo a coronary angiogram. Often, normal coronary arteries are found. Does that mean the doctor was wrong in requesting it? As for the male UTI patients: patients have to give consent before being tested for ''anything'', especially STDs. Times are long past that in these matters consent was considered to be implicit. I am very concerned about your bias. You cannot simply carry on pushing the same version now. Please address the issues. If you are willing, we can WP:RFC from the Wikipedia user community whether your or "my" version is more POV. User:Jfdwolff | User_talk:Jfdwolff 13:00, 7 Mar 2005 (UTC) :No, the MD is not wrong for ordering a test that proves negative. But that is different than questioning a patient's integrity and then expecting the patient or his insurance company to pay for it. BTW, what does my "bias" have to do with the correctness of my post to the article?--User:Silverback 16:07, 7 Mar 2005 (UTC) Pardon me for introducing a new section heading so it's easier to edit. I find your latest complaint interesting concerning statistics and lying: it truly indicates how little you understand what we do and what we are talking about. The ability of a doctor to help solve a patient's problem is partly based on lengthy schooling about how the body works, but in daily practice is based primarily on our experience with other patients with similar problems. We are far likely to be able to help ''you'' if we have seen a hundred other people with the same problem; otherwise all we are doing is looking something up in a book, which is something you might do as well. Statistics are a way to carry out a reality check on impressions. Impressions are a useful piece of evidence we gather for problem solving (e.g., I have the impression that treatment x works better than y for condition z), but an intelligent person has a healthy mistrust of his own impressions-- not ignoring them, but wanting to confirm them with other evidence. Statistics are how we keep our brain heuristics from misleading us. Awareness of probability statistics when treating people is more effectively done consciously than unconsciously. Trust me, you ''want'' a doctor who is aware of the probabilities. (Obviously if your use of the term "statistic" is simply a way of saying, "my doctor gives me the impression that he doesn't see me as a unique person worth making at least a brief human relationship with", then you are actually talking about an entirely different issue (caring and what you called the "touchy-feely stuff")-- I am paying you the respect of assuming you mean what you say). So what do statistics have to do with lying? Part of the evidence we gather to solve a problem is what the patient tells us, but we are being paid to use as much information as possible to solve a problem, so we are doing you a service, not a disservice, when we wonder about what you are not telling us or when we evaluate your account the same way we do the exam, the lab report, or the textbook-- the data may be misleading in this case. In many areas of concerns about health, people find it hard to be accurate and honest about what they have done or not done. A doctor with some maturity and experience can be skeptical and still respect and care about the person--- I run into this issue on a daily basis as I take care of people with diabetes. I have been wrong both ways of course, both in trusting and in not trusting what someone told me, but many times I have solved problems other doctors couldn't because I didn't take the first account at face value. There are better and worse ways to handle this issue of course. I once heard a famous expert on sexual disorders say that he always started every visit by telling his patient he will assume that part of what he tells him is untrue. In some circumstances this level of honesty actually improves mutual confidence and communication. It is far more dangerous to our patients if a doctor thinks that lying is something that only a few rare, "bad" people do, than if he considers it a normal part of interpersonal interaction. At least you modified your assertion by claiming that "most" doctors check for STDs. Few of us blindly follow rules like that without making individual adjustments; most of us would not order STD screens if you were paying out of pocket and persuasively denied such risk. And we would be wrong in a few of those instances as well. As you probably know, most people do not object or complain when we check for stds and pregnancy. You seem to have told us a lot about yourself as a patient: your insecurity at putting yourself in someone else's hands and need for reassurance that that your doctor acknowledges how much you know, your dislike of discussing emotions, your dislike of discussing a problem in terms of probabilities and uncertainties, and especially your dislike of the idea that your doctor might think of you in a way different than the persona you present. Do you call your doctor "doc" as well? If so, you are a very recognizable kind of patient (one that Osler warned about). Each of us find we are better at dealing with some personalities than others. And if you don't like my "reading" of you, perhaps it is wrong and I would get a different impression in person. And of course, maybe you are right and you really do know more than all of us about practicing medicine. User:Alteripse 13:29, 7 Mar 2005 (UTC) :Yes there are lots of conditions where patients perceptions can mislead them in self diagnosis if they are unaware of those situations. The danger that a lying patient gets into is the patients responsibility not the doctors. You are correct that I like to make my own decisions in areas I consider important, but wrong about discussing emotions, although they aren't the way I make decisions, I do consider their input. I have no problem with probabilities if that is the state of the science, and I agree that it is efficient to work rule out the more common or probable conditions first, but in some areas I opt for more information than is considered "cost effective". What I don't like is inconvenience and coercion, i.e., having to bother with a doctor for the routine, like renewing or adjusting prescriptions, ordering and reading blood tests, etc that unnecessarily increase the cost of medicine. The coercion is of course, the government guns that enforcement the physicians monopoly. I have no problems with physicians that act as consultants, and that don't pretend to know more than they do. What inspires my confidence is if they are willing to say what they don't know, and even look things up in front of you, or get back to you later. :I don't want to be an expert in all areas of medicine, medicine is a broad field and not all parts are equally interesting. Don't get me wrong, there are physicians I admire, and services I would employ them for. I just don't think it should be at the point of a gun. Do you think medicine could survive as it once did, without exclusive government monopolies?--User:Silverback 16:07, 7 Mar 2005 (UTC) I haven't the slightest fear that we need a gov monopoly to keep our jobs. We offer a service that is so desired by people that many consider access a "social right". The only effect of dropping the licensure and presciption laws is that it would take us back a century to an even greater degree of caveat emptor. The immediate response would be some sort of certifying procedure so people could assure themselves they were getting someone with training, experience, and accountability, and the insurance companies (both health and liability) would respond by only paying for certified doctors and certified prescriptions and we would be right back where we started. User:Alteripse 16:44, 7 Mar 2005 (UTC) :I would hope that such certification would spring up, and in fact it did exist to some extent, and was codified into law, no doubt with some physician lobbying.--User:Silverback 11:18, 8 Mar 2005 (UTC) :So then what would be the advantage of repealing the existing de jure licensure & prescription restrictions if the rapid result was de facto certification and prescription access restriction by private corporations? A potentially big social disadvantage would be a widening of the gap between people able to afford and not afford corporate-certified access and drugs. User:Alteripse 13:35, 8 Mar 2005 (UTC) ::An advantage would be easier access to the drugs and a reduction in costs. I would work to oppose the insurance and corporate reinstitutionalizing of physicians, in fact I advocate that my employer supply antihypertensives and statins free, and monitor the blood tests themselves as a convenience and preventive cost saving measure. Health classes in high schools should be able to teach the principles of selecting and titrating the doses of these drugs as well as reading basic blood tests for monitoring drugs. In the current system internet MDs and pharmacies should be able to wring out some of the costs this way. I also would work to have medical plans cover expensive over the counter drugs such as the non-sedating anti-histamines.--User:Silverback 16:37, 8 Mar 2005 (UTC) ''Gentlemen, can we go back to discussing the article, instead of how Silverback would change the medical world?'' User:Jfdwolff | User_talk:Jfdwolff 17:53, 8 Mar 2005 (UTC) :Chill -- we are community building here and have strayed only about a millimeter off topic.--User:Silverback 18:41, 8 Mar 2005 (UTC) We are going to teach kids in high school how to prescribe their own medicines for when they develop chronic adult diseases in 10,20,30 years?! I take care of teenagers with diabetes and other chronic diseases every day. I have been continuing this discussion under the apparently mistaken assumption that you and I belong to the same species living in the same universe. You are pulling my leg, aren't you? User:Alteripse 03:44, 9 Mar 2005 (UTC) :I've been on anti-hypertensives since age 19. There is a consensus building that atherosclerosis begins in the young, and the increase in obesity has more teans that are pre-diabetic or with type II diabetes. I suspect that soon we will have anti-obesity drugs. I would prefer that schools just focus on scientific literacy because that is all that is really needed for someone who wants to prescribe for themselves or their families. However, since schools teach all kinds of "subjects" other than basic skills, there is no reason for them to be kept in ignorance about medical matters. I don't engage in personal attacks.--User:Silverback 23:52, 9 Mar 2005 (UTC) Forgive me. I didn't intend astonishment to seem like a personal attack, although I guess if you offered that in good faith it must seem like one. Shall we say so many objections problems occurred to me that suggested that your idea of what a high school can teach a teenager about his own ''future'' health differs so radically different from my daily experience as to suggest our ideas of what is possible with the subspecies ''homo adulescens'' are incompatibly divergent? I'm not sure there is anywhere to go with this than, "we are all entitled to our opinions" I think you may have been a teenager several standard deviations from normal. I certainly admit to the same, so that conjecture is not intended as a personal attack. User:Alteripse 01:23, 10 Mar 2005 (UTC) :Happy to forgive and forget. It was the species and universe part that seemed like an attack. I had missed your statement about treating teens with diabetes, so apologies for spouting that redundant information. --User:Silverback 19:20, 10 Mar 2005 (UTC) == Overall Review == I wish Wikip. had an "Article review" button for each article (maybe it does). Anyway, this article seems to be fairly comprehensive and knowledgeable, yet needs a lot of editing for style, sexist pronoun use, and a range of point-of-view issues which characterize a text lacking a degree of scientific precision when it comes to language and writing--less than satisfactory cultural context for its assertions...and style needs improvement. Hope that isn't too critical. I'll try to clean up what I can when I have time. Thanks! User:70.57.141.70 02:41, 7 Mar 2005 (UTC) :I'm not sure what the purpose of "article review" would be. WP:BB and start editing! If one of us doesn't like it, we'll just revert :-) User:Jfdwolff | User_talk:Jfdwolff 07:59, 7 Mar 2005 (UTC) :I just had a little copyedit, and the article is actually not bad at all. If you have any specific complaints, perhaps you could mention them here first so we can achieve consensus. I'm categorically against writing ''his/her'' whenever the patient or doctor is referred to. Please stick to "he". A large number of publications follows this principle for stylistic reasons, and I see no reason why we should deviate from this. User:Jfdwolff | User_talk:Jfdwolff 08:15, 7 Mar 2005 (UTC) The English pronoun "he" refers to a both a male antecedent as well as to antecedents of unknown or unspecified gender; that is, when the antecedent is masculine, "he" is masculine, and when the antecedent is neutral or unspecified, so is "he." "He/she" is equivalent saying "the unspecified masculine or feminine antecedent or the feminine antecedent," which is just wasted effort. Grammar, and not sexism, should make the choice between he and she, and grammar calls for he. The writing through out the article is adequate but not inspired or artful; I think that is largely the result of so many authors. ==Wikicities== Why is there the commercial link wikicities:books in the article? As it contains adds by google, it should be removed. --User:Eleassar777 10:42, 15 Apr 2005 (UTC) == The intro == The intro of this article was: :Medicine is a branch of health science concerned with restoring and maintaining health. Broadly, it is the practical science of preventing and curing diseases. However, ''medicine'' often refers more specifically to matters dealt with by physicians and surgery. I removed the third line. It suggests that medicine as practiced by physicians and surgeons is not "real medicine". I hotly contest this. Firstly, the remainder of the intro explains exactly what we want (that medicine is a science and a profession). Secondly, medicine as we know it is practiced by many more than just doctors. It is a system - medicine collapses without nurses, laboratory scientists and hospital porters. To claim that medicine is the sole jurisdiction of MDs is a strawman. I'm glad I changed it, and it should not come back. User:Jfdwolff | User_talk:Jfdwolff 22:08, 21 May 2005 (UTC)
{| style="margin:0 auto;" align=center width=75% class="toccolours" |align=center style="background:#ccccff"| Health science - Medicine |- |align=center| Anesthesia - Dermatology - Emergency medicine - General practitioner - Intensive care medicine - Internal medicine - Neurology - Obstetrics & Gynaecology - Pediatrics - Podiatry - Public health & Occupational Medicine - Psychiatry - Radiology - Surgery |- |align=center style="background:#ccccff"| Branches of Internal medicine |- |align=center| Cardiology - Endocrinology - Gastroenterology - Hematology - Infectious diseases - Nephrology - Oncology - Pulmonology - Rheumatology |- |align=center style="background:#ccccff"| Branches of Surgery |- |align=center| General Surgery - Cardiothoracic surgery - Neurosurgery - Ophthalmology - Orthopedic surgery - Otolaryngology (ENT) - Pediatric surgery - Plastic surgery - Podiatric surgery - Urology - Vascular surgery |}
#redirect Template:Medicine
Health sciences Biology Humans For a list of articles in this category that need some further work, see :Category:Medicine stubs. minnan:Category:I-ha̍k vi:Category:Y khoa
any body else think sexology don't belong here? it is about as related as sports science! User:Erich gasboy 22:29, 14 Jun 2004 (UTC) ==WikiProject== See: * Wikipedia:WikiProject Clinical medicine (moved from article --User:Lexor|User talk:Lexor 11:14, 5 Sep 2004 (UTC))
See other meanings of words starting from letter:
Words begining with Medicine:
Medicine
Medicine
Medicine
Medicine
Medicine
Medicine
Medicine/Archive_1
Medicine/Archive_2
Medicinemen
Medicines
Medicines_and_Healthcare_products_Regulatory_Agency
Medicine_(band)
Medicine_(history)
Medicine_(shamanism)
Medicine_(shamanism)
Medicine_bag
Medicine_ball
Medicine_Bar
Medicine_basic_topics
Medicine_Bow
Medicine_Bow,_WY
Medicine_Bow,_Wyoming
Medicine_Bow_Mountains
Medicine_Bow_Range
Medicine_Bow_River
Medicine_Buddha
Medicine_bundle
Medicine_Hat
Medicine_Hat,_Alberta
Medicine_Hat,_Alberta
Medicine_Hat_(electoral_district)
Medicine_Hat_(provincial_electoral_district)
Medicine_Hat_Arena
Medicine_Hat_College
Medicine_Hat_Tigers
Medicine_Hat_Tigers
Medicine_Lake
Medicine_Lake,_Minnesota
Medicine_Lake,_MN
Medicine_Lake,_Montana
Medicine_Lake,_MT
Medicine_Lake_Volcano
Medicine_Lake_Volcano
Medicine_Lodge
Medicine_Lodge,_Kansas
Medicine_Lodge,_KS
Medicine_Lodge_Treaty
Medicine_Man
Medicine_man
Medicine_man
Medicine_men
Medicine_Park
Medicine_Park,_OK
Medicine_Park,_Oklahoma
Medicine_show
Medicine_standards
Medicine_stubs
Medicine_wheel
Medicine
Medicine is a branch of health science concerned with maintaining health and restoring it by treating disease. Medicine is both an area of knowledge (a science), and the application of that knowledge (by the medical profession and other health professionals such as nurses). The various specialized branches of the science of medicine correspond to equally specialized medical professions dealing with particular organs or diseases. The science of medicine is the knowledge of body systems and diseases, while the profession of medicine refers to the social structure of the group of people formally trained to apply that knowledge to treat disease. There are traditions and schools of healing which are usually not considered to be part of (Western) medicine in a strict sense (see health science for an overview). The most highly developed systems of medicine outside of the Western or Hippocrates tradition are the Ayurvedic medicine (of India) and traditional Chinese medicine. The remainder of this article focuses on modern (Western) medicine. ==History of medicine== ''Main articles: History of medicine, Timeline of medicine and medical technology''. Medicine as it is practiced now is rooted in various traditions, but developed mainly in the late 18th century and early 19th century in Germany (Rudolf Virchow) and France (Jean-Martin Charcot, Claude Bernard and others). The new, "scientific" medicine replaced more traditional views based on the "four humours". The development of clinical medicine shifted to the United Kingdom and the United States during the early 1900s (William Osler, Harvey Cushing). Evidence-based medicine is the recent movement to link the practice and the science of medicine more closely through the use of the scientific method and modern information science. Genomics is already having a large influence on medical practice, as most monogenic genetic disorders have now been linked to causative genes, and molecular biology techniques are influencing medical decision-making. ==Practice of medicine== The medical encounter or patient-medical doctor relationship is an important part of what medicine is about (there are other relationships between health professionals and patients that are also important, e.g. nurse - patient). A person with a health problem or concern sees a doctor for help. The practice of medicine combines both science and art. Science and technology are the evidence base for many clinical problems for the general population at large. The art of medicine is the application of this medical knowledge in combination with intuition and clinical judgment to determine the proper diagnoses and treatment plan for this unique patient and to treat the patient accordingly. The doctor needs to: *develop a relationship with the patient *gather data (anamnesis and physical examination combined with laboratory or imaging studies) *analyze and synthesize that data (assessment and/or differential diagnosis), and then * develop a treatment plan (more testing, therapy, watchful observation, referral and follow-up) * treat the patient accordingly * assess the progress of treatment and alter the plan as necessary. The medical encounter is documented in a medical record. One method that is used is called the ''problem-oriented medical record'' (POMR), which includes a problem list of diagnoses and a "SOAP" method of documentation for each visit: * ''S'' - Subjective, the medical history of the problem from the point-of-view of the patient. * ''O'' - Objective, the physical examination and any laboratory or imaging studies. * ''A'' - Assessment, is the medical decision-making process including the differential diagnoses and most probable diagnoses. * ''P'' - Plan, the way resolve the problem and monitor progress ===Medical systems=== Medicine is practiced within the medical system of a particular culture or government. Leaving aside tribal cultures, the most significant divide in developed countries is that between universal health care and the market based health care (such as practiced in the US). ===Patient-doctor relationship=== The doctor-patient relationship and interaction is a central process in the practice of medicine. There are many perspectives from which to understand and describe it. An idealized physician's perspective, such as is taught in medical school, sees the core aspects of the process as the physician learning from the patient his symptoms, concerns and values; in response the physician examines the patient, interprets the symptoms, and formulates a diagnosis to explain the symptoms and their cause to the patient and to propose a treatment. In more detail, the patient presents a set of complaints or concerns about his health to the doctor, who then obtains further information about the patient's symptoms, previous state of health, living conditions, and so forth, and then formulates a diagnosis and enlists the patient's agreement to a treatment plan. Importantly, during this process the doctor educates the patient about the causes, progression, outcomes, and possible treatments of his ailments, as well as often providing advice for maintaining health. This teaching relationship is the basis of calling the physician doctor, which originally meant "teacher" in Latin. The patient-doctor relationship is additionally complicated by the patient's suffering (patient comes from the Latin ''patiens'', "suffering") and limited ability to relieve it on his own. The doctor's expertise comes from his knowledge about, or experience with, other people who have suffered similar symptoms, and his presumed ability to relieve it with medicines or other therapies about which the patient may initially have little knowledge. The doctor-patient relationship can be analyzed from the perspective of medical ethics concerns, in terms of how well the goals of non-maleficence, beneficence, autonomy, and justice are achieved. Many other values and ethical issues can be added to these. In different societies, periods, and cultures, different values may be assigned different priorities. For example, in the last 30 years medical care in the Western World has increasingly emphasized patient autonomy in decision making. The relationship and process can also be analyzed in terms of social power relationships (e.g., by Michel Foucault), or economic transactions. Physicians have been accorded gradually higher status and respect over the last century, and they have been entrusted with control of access to prescription medicines as a public health measure. This represents a concentration of power and carries both advantages and disadvantages to particular kinds of patients with particular kinds of conditions. A further twist has occurred in the last 25 years as costs of medical care have risen, and a third party (an insurance company or government agency) now often insists upon a share of decision-making power for a variety of reasons, reducing freedom of choice of both doctors and patients in many ways. The quality of the patient-doctor relationship is important to both parties. The better the relationship in terms of mutual respect, knowledge, trust, shared values and perspectives about disease and life, and time available, the better will be the amount and quality of information about the patient's disease transferred in both directions, enhancing accuracy of diagnosis and increasing the patient's knowledge about the disease. In some settings, e.g. the hospital ward, the patient-doctor relationship is much more complex, and many other people are involved when somebody is ill: relatives, neighbors, rescue specialists, nurses, technical personnel, social workers and others. ===Clinical skills=== ''Main articles: Anamnesis, Physical examination.'' A complete medical evaluation includes a anamnesis, a physical examination, appropriate laboratory or imaging studies, analysis of data and medical decision making to obtain diagnoses, and treatment plan. The components of the medical history are: * Chief complaint (CC) - the reason for the current medical visit. * History of present illness (HPI) - the chronological order of events of symptoms. A mnemonic PQRST is sometimes helpful in obtaining the history: ** Provocative-palliative factors - what makes a symptom worse or better. ** Quality - description of the symptom ** Region - which part of the body is affected ** Severity - what is the intensity of the symptom; using a scale of 0-10 (10 worst) ** Timing - what is the course of the symptom * Current activity - occupation, hobbies, what the patient actually does. * Medications - what drugs including OTCs, and home remedies, as well as herbal medicine remedies such as St. John's Wort. Allergy are recorded. * Past medical history (PMH/PMHx) - other medical diagnoses, past hospitalizations and surgerys, injuries, past infectious diseases and/or vaccinations * Review of systems (ROS) - an outline of additional symptoms to ask which may be missed on HPI, generally following the body's main organ systems (heart, lungs, digestive tract, urinary tract, etc.) * Social history (SH) - birthplace, residences, marital history, social and economic status, habits including diet (nutrition), drugs, tobacco, alcohol * Family history (FH) - listing of diseases in the family that may impact the patient. A family tree is sometimes used. The physical examination is the examination of the patient looking for signs of disease. The doctor uses his senses of sight, hearing, touch, and sometimes smell (taste has been replaced by modern lab tests). Four chief methods are used: inspection, palpation, percussion, and auscultation; smelling may be useful (e.g. infection, uremia, diabetic ketoacidosis). * Vital signs include height, weight, body temperature, blood pressure, pulse, respiration rate, hemoglobin oxygen saturation * General appearance of the patient * Skin * Head, eye, ear, nose, and throat (HEENT) * Cardiovascular - heart and blood vessels * Respiratory - lungs * Abdomen and rectosigmoid * Genitalia * Spine and extremities - musculoskeletal * Neuropsychiatric Medical laboratory and Medical imaging results, if any. Medical decision making (MDM) process involves the analysis and synthesis of all the above data to come with a list of possible diagnoses (the differential diagnosis) and what needs to be done to come up with a final diagnosis which would explain the patient's problem. Treatment plan may include ordering additional labs and studies, starting therapy, referring to a specialist, or watchful observation. Follow-up may be needed. This process is used by primary care providers as well as specialists. It may take only a few minutes if the problem is simple and straightforward. Or it may take weeks for a patient who has been hospitalized with multiple system problems involving several specialists. On subsequent visits, the process may be repeated in an abbreviated manner to obtain any new history, symptoms, physical findings, and lab or imaging results or specialist consultations. ==Settings where medical care is delivered== ''See also clinic, hospital, and hospice'' Medicine is a diverse field and the provision of medical care is therefore provided in a variety of locations. Primary care medical services are provided by physicians or other health professionals who has first contact with a patient seeking medical treatment or care. These occur in physician's office, clinics, nursing homes, schools, home visits and other places close to patients. About 90% of medical visits can be treated by the primary care provider. These include treatment of acute and chronic illnesses, preventive care and health education for all ages and both sex. Secondary care medical services are provided by medical specialists in their offices or clinics or at local community hospitals for a patient referred by a primary care provider who first diagnosed or treated the patient. Referrals are made for those patients who required the expertise or procedures performed by specialists. These include both ambulatory care and inpatient services, emergency rooms, intensive care medicine, surgery services, physical therapy, childbirth, endoscopy units, diagnostic laboratory and medical imaging services, hospice centers, etc. Some primary care providers may also take care of hospitalized patients and deliver babies in a secondary care setting. Tertiary care medical services are provided by specialist hospitals or regional centers equipped with diagnostic and treatment facilities not generally available at local hospitals. These include trauma centers, burn (injury) treatment centers, advanced neonatology unit services, organ transplants, high-risk pregnancy, radiation therapy oncology, etc. Modern medical care also depends on information - still delivered in many health care settings on paper records, but increasingly nowadays by electronic means. ==Branches of medicine== The delivery of modern health care depends, not just on medical practitioners, but on an expanding group of highly trained profession coming together as an interdisciplinary team. A full list is given on the health profession page. Some examples include: nurse, laboratory scientists, pharmacy, physiotherapy, speech therapy, occupational therapy, dietitians and bioengineering. The scope and sciences underpinning human medicine overlap many other fields. Dentistry and clinical psychology, while separate disciplines from medicine, are sometimes also considered medical fields. Physician assistants, nurse practitioners and midwives treat patients and prescribe medication in many legal jurisdictions. Veterinary medicine applies similar techniques to the care of animals. Medical doctors have many specializations and subspecializations which are listed below. ===Basic sciences=== *''Anatomy'' is the study of the physical structure of organisms. In contrast to ''macroscopic'' or ''gross anatomy'', ''cytology'' and ''histology'' are concerned with microscopic structures. *''Biochemistry'' is the study of the chemistry taking place in living organisms, especially the structure and function of their chemical components. *''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 and evidence-based medicine. *''Cytology'' is the microscopic study of individual cell (biology). *''Embryology'' is the study of the early development of organisms. *''Epidemiology'' 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'' is the study of the structures of biological tissues by light microscopy, electron microscopy and histochemistry. *''Immunology'' is the study of the immune system, which includes the innate and adaptive immune system in human, for example. *''Microbiology'' is the study of microorganisms, including protozoa, bacterium, fungus, and viruses. *''Neuroscience'' is a comprehensive term for 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. *''Nutrition'' 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 neoplasia diseases. *''Pathology'' is the study of disease - the causes, course, progression and resolution thereof. *''Pharmacology'' is the study of drugs and their actions. *''Physiology'' is the study of the normal functioning of the body and the underlying regulatory mechanisms. *''Toxicology'' is the study of hazardous effects of drugs and poisons. ===Diagnostic specialties=== *''Clinical laboratory sciences'' are the clinical diagnostic services which 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, each of whom usually hold a medical technology degree, who actually perform the medical tests, assays, and procedures needed for providing the specific services. **''Transfusion medicine'' is concerned with the transfusion of blood and blood component, including the maintenance of a "''blood bank''". **''Cellular pathology'' is concerned with diagnosis using samples from patients taken as tissues and cells using histology and cytology. **''Chemical pathology'' is concerned with diagnosis by making biochemical analysis of blood, body fluids and tissues. **''Hematology'' is concerned with diagnosis by looking at changes in the cellular composition of the blood and bone marrow as well as the coagulation system in the blood. **''Clinical microbiology'' is concerned with the ''in vitro'' diagnosis of diseases caused by bacterium, viruses, fungus, and parasites. **''Clinical immunology'' is concerned with disorders of the immune system and related body defenses. It also deals with diagnosis of allergy. *''Radiology'' is concerned with imaging of the human body, e.g. by x-rays, x-ray computed tomography, ultrasonography, and nuclear magnetic resonance tomography. **''Interventional radiology'' is concerned with using imaging of the human body, usually from CT, ultrasound, or fluoroscopy, to do biopsy, place certain tubes, and perform intravascular procedures. **''Nuclear Medicine'' uses radioactive substances for ''in vivo'' and ''in vitro'' diagnosis using either imaging of the location of radioactive substances placed into a patient, or using ''in vitro'' diagnostic tests utilizing radioactive substances. ===Clinical disciplines=== *''Anesthesiology'' (American English), ''Anaesthesia'' (British English), is the clinical discipline concerned with providing anesthesia. Pain medicine is often practiced by specialised anesthesiologists. *''Dermatology'' is concerned with the skin and its diseases. *''Emergency medicine'' is concerned with the diagnosis and treatment of acute or life-threatening conditions, including trauma, surgical, medical, pediatric, and psychiatric emergencies. *''General practice'' or ''family medicine'' or ''primary care'' is, in many countries, the first port-of-call for patients with non-emergency medical problems. Family doctors are usually able to treat over 90% of all complaints without referring to specialists. *''Geriatrics'' is concerned with medical care of the elderly. *''Hospital medicine'' is the general medical care of hospitalized patients. Doctors whose primary professional focus is hospital medicine are called hospitalists. *''Intensive care medicine'' is concerned with the therapy of patients with serious and life-threatening disease or injury. Intensive care medicine employs invasive diagnostic techniques and (temporary) replacement of organ functions by technical means. *''Internal medicine'' is concerned with diseases of inner organs and systemic dieseases of adults, i.e. such that affect the body as a whole. There are several subdisciplines of internal medicine: **''Cardiology'' is concerned with the heart and cardiovascular system and their diseases. **''Gastroenterology'' is concerned with the organs of digestion. **''Endocrinology'' is concerned with the endocrine system, i.e. endocrine glands and hormones. **''Hematology'' (or ''haematology'') is concerned with the blood and its diseases. **''Infectious diseases'' is concerned with the study, diagnosis and treatment of diseases caused by biological agents. **''Nephrology'' is concerned with diseases of the kidneys. **''Oncology'' is devoted to the study, diagnosis and treatment of cancer and other malignant diseases. **''Pulmonology'' (or ''chest medicine'', ''respiratory medicine'' or ''lung medicine'') is concerned with diseases of the lungs and the respiratory system. **''Rheumatology'' is devoted to the diagnosis and treatment of inflammatory diseases of the joints and other organ systems. *''Neurology'' is concerned with the diagnosis and treatment of nervous system diseases. *''Obstetrics and Gynecology'' (often abbreviated as Obstetrics and Gynaecology) are concerned respectively with childbirth and the female reproductive and associated organs. Reproductive medicine and fertility medicine is generally practiced by gynecological specialists. *''Palliative care'' is a relatively modern branch of clinical medicine that deals with pain and symptom relief and emotional support in patients with terminal diseases (cancer, heart failure). *''Pediatrics'' (or ''paediatrics'') is devoted to the care of children, and adolescents. Like internal medicine, there are many pediatric subspecialities for specific age ranges, organ systems, disease classes and sites of care delivery. Most subspecialities of adult medicine have a pediatric equivalent such as pediatric cardiology, pediatric endocrinology, pediatric gastroenterology, pediatric hematology, and pediatric oncology. *''Physical medicine and rehabilitation'' (or ''physiatry'') is concerned with functional improvement after injury, illness, or congenital abnormality. *''Preventive medicine'' is the branch of medicine concerned with preventing disease. **''Community health care'' or ''public health'' is an aspect of health services concerned with threats to the overall health of a community based on population health analysis. **''Occupational medicine'''s principal role is the provision of health advice to organisations and individuals to ensure that the highest standards of health and safety at work can be achieved and maintained. *''Psychiatry'' is a branch of medicine that studies and treats mental disorders. Related non-medical fields are psychotherapy and clinical psychology. There are several subdisciplines of Psychiatry: **''Child & adolescent psychiatry'' focuses on the care of children and adolescents with mental/emotional/learning problems (i.e., ADHD, Autism, family conflicts). **''Geriatric psychiatry'' focuses on the care of elderly people with mental illnesses (i.e., dementias, post stroke cognitive changes, depression). **''Addiction psychiatry'' focuses on substance abuse and its treatment. **''Forensic psychiatry'' focuses on the interface of psychiatry and the Law. *''Radiation therapy'' is concerned with the therapeutic use of ionizing radiation and high energy elementary particle beams in patient treatment. *''Surgical specialties'' - there are many medical disciplines that employ operative treatment. Some of these are highly specialized and are often not considered subdisciplines of surgery, although their naming might suggest so. **''General surgery'' is traditionally defined as the specialty of surgery of the skin, endocrine glands, and abdomen (and, sometimes, the mammary glands). In some countries, it is still deemed a pre-requisite training prior to progression to training in certain sub-specialties, but lately has evolved into its own sub-specialty. **''Cardiovascular surgery'' is the surgical specialty that is concerned with the heart and major blood vessels of the chest. **''Neurosurgery'' is concerned with the operative treatment of diseases of the nervous system. **''Maxillofacial surgery'' (technically a subspeciality of dentistry) **''Ophthalmology'' deals with the diseases of the eyes and their treatment. **''Orthopedic surgery'' consists on surgery of the locomotor system. **''Otolaryngology'' (or ''otorhinolaryngology'' or ''ENT''/ear-nose-throat) is concerned with treatment of ear, nose and throat disorders. The term head and neck surgery defines a closely related specialty which is concerned mainly with surgical oncology of the same anatomical structures. **''Pediatric surgery'' treats a wide variety of chest and abdominal (and sometimes urology) diseases of childhood. **''Plastic surgery'' includes aesthetic surgery (operations that are done for other than medical purposes) as well as reconstructive surgery (operations to restore function and/or appearance after traumatic or operative mutilation). **''Surgical oncology'' is concerned with curative and palliative surgical approaches to cancer treatment. **''Urology'' focuses on the urinary tracts of males and females, and on the male reproductive system. It is often practiced together with andrology ("men's health"). **''Vascular surgery'' is surgery of "peripheral" blood vessels, i.e. those outside of the chest (usually operated on by cardiovascular surgery) and of the central nervous system (treated by neurosurgery). *''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. ===Interdisciplinary fields=== Interdisciplinary sub-specialties of medicine are: *''Aerospace medicine'' deals with medical problems related to flying and space travel. *''Bioethics'' is a field of study which concerns the relationship between biology, science, medicine and ethics, philosophy and theology. *''Clinical pharmacology'' 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, or medical geology. *''Diving medicine'' (or hyperbaric medicine) is the prevention and treatment of diving-related problems. * ''Evolutionary medicine'' 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. *''Medical humanities'' includes the humanities (literature, philosophy, ethics, history and religion), social science (anthropology, cultural studies, psychology, sociology), and the arts (literature, theater, film, and visual arts) and their application to medical education and practice. *''Medical informatics'' and ''medical computer science'' are relatively recent fields that deal with the application of computers and information technology to medicine. *''Nosology'' is the classification of diseases for various purposes. *''Sports medicine'' deals with the treatment and preventive care of athletics, amateur and professional. The team includes specialty physicians and surgeons, athletic trainers, physical therapists, Coach (sport)es, other personnel, and, of course, the athlete. ==Medical education== ''See also the main article, Medical doctor (British English) or Physician (American English)'' Medical training involves several years of university study followed by several more years of residential practice at a hospital. Entry to a medical degree in some countries (such as the United States) requires the completion of another degree first, while in other countries (such as the United Kingdom, Australia and New Zealand) medical training can be commenced as an undergraduate degree immediately after secondary education. The name of the medical academic degree gained at the end varies: some countries (e.g. the US) call it "Doctor of Medicine" (abbreviated 'M.D.'), while other countries (mostly following the British Oxbridge system) call it "''Medicinæ Baccalaureus & Baccalaureus Chirurgiæ''" (Latin for "Bachelors of Medicine and Surgery", Old English: "''Chirurgie''"); this is technically a double degree, frequently abbreviated 'MB BChir', 'MB ChB', 'MB BS' (or variations thereof), dependent on the medical school. In either case, graduates of a medical degree may call themselves physician. In the US and some other countries there is a parallel system of medicine called "osteopathy" which awards the degree D.O. (doctor of osteopathy). In many countries, a doctorate of medicine does not require original research as does, in distinction, a Doctor of Philosophy. Once graduated from medical school most physicians begin their residency/house post training, where skills in a speciality of medicine are learned, supervised by more experienced doctors. The first year of residency is known as the "intern" year (USA) or "junior/pre-registration house officer" year (UK). The duration of residency training depends on the speciality. A medical graduate can then enter general practice and become a general practitioner (or primary care internist in the United States); training for these is generally shorter, while specialist training is typically longer. ==Medical devices== ''See also the main articles: implant (medicine), artificial limbs, corrective lenses, cochlear implants, ocular prosthetics, facial prosthetics, somato prosthetics, surgical prosthetics, maxillo-facial prosthetics and dental implants'' Medical devices are devices used by health professionals as tools in diagnosis, treatment or other aspects of patient care. ==Legal restrictions== In most countries, it is a legal requirement for medical doctors 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 doctors 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 and healing, such as alternative medicine or faith healing. ==Criticism== Criticism against medicine has a long history. In the Middle Ages, it was not considered a profession suitable for Christians, as disease was considered Godsent, and interfering with the process a form of blasphemy. Barber surgeon generally had a bad reputation that was not to improve until the development of academic surgery as a specialism of medicine, rather than an accessory field. Through the course of the twentieth century, doctors naturally focused increasingly on the technology that was enabling them to make dramatic improvements in patients' health. This resulted in criticism for the loss of compassion and mechanistic, detached treatment. This issue started to reach collective professional consciousness in the 1970s and the profession had begun to respond by the 1980 and 1990s. Perhaps the most devastating criticism came from Ivan Illich in his 1976 work ''Medical Nemesis''. In his view, modern medicine only ''medicalises'' disease, causing loss of health and wellness, while generally failing to restore health by eliminating disease. The human being thus becomes a lifelong ''patient''. Other less radical philosophers have voiced similar views, but none were as virulent as Illich. (Another example can be found in ''Technopoly: The Surrender of Culture to Technology'' by Neil Postman, 1992, which criticises overreliance on technological means in medicine.) Criticism of modern medicine has led to some improvements in the curricula of medical schools, which now teach students systematically on medical ethics, holistic medicine to medicine, the biopsychosocial model and similar concepts. The inability of modern medicine to properly address many common complaints continues to prompt many people to seek support from alternative medicine. Although most alternative approaches lack scientific validation, many report improvement of symptoms after obtaining alternative therapies. Medical errors are the focus of many complaints and negative coverage. In many ways the prevention of error in medicine is thought by many practitioners of human factors engineering to be similar yet far behind aviation safety, where it was long ago realized that it is dangerous to place too much responsibility on one "superhuman" individual and expect him or her not to make errors. Reporting systems and checking mechanisms are becoming more common in identifying sources of error and improving practice. ==See also== *Big killers *Complementary and alternative medicine *Health profession *Healthcare system *Iatrogenesis (ill health caused by medical treatment) *List of biomedical terms: | List of biomedical topics (numbers) | List of biomedical topics, A | List of biomedical topics, B | List of biomedical topics, C | List of biomedical topics, D | List of biomedical topics, E | List of biomedical topics, F | List of biomedical topics, G | List of biomedical topics, H | List of biomedical topics, I | List of biomedical topics, J | List of biomedical topics, K | List of biomedical topics, L | List of biomedical topics, M | List of biomedical topics, N | List of biomedical topics, O | List of biomedical topics, P | List of biomedical topics, Q | List of biomedical topics, R | List of biomedical topics, S | List of biomedical topics, T | List of biomedical topics, U | List of biomedical topics, V | List of biomedical topics, W | List of biomedical topics, X | List of biomedical topics, Y | List of biomedical topics, Z *List of diseases *List of medical abbreviations *List of medical schools *Medical equipment *Rare diseases *List of publications in medicine ==External links== *[http://www.nlm.nih.gov NLM] (United States National Library of Medicine, contains resources for patients and healthcare professionals) *[http://www.vh.org Virtual Hospital] (digital health sciences library by the University of Iowa) *[http://cancerweb.ncl.ac.uk/omd/index.html Online Medical Dictionary] *[http://www.wikimd.org/index.php?title=Free_Medical_Resources Collection of links to free medical resources] Medicine Health bn:ঔষধ fa:پزشکی ga:Leigheas iu:ᐊᓐᓂᐊᒥ ᖃᐅᔨᓴᕐᓂᖅ la:Medicina li:Genaeskónde nds:Medizin simple:Medicine sw:Utibabi th:แพทยศาสตร์ vi:Y khoa minnan:I-ha̍k
Medicine
Old talk: * /Archive 1 and /Archive 2 Feel free to visit the Wikipedia_talk:WikiProject_Clinical_medicine where topics related to medicine are discussed. == Criticism of medicine sections seems short and weak == The practice of modern medicine has been criticised for many other things than listed here. Its tendency to use government to establish monopoly control over procedures and chemicals. Its tendency to substitute the values of the practitions for those of patient, withholding information (more common in Japan), making decisions about what quality of life is worthwhile, discrimination against the elderly, making cost effective decisions instead of lowest risk ones, other the other hand practicing expensive "defensive" medicine, assuming patients are lying and order unnecessary tests as when ER patient with urinary tract infection reports no extra marital sexual relations, substituting their own assessment of the facts such as when Thomas Morris was denied access to anti-biotics because he suspected he had been exposed to anthrax (he had been and subsequently died) denying patients a basic right to self defense, etc.--User:Silverback 20:23, 11 Oct 2004 (UTC) Please amplify in the article then. I don't think anyone considered it complete. User:Alteripse 20:35, 11 Oct 2004 (UTC) I think Silverback is attempting to start a conversation about this important subject, before making the article itself a forum for the debate, which is my understanding is how this is meant to work. I agree there is enough (just in MY experience) for an entire article about this, but that does not mean as exhaustive a summary as possible does not belong here. I will try to add to the list of criticisms in this space in the near future, but for now wanted to point out there should be more support for the expansion of this section than 4 months of silence. -Jonathan Stone 2 Jan 05 You might want to consider at least 3 things. First, there are a zillion potential medical topics. No contributor has any more "obligation" or "duty" to write about any particular topic than you do. Second, remember that a general overview article such as Medicine should avoid a U.S. bias; a detailed treatment of the advantages and shortcomings of the American healthcare system probably belongs in its own separate article. Third, if you stick to generalities and complain that sometimes doctors fail to do all the things they should or sometimes do some things they shouldn't, it becomes pretty banal unless you actually want to describe and analyze the forces and influences involved. User:Alteripse 04:28, 2 Jan 2005 (UTC) Hey Alteripse!! happy new year!! hope all is well. I aggree that the criticism section is weak and short.. so is the section (there isn't one) on what is to be a doc... the way medicine can take over your life... the 24/24 on call... the fact you can be walking down the street and suddenly find yourself administering first aid... the family and emothional stress (confronting your own limitations, and fighting death and loosing) ... the enormous rewards (respect, $$, choice)... It'd be nice to expand this especially for the 18 year olds considering the vocation. User:Erich gasboy 08:12, 2 Jan 2005 (UTC) ==recent removal of link== JD, that link you removed is spam in a sense, but does contain a useful collection of links. I thought about deleting it a couple weeks ago when first posted but decided to let it stay after I looked at it. I wish the poster would discuss here, but I vote for retention. (and I have no connection whatsover with the site) User:Alteripse 13:37, 20 Feb 2005 (UTC) :Although it is spam, I find this link extremely useful and believe it should be put back. --User:Eleassar777 13:43, 20 Feb 2005 (UTC) Okay, I'll put it back. Mr Spammer also removed an interlanguage link; I wonder why. Please promise me that WikiMD will get no more links in other articles. It's a messy wiki that has spammed this site numerous times. User:Jfdwolff | User_talk:Jfdwolff 19:51, 20 Feb 2005 (UTC) :Sure, boss. I agree it's worth nothing but the links. (smile) User:Alteripse 20:07, 20 Feb 2005 (UTC) BOSS? C'mon, we're not getting hierarchical on this site that runs on anarchy, are we? User:Jfdwolff | User_talk:Jfdwolff 21:55, 20 Feb 2005 (UTC) It just seemed the appropriate tone. Joke. User:Alteripse 00:48, 21 Feb 2005 (UTC) == Eleassar777, please discuss and document == Why are you deleting the important information about importance of the doctor/patient relationship to the patient, and replacing it with unfounded overgeneralizations such as the relationship being "central" to medicine, and introducing a novel "teaching" role. I don't know what country you have experienced medicine in, but most doctors have little to no time to "teach", and in many cultures they jealously guard their knowledge and withhold information from patients.--User:Silverback 13:21, 28 Feb 2005 (UTC) : Alteripse presented the arguments very well, so read below. --User:Eleassar777 13:56, 28 Feb 2005 (UTC) ::No she didn't, perhaps you can do better?--User:Silverback 15:33, 28 Feb 2005 (UTC) :::Silverback, if one patient going to a doctor and saying, "Doc, I hurt. Make it better." isn't the core of medicine, please tell us all what is. "Doctor" literally means "teacher" and has been the title of physicians in English speaking societies for several centuries now--there is nothing "novel" about the physician as teacher. Furthermore, the "important information" about the doctor patient relationship you are so desperately clinging to was a poorly written paragraph that mentioned 1) a physician's relationship with his medicines, which he must compel a patient to take, and 2) a patient's relationship with his government and his insurer, but did NOT mention the physician and patient relating to each other. --User:Matdaddy 23:27, 1 Mar 2005 (UTC) ::Well said. I hadn't realised the etymology of "doctor", but now I understand why I love teaching as well. (Is "indoctrination" an influx of physicians in a busy bar?) User:Jfdwolff | User_talk:Jfdwolff 13:03, 7 Mar 2005 (UTC) ==patient-doctor relationship section== Silverback, a few gentle reminders. #Don't you think your viewpoint might be a bit too "American-centric"? The ER phenomenon you are complaining about is a relatively contemporary American problem that still applies to a minority of the doctor-patient interactions even today in the US. Step back and take a bigger look at the process of "doctoring" across history and cultures. An intro to an article like this should be broadly applicable. ::No is isn't uniquely American, ERs have always had to deal with unconscious or severely ill patients who are unable to make their own medical decisions and for whom the MD/patient relationship is irrelevant.--User:Silverback 15:32, 28 Feb 2005 (UTC) #Please read more carefully, or at least match your reasons to the text you are editing. Your comment about the ER doesn't really contradict the description you removed. I agree it degrades the process by removing prior acquaintance (makes every interaction a first one), reducing the time, and requiring attention only to immediate problems rather than chronic ones. But if you re-read what you removed, it made no claims about any of these three issues. ::It did make claims about what was "central". The ER is more central and especially in this internet and college educated age, MDs are having to deal with informed patients with strong opinions about their care.--User:Silverback 15:32, 28 Feb 2005 (UTC) #I know you don't like it when someone suggests your assertion might be a bit POV, but this is such an example. WP has thousands of articles describing human service relationships. Nearly all start off with a description of what service gets provided in a general ideal way. We don't start the intro to an article about air travel by complaining about how expensive tickets are or how pilots make mistakes and crash the plane sometimes or how unfair it is that you have to get government approval to start a new airline. Your edit justifications might strike some as sounding like this. You might not get multiple people reverting you if you put your opinions in the criticism section of this article and label them more clearly as such, and applicable to current US healthcare system. Note I am not disputing the validity of your opinions here, just asking you to recognize that they are not quite at the level of the most fundamental indisputable fact about this topic for most of us. ::Look whose talking about POV, when did you suddenly take an interest in the medical article and start deleting the previous text wholesale.--User:Silverback 15:32, 28 Feb 2005 (UTC) I am open to your suggestions, but please don't revert any more. Thanks. User:Alteripse 13:37, 28 Feb 2005 (UTC) PS: I wrote this before you entered the note above. Thanks for elaborating your opinion. I like the intro and consider it preferable for reasons stated above. User:Alteripse 13:45, 28 Feb 2005 (UTC) :A good compromise would be just to add this new text to the existing text rather than deleting valid information? --User:Silverback 15:36, 28 Feb 2005 (UTC) :PS: I didn't revert the "intro".--User:Silverback 15:39, 28 Feb 2005 (UTC) First you are correct, it isn't the intro. My mistake. Second, I am generally in favor of adding rather than removing. I hadn't noticed much was removed but I will look again. I am certainly open to compromise and suggestion. I have a terribly slow connection right now and it takes several minutes to go between pages and versions. User:Alteripse 17:17, 28 Feb 2005 (UTC) I probably owe you at least a partial apology. There was no reason for Mattdaddy to replace what was originally there (about gatekeeper responsibility etc) and I missed that it wasn't just an addition. I responded to your edit summaries and removal and didn't understand your point about what was prev removed. Let's keep both in the same section; they are both valid points. Do you want to re-integrate or shall I? I will not try until I have a better connection later today. User:Alteripse 17:29, 28 Feb 2005 (UTC) My graf was attempt to describe the interaction between one patient and one doctor in an exam room which is the heart of medicine. In place of a discussion of the complicated exchange between doctor and patient, the previous graf portrays the doctor as an obstruction/intermediate between the patient and the government or an insurance company, as if healing results from an interaction between a patient and the gov't or between a patient and his insurer. There is an enormous imbalance of power and knowledge between patient and physician. A patient walks into a doctor's office apprehensive and scared because he often has little idea why he is in pain or can't get his breath or what have you, and he may not be able to tell if the cause is something benign, that will soon relent, or something that will permanently disable him. At the same time, the patient has first hand knowledge about this suffering, and only the patient can decide exactly how great a risk he will take to rid himself of it. Many educated and resourceful patients do some research on their ailments before presenting to a doctor, especially with common diseases, but few if any can present their doctor with a list of likely causes of their ailment, a check list of tests that should be performed to rule out the most dangerous and confirm the most likely, and first line therapy for more than the most common cause. And I doubt that there is anyone anywhere who has gone to his doctor having correctly diagnosed himself with myeloma and asked for his doctor's signature allowing him to treat himself with thalidomide plus dexamethasone every week for three months with bisphosphonate adjunctive therapy and prophylactic allopurinol. The doctor does not usually have first hand knowledge of the suffering the patient's disease causes, but does have experience and knowledge to consider alternate causes and suggest how likely it is that the disease will respond to conventional therapy given any modifying factors in the patient's history. Of course, some patients have researched non-conventional therapies, which the doctor hopefully then researches himself and compares with conventional means for the benefit of the patient. Anyway, I would refer anyone interested in the doctor-patient relationship to the opening chapters of Harrison's Internal Medicine, at least, or even better Ed Pellegrino's work. And think about all this yourself the next time you go see your doctor. --User:Matdaddy 22:15, 28 Feb 2005 (UTC) :Some patients have researched conventional therapies as well, as someone who follows the medical literature, I have educated my physicians about the latest research on ACE inhibitors, ARBs, matrix-metalloprotease inhibitors, thalidomide, beta blockers, melatonin, naltrexone the latest medical tests for novel risk factors, etc. I would not have had to go to this trouble if physicians had not lobbied the government so hard to gain and their maintain their monopoly powers. But because they are coercively in the loop with this government imposed monopoly, the patient doctor relationship is important to the patient. This fact should not be left out.--User:Silverback 08:54, 2 Mar 2005 (UTC) OK, I wasn't trying to leave anything out, but I don't follow your argument here. You would have to educate your doctors far more about medicines they ''don't'' have a prescription power over. That is one ofthe complaints of patients who want all doctors to know about all manner of alternative treatments. As much more as we might like doctors to know about ''prescription'' medications, they have far less access to information about'' non-prescription'' treatments. This fact seems to directly contradict your point, unless I am misunderstanding it? User:Alteripse 05:05, 3 Mar 2005 (UTC) :Of those I mentioned, only melatonin is non-prescription and that may change because a scientist has a use patent, and is trying to get it FDA approved. So, overall it is prescription medications I was educating the doctors about. --User:Silverback 05:51, 3 Mar 2005 (UTC) Exactly. You seemed to be making the point that information would be ''easier'' to get about drugs if they were non-prescription and I think you are incorrect, because there is almost no good source of information for consumers or doctors about non-prescription drugs (melatonin being an example). In fact, I can give you some other powerful arguments ''against'' "do-it-yourself" prescribing: #as imperfect as the current system is, abolishing it would make it far less possible to track rare side effects (e.g., the Vioxx & Rezulin recalls) once it was marketed; ::We are protected too much from "rare" side effects, recall that Contact contained a decongestant, that was withdrawn due to increased risk of stroke. Several studies were done before one with enough statistical power showed that it increased the risk of stroke in women. The increased risk was about twice as much as from caffiene. The same study showed it was PROTECTIVE against stroke in men. It was the only decongestant the worked for my daughter, and when she was suffering should would probably have been willing to drive 20+ miles to get it rather than use pseudoephedrine HCL. Her risk of death or serious injury was probably much greater on the drive than from the medicine. patients should be allowed to make their own decisions about the risks if they want to. #there is already an enormous controlled trial going on of consumer prescribing power-- the non-prescription "dietary supplement" industry, which makes drugs in all but name. Would you want Lilly and Merck acting like the companies that make non-prescription drugs-- a huge industry that provides almost ''zero'' public information about how to use them or potential risks, and wards off regulatory scrutiny in the name of "health freedom" with false and dishonest claims to consumers that someone is trying to take their vitamins away, and by contributing money to politicians (e.g., the ephedra scandal)? Think of the public knowledge about what works or doesn't work published by the NCCAM-- which was set up by public demand to provide reliable information on non-prescription treatments, and after nearly 10 years and hundreds of millions of dollars, has not reported that a SINGLE alt med treatment works or doesn't work, and has even rewritten the mission statement on their website so that people will stop expecting that type of information any time soon. ::I have no problem with you using ephedra if you want.-- [User:Silverback|Silverback]] 03:54, 4 Mar 2005 (UTC) ::That's generous of you. My problem with it was twofold-- first, it was a perfect example of false and incomplete advertising-- no info about risks was available to the consumer because the manufacturers were hiding behind the dietary supplement laws and (2) even as a few children and a young adults died each year a consortium of the companies was giving money to the legislators in Texas, Florida, and elsewhere to stop dead an attempt by regulatory agencies to publicly examine the risks. No honesty, no honor, just deceit and greed behind the "health freedom" movement. #if you took prescribing power away from physicians, the folks who would immediately take it from you would be the insurance companies, who would quickly publish (as they try do now to some extent) lists of what drugs they would pay for and for what conditions, and would require that doctors or some other third party confirm that you had that condition. #we already have problems with overuse of certain antibiotics and are trying to tighten rules on which doctors can prescribe them so we can hold on to something to which the increasingly scary bugs out there don't quickly get resistant; I wouldn't want to go the other direction and let people go to the local convenience store for over-the-counter Megastompacillin for their colds. ::::Historically antibiotics have also been under prescribed, it took over a decade before the medical community finally accepted that H pylori caused most stomach ulcers. There are currently bacterial theories of atherosclerosis and kidney stones and a role for fungal infections in chronic sinusitis although current antifungals damage the kidneys. Recall that postal worker Thomas Morris was denied access to Cipro by a physician before he died of anthrax. Chemical freedom should be as basic a right as self defense. Over 1,000,000 are estimate to have died as a result of FDA delays in approving beta blockers and clot busters. Most americans who unthinkingly step into voting booths an pull the lever for some politician who supports the FDA are mass murderers, I know, I was one. Makes al Qaeda look like they were playing pattycake.--User:Silverback 03:54, 4 Mar 2005 (UTC) ::::Bearing in mind the weakness of the series of one, I would point out that no one "denied" ciprofloxacin to Morris--they did fail to diagnose anthrax in him and so did not treat anthrax in him. One might as well say that you are presently being denied treatment for diseases you are not yet known to have. Along those lines, since you seem to have known for years before everyone else that H pylori caused gastric ulcers, why didn't you tell anyone else? Granted, you would have been laughed at at first, but once a few doctors became curious about the little buggers and started looking for them in the ulcers of their patients, those patients taught us all about H pylori and the pathogenesis of most ulcers. --User:Matdaddy 02:29, 5 Mar 2005 (UTC) :::::Morris informed the doctor of the white powder he had been exposed to, and that he wanted Cipro, the MD substituted his judgement and assessment of the risks for Morris. I DID tell people and doctors about the researcher in Austrailia, just not under the name "Silverback", I wasn't the first, but I was an early adopter.--User:Silverback 11:13, 5 Mar 2005 (UTC) :::The best argument against self-prescribing is that it is no safer than performing surgery on oneself. Pseudoephedrine for nasal congestion and the like are about as safe as popping pimples (ahem, incising and draining lesions of acne vulgaris) and the risks of interventions (pharmaceutical or surgical) rise from there. --User:Matdaddy 01:49, 4 Mar 2005 (UTC) ::::That probably is the best argument, and it is wrong of course. --User:Silverback 03:54, 4 Mar 2005 (UTC) ::::On what grounds? Becuase you said so? --User:Matdaddy 02:29, 5 Mar 2005 (UTC) :::::I certainly can't think of a better argument than this wrong one. Many medicines are safer than performing surgery on oneself, although I don't think there is much about self surgery in the literature. I couple of amputations. The safety of most of the anti-hypertensives, statins, and short term use of NSAIDs are all generally safer than performing surgery on oneself.--User:Silverback 11:13, 5 Mar 2005 (UTC) :::::You are naive about self-surgery, Silverback. Look around on the internet and find all the websites about trepanning (sometimes spelled trephining). You can also find plenty of case reports in the medical literature of various self-surgery attempts, mostly castrations, but the one that sticks in my mind was the college student who tried to do an adrenalectomy on himself in his dorm room. That was, I think, in JAMA in the early 80s. Oh, and how about that murderous C-section in Missouri a couple of months ago? User:Alteripse 17:03, 5 Mar 2005 (UTC) Please don't accuse me of claiming doctors are perfect or there is no downside to the current system or of trying to exclude anything negative from this article. It's just that there were lots of good reasons that precribing laws were established, and they were the same reasons that clean food laws were passed: the average knowledge of consumers and prescribers about "drugs" being used a century ago was far worse than it is today, the kind of situation that brings to mind a cliche like, "those who don't know history are condemned to repeat it". I may not change your mind but it seemed worthwhile reminding people exactly why prescribing and licensing laws exist. :I have no objection to someone insisting on only FDA approved drugs, and on only taking them if they are prescribed by a physician. But those benefits could be available voluntarily. Everyone complains about the drug companies and the cost of drugs, hwoever, the largest component of the cost of obtaining drugs for most people is the cut that the physician gets. The point about the information I want retained in the article is not whether it is negative or positive, but whether it is true, and it is.--User:Silverback 03:54, 4 Mar 2005 (UTC) Finally I thought I was supporting your point about power and dependence by expanding it into a paragraph. Did I make it even broader than you wanted, or less clear? How do you suggest we modify it?User:Alteripse 12:30, 3 Mar 2005 (UTC) :Hmmm, all said, that was pretty good. Not as blunt as I would like, but pretty good.--User:Silverback 04:00, 4 Mar 2005 (UTC) Silverback, Eleassar, Matdaddy, please check to see that the new "melded" version contains all the points you each thought was important. User:Alteripse 04:05, 1 Mar 2005 (UTC) :Much has been said about the p-d relationship in these posts and the new version surely is more neutral. However, it is not evident (or at least not clearly explained) what relationships between patient and doctor prevail in different circumstances. I mean, I believe that usually this is the idealized relationship, however in some cases it is also the "ER relationship". It should be specifically written where different kinds of relationship apply. However, we could even argue that in the case of ER there is no relationship. :The other thing I wish to call attention to refers to semantics. Perhaps it would be better to use the phrase ''patient-doctor relationship'' instead of ''doctor-patient relationship''. I mean, it is usually the patient who establishes contact with doctor so the patient should be written first. We could go even further and replace ''doctor'' with ''physician'', because the physician is not always a doctor, according to the Latin meaning of the word. --User:Eleassar777 18:12, 3 Mar 2005 (UTC) ::The literature in the fields of medicine and medical ethics have traditionally used the phrase doctor-patient relationship, although a quick Google search found 50k hits for ''"patient-doctor" relationship'' (compared with 300k for ''"doctor-patient" relationship''). Beauchamp, Pellegrino, Childress, and Thomasma all use doctor-patient relationship, although in some essays Pellegrino has used physician-patient. A reviewed criticism of these authors, who began cultivating medical ethics as a field in itself and promulgated the virtue-based model of ethics (non-maleficence, beneficence, autonomy, and justice) 30-40 years ago, would be the appropriate place to challenge this terminology and suggest alternatives, not an encyclopedia entry. ::The terms physician and doctor should be uniformly used thoughout the medicine section with clearly stated definitions near the beginning of this entry, or they should be used interchangeably. Some associate physician with practitioners of internal medicine and its subspecialties to the exclusion of surgeons, for example, while in other countries, only practitioners in internal medicine are called "Doctor" and surgeons are addressed as "Mister". The present day usage of the terms are very imprecise, as in most countries following the Oxbridge system, doctors do not hold a doctoral degree, making the salutation honorary or conventional but not technically accurate. And even in countries where "doctors" hold doctoral degrees, they do not research or defend theses, so their doctorate is largely titular anyway. (Law, the other profession that awards titular doctoral degrees, does not ask that holders of the Juris Doctor be addressed as "doctor.") ::I agree that the terminology is imprecise and generally unsatisfactory, but an important function of reference material is to introduce the reader to a field and its idiosyncracies, so I would present the norms. --User:Matdaddy 01:32, 4 Mar 2005 (UTC) :That's great if you will (don't take this as being hustled, it's only that probably you can do this better than me because you know more about this topic). I mean, what is really important here is not whether we use one term or another, but that the usage of these terms is explained in the article and that it is grounded in some facts. For example, it should be explained, what is the difference between ''doctor'' and ''physician'' (it is to some degree but not at all so thoroughly as in your post here) and why it is more common to use the phrase ''doctor-patient relationship'' instead of ''patient-doctor relationship''. Also, we should strive after consistence. :The other thing is that it should be explained in what circumstances different doctor-patient relationships develop and what influences them. It does not suffice if it is just written that some kind of it is "ideal" and "taught in school" but not said where it appears in practice. :I also see that the facts that belong together are scattered throughout the article. It will be my pleasure to correct this when you (or someone else) add the missing ones and this discussion finally ends. --User:Eleassar777 23:33, 4 Mar 2005 (UTC) Silverback, the basic reason that what others have written don't include your points in the way you want to make them is that we are talking about different topics. Mattdaddy's original description of the ''structure'' of the the basic doctor-patient relationship was as unexceptionable as beginning a discussion of English sentence structure by saying, "a basic English sentence includes a subject and predicate." We all know that some meaningful utterances don't follow the paradigm, but it's still the starting point. Your point about ERs and prescription monopoly was perfectly true and perfectly irrelevant to an explanation of the structure of the basic doctor-patient interaction. Your point about it being "more important now because doctors have prescription monopoly" is a failure to understand the other points. The basic interactional structure of the relationship has not changed in 2500 years. Different aspects get distorted by local customs or circumstances (e.g., the old Chinese practice of a patient describing symptoms on a doll instead of allowing a direct visual inspection of an important person), but it is basically and usually: ''patient describes problem, doctor gathers info, doctor interprets info from professional knowledge perspective, doctor explains diagnosis to patient with treatment recommendation''. In this context, it ''doesn't matter'' who can prescribe-- that is an irrelevant piece of local circumstance. The process is the same if the doctor is a Greek slave, shaman, chiropractor, or an ER doc. Your 3 important points, if I recall, were that in ER interactions the doctor and patient don't know each other, that in critical care situations the doctor doesn't explain much to the patient, and that when government licenses prescription power it changes the potential advantages and disadvantages to the patient. These are perfect examples of modification of way the interaction operates by special circumstances or particular social rules but none of them replace or invalidate the basic interaction structure. Your points are both valid and deserve to be in this article, but not in the same paragraph and not as a "contradiction" or "more accurate view", which is how it seemed you were offering them. I am sorry you thought my attempt to generalize your points into something less specific and place-bound was "namby-pamby." I wasn't trying to exclude your points, nor get into a conflict, just to put them in a context that didn't make it look so much like you just didn't get the point of the section. User:Alteripse 18:21, 6 Mar 2005 (UTC) :It wasn't you attempt to generalize my points that I considered namby pamby, it was what was done to the whole section, it was the touchy feely bs that I generally skip over when I read looking for straight forward information content. Perhaps it is because we live in a literate age, where MDs are more in the way of the informed patient, and if they are too obstinate or insecure then we have to either cleverly work them, or feign deference, or doctor shop to get what we want.--User:Silverback 21:44, 6 Mar 2005 (UTC) Silverback, the version you are pushing suggests that the patient-doctor relationship is all about power. I vehemently disagree. While there is obviously an element of power (governments have entrusted doctors with the prescription pad, not just doctors themselves), the patient-doctor relationship is primarily that of someone in need of "health", which the doctor provides as a healthcare provider (horrible term, but it's true). To paint this relationship as one of power is very much WP:NPOV, and it seems consensus is against it. Of course it should be mentioned that doctors determine access to treatment, but that is their ''professional judgment'' and should be mentioned ''last'', not ''first'' in the paragraph on the patient-doctor relationship. User:Jfdwolff | User_talk:Jfdwolff 00:38, 7 Mar 2005 (UTC) ==power, statistics, and lying== :No my version is NOT all about power, please note that it INCLUDES your version. You also seem to be implying that power is somehow wrong, but your part is partially about paternalism and that is a more benevolent face of power, but power nonetheless. I just state the facts more boldly, and certainly in a more subdued and defensible manner than I state my opinion here. Some people don't want paternalism. NPOV is obscured by not laying out the power aspects of the relationship plainly. I've just thought of a way that your version is POV. It doesn't reflect how patients are treated like statistics. Consider an adult male seeking treatment for a UTI (urinary tract infection), most MDs will order a test for STDs even if the patient doesn't want them and assures the MD that there is no possibility of that, because the MDs have been trained that statistically a significant number of men will be lying about this. How does treating the patient like a statistic and assuming your patient is lying fit in with your version of the "relationship"?--User:Silverback 09:00, 7 Mar 2005 (UTC) "My" version already makes good mention of the "power of the prescription pad" with more references. There is no need to state the facts more boldly. An intelligent reader will get the message without you shouting at him. About paternalism: patients are treated like statistics because statistics is the only thing that really matters in the final analysis. Most heart attacks are due to atherosclerosis. Many post-MI patients undergo a coronary angiogram. Often, normal coronary arteries are found. Does that mean the doctor was wrong in requesting it? As for the male UTI patients: patients have to give consent before being tested for ''anything'', especially STDs. Times are long past that in these matters consent was considered to be implicit. I am very concerned about your bias. You cannot simply carry on pushing the same version now. Please address the issues. If you are willing, we can WP:RFC from the Wikipedia user community whether your or "my" version is more POV. User:Jfdwolff | User_talk:Jfdwolff 13:00, 7 Mar 2005 (UTC) :No, the MD is not wrong for ordering a test that proves negative. But that is different than questioning a patient's integrity and then expecting the patient or his insurance company to pay for it. BTW, what does my "bias" have to do with the correctness of my post to the article?--User:Silverback 16:07, 7 Mar 2005 (UTC) Pardon me for introducing a new section heading so it's easier to edit. I find your latest complaint interesting concerning statistics and lying: it truly indicates how little you understand what we do and what we are talking about. The ability of a doctor to help solve a patient's problem is partly based on lengthy schooling about how the body works, but in daily practice is based primarily on our experience with other patients with similar problems. We are far likely to be able to help ''you'' if we have seen a hundred other people with the same problem; otherwise all we are doing is looking something up in a book, which is something you might do as well. Statistics are a way to carry out a reality check on impressions. Impressions are a useful piece of evidence we gather for problem solving (e.g., I have the impression that treatment x works better than y for condition z), but an intelligent person has a healthy mistrust of his own impressions-- not ignoring them, but wanting to confirm them with other evidence. Statistics are how we keep our brain heuristics from misleading us. Awareness of probability statistics when treating people is more effectively done consciously than unconsciously. Trust me, you ''want'' a doctor who is aware of the probabilities. (Obviously if your use of the term "statistic" is simply a way of saying, "my doctor gives me the impression that he doesn't see me as a unique person worth making at least a brief human relationship with", then you are actually talking about an entirely different issue (caring and what you called the "touchy-feely stuff")-- I am paying you the respect of assuming you mean what you say). So what do statistics have to do with lying? Part of the evidence we gather to solve a problem is what the patient tells us, but we are being paid to use as much information as possible to solve a problem, so we are doing you a service, not a disservice, when we wonder about what you are not telling us or when we evaluate your account the same way we do the exam, the lab report, or the textbook-- the data may be misleading in this case. In many areas of concerns about health, people find it hard to be accurate and honest about what they have done or not done. A doctor with some maturity and experience can be skeptical and still respect and care about the person--- I run into this issue on a daily basis as I take care of people with diabetes. I have been wrong both ways of course, both in trusting and in not trusting what someone told me, but many times I have solved problems other doctors couldn't because I didn't take the first account at face value. There are better and worse ways to handle this issue of course. I once heard a famous expert on sexual disorders say that he always started every visit by telling his patient he will assume that part of what he tells him is untrue. In some circumstances this level of honesty actually improves mutual confidence and communication. It is far more dangerous to our patients if a doctor thinks that lying is something that only a few rare, "bad" people do, than if he considers it a normal part of interpersonal interaction. At least you modified your assertion by claiming that "most" doctors check for STDs. Few of us blindly follow rules like that without making individual adjustments; most of us would not order STD screens if you were paying out of pocket and persuasively denied such risk. And we would be wrong in a few of those instances as well. As you probably know, most people do not object or complain when we check for stds and pregnancy. You seem to have told us a lot about yourself as a patient: your insecurity at putting yourself in someone else's hands and need for reassurance that that your doctor acknowledges how much you know, your dislike of discussing emotions, your dislike of discussing a problem in terms of probabilities and uncertainties, and especially your dislike of the idea that your doctor might think of you in a way different than the persona you present. Do you call your doctor "doc" as well? If so, you are a very recognizable kind of patient (one that Osler warned about). Each of us find we are better at dealing with some personalities than others. And if you don't like my "reading" of you, perhaps it is wrong and I would get a different impression in person. And of course, maybe you are right and you really do know more than all of us about practicing medicine. User:Alteripse 13:29, 7 Mar 2005 (UTC) :Yes there are lots of conditions where patients perceptions can mislead them in self diagnosis if they are unaware of those situations. The danger that a lying patient gets into is the patients responsibility not the doctors. You are correct that I like to make my own decisions in areas I consider important, but wrong about discussing emotions, although they aren't the way I make decisions, I do consider their input. I have no problem with probabilities if that is the state of the science, and I agree that it is efficient to work rule out the more common or probable conditions first, but in some areas I opt for more information than is considered "cost effective". What I don't like is inconvenience and coercion, i.e., having to bother with a doctor for the routine, like renewing or adjusting prescriptions, ordering and reading blood tests, etc that unnecessarily increase the cost of medicine. The coercion is of course, the government guns that enforcement the physicians monopoly. I have no problems with physicians that act as consultants, and that don't pretend to know more than they do. What inspires my confidence is if they are willing to say what they don't know, and even look things up in front of you, or get back to you later. :I don't want to be an expert in all areas of medicine, medicine is a broad field and not all parts are equally interesting. Don't get me wrong, there are physicians I admire, and services I would employ them for. I just don't think it should be at the point of a gun. Do you think medicine could survive as it once did, without exclusive government monopolies?--User:Silverback 16:07, 7 Mar 2005 (UTC) I haven't the slightest fear that we need a gov monopoly to keep our jobs. We offer a service that is so desired by people that many consider access a "social right". The only effect of dropping the licensure and presciption laws is that it would take us back a century to an even greater degree of caveat emptor. The immediate response would be some sort of certifying procedure so people could assure themselves they were getting someone with training, experience, and accountability, and the insurance companies (both health and liability) would respond by only paying for certified doctors and certified prescriptions and we would be right back where we started. User:Alteripse 16:44, 7 Mar 2005 (UTC) :I would hope that such certification would spring up, and in fact it did exist to some extent, and was codified into law, no doubt with some physician lobbying.--User:Silverback 11:18, 8 Mar 2005 (UTC) :So then what would be the advantage of repealing the existing de jure licensure & prescription restrictions if the rapid result was de facto certification and prescription access restriction by private corporations? A potentially big social disadvantage would be a widening of the gap between people able to afford and not afford corporate-certified access and drugs. User:Alteripse 13:35, 8 Mar 2005 (UTC) ::An advantage would be easier access to the drugs and a reduction in costs. I would work to oppose the insurance and corporate reinstitutionalizing of physicians, in fact I advocate that my employer supply antihypertensives and statins free, and monitor the blood tests themselves as a convenience and preventive cost saving measure. Health classes in high schools should be able to teach the principles of selecting and titrating the doses of these drugs as well as reading basic blood tests for monitoring drugs. In the current system internet MDs and pharmacies should be able to wring out some of the costs this way. I also would work to have medical plans cover expensive over the counter drugs such as the non-sedating anti-histamines.--User:Silverback 16:37, 8 Mar 2005 (UTC) ''Gentlemen, can we go back to discussing the article, instead of how Silverback would change the medical world?'' User:Jfdwolff | User_talk:Jfdwolff 17:53, 8 Mar 2005 (UTC) :Chill -- we are community building here and have strayed only about a millimeter off topic.--User:Silverback 18:41, 8 Mar 2005 (UTC) We are going to teach kids in high school how to prescribe their own medicines for when they develop chronic adult diseases in 10,20,30 years?! I take care of teenagers with diabetes and other chronic diseases every day. I have been continuing this discussion under the apparently mistaken assumption that you and I belong to the same species living in the same universe. You are pulling my leg, aren't you? User:Alteripse 03:44, 9 Mar 2005 (UTC) :I've been on anti-hypertensives since age 19. There is a consensus building that atherosclerosis begins in the young, and the increase in obesity has more teans that are pre-diabetic or with type II diabetes. I suspect that soon we will have anti-obesity drugs. I would prefer that schools just focus on scientific literacy because that is all that is really needed for someone who wants to prescribe for themselves or their families. However, since schools teach all kinds of "subjects" other than basic skills, there is no reason for them to be kept in ignorance about medical matters. I don't engage in personal attacks.--User:Silverback 23:52, 9 Mar 2005 (UTC) Forgive me. I didn't intend astonishment to seem like a personal attack, although I guess if you offered that in good faith it must seem like one. Shall we say so many objections problems occurred to me that suggested that your idea of what a high school can teach a teenager about his own ''future'' health differs so radically different from my daily experience as to suggest our ideas of what is possible with the subspecies ''homo adulescens'' are incompatibly divergent? I'm not sure there is anywhere to go with this than, "we are all entitled to our opinions" I think you may have been a teenager several standard deviations from normal. I certainly admit to the same, so that conjecture is not intended as a personal attack. User:Alteripse 01:23, 10 Mar 2005 (UTC) :Happy to forgive and forget. It was the species and universe part that seemed like an attack. I had missed your statement about treating teens with diabetes, so apologies for spouting that redundant information. --User:Silverback 19:20, 10 Mar 2005 (UTC) == Overall Review == I wish Wikip. had an "Article review" button for each article (maybe it does). Anyway, this article seems to be fairly comprehensive and knowledgeable, yet needs a lot of editing for style, sexist pronoun use, and a range of point-of-view issues which characterize a text lacking a degree of scientific precision when it comes to language and writing--less than satisfactory cultural context for its assertions...and style needs improvement. Hope that isn't too critical. I'll try to clean up what I can when I have time. Thanks! User:70.57.141.70 02:41, 7 Mar 2005 (UTC) :I'm not sure what the purpose of "article review" would be. WP:BB and start editing! If one of us doesn't like it, we'll just revert :-) User:Jfdwolff | User_talk:Jfdwolff 07:59, 7 Mar 2005 (UTC) :I just had a little copyedit, and the article is actually not bad at all. If you have any specific complaints, perhaps you could mention them here first so we can achieve consensus. I'm categorically against writing ''his/her'' whenever the patient or doctor is referred to. Please stick to "he". A large number of publications follows this principle for stylistic reasons, and I see no reason why we should deviate from this. User:Jfdwolff | User_talk:Jfdwolff 08:15, 7 Mar 2005 (UTC) The English pronoun "he" refers to a both a male antecedent as well as to antecedents of unknown or unspecified gender; that is, when the antecedent is masculine, "he" is masculine, and when the antecedent is neutral or unspecified, so is "he." "He/she" is equivalent saying "the unspecified masculine or feminine antecedent or the feminine antecedent," which is just wasted effort. Grammar, and not sexism, should make the choice between he and she, and grammar calls for he. The writing through out the article is adequate but not inspired or artful; I think that is largely the result of so many authors. ==Wikicities== Why is there the commercial link wikicities:books in the article? As it contains adds by google, it should be removed. --User:Eleassar777 10:42, 15 Apr 2005 (UTC) == The intro == The intro of this article was: :Medicine is a branch of health science concerned with restoring and maintaining health. Broadly, it is the practical science of preventing and curing diseases. However, ''medicine'' often refers more specifically to matters dealt with by physicians and surgery. I removed the third line. It suggests that medicine as practiced by physicians and surgeons is not "real medicine". I hotly contest this. Firstly, the remainder of the intro explains exactly what we want (that medicine is a science and a profession). Secondly, medicine as we know it is practiced by many more than just doctors. It is a system - medicine collapses without nurses, laboratory scientists and hospital porters. To claim that medicine is the sole jurisdiction of MDs is a strawman. I'm glad I changed it, and it should not come back. User:Jfdwolff | User_talk:Jfdwolff 22:08, 21 May 2005 (UTC)
Medicine
{| style="margin:0 auto;" align=center width=75% class="toccolours" |align=center style="background:#ccccff"| Health science - Medicine |- |align=center| Anesthesia - Dermatology - Emergency medicine - General practitioner - Intensive care medicine - Internal medicine - Neurology - Obstetrics & Gynaecology - Pediatrics - Podiatry - Public health & Occupational Medicine - Psychiatry - Radiology - Surgery |- |align=center style="background:#ccccff"| Branches of Internal medicine |- |align=center| Cardiology - Endocrinology - Gastroenterology - Hematology - Infectious diseases - Nephrology - Oncology - Pulmonology - Rheumatology |- |align=center style="background:#ccccff"| Branches of Surgery |- |align=center| General Surgery - Cardiothoracic surgery - Neurosurgery - Ophthalmology - Orthopedic surgery - Otolaryngology (ENT) - Pediatric surgery - Plastic surgery - Podiatric surgery - Urology - Vascular surgery |}
Medicine
#redirect Template:Medicine
Medicine
Health sciences Biology Humans For a list of articles in this category that need some further work, see :Category:Medicine stubs. minnan:Category:I-ha̍k vi:Category:Y khoa
Medicine
any body else think sexology don't belong here? it is about as related as sports science! User:Erich gasboy 22:29, 14 Jun 2004 (UTC) ==WikiProject== See: * Wikipedia:WikiProject Clinical medicine (moved from article --User:Lexor|User talk:Lexor 11:14, 5 Sep 2004 (UTC))
See other meanings of words starting from letter:
M
MA | MB | MC | MD | ME | MF | MG | MH | MI | MJ | MK | ML | MN | MO | MP | MR | MS | MT | MU | MW | MX | MY | MZ |Words begining with Medicine:
Medicine
Medicine
Medicine
Medicine
Medicine
Medicine
Medicine/Archive_1
Medicine/Archive_2
Medicinemen
Medicines
Medicines_and_Healthcare_products_Regulatory_Agency
Medicine_(band)
Medicine_(history)
Medicine_(shamanism)
Medicine_(shamanism)
Medicine_bag
Medicine_ball
Medicine_Bar
Medicine_basic_topics
Medicine_Bow
Medicine_Bow,_WY
Medicine_Bow,_Wyoming
Medicine_Bow_Mountains
Medicine_Bow_Range
Medicine_Bow_River
Medicine_Buddha
Medicine_bundle
Medicine_Hat
Medicine_Hat,_Alberta
Medicine_Hat,_Alberta
Medicine_Hat_(electoral_district)
Medicine_Hat_(provincial_electoral_district)
Medicine_Hat_Arena
Medicine_Hat_College
Medicine_Hat_Tigers
Medicine_Hat_Tigers
Medicine_Lake
Medicine_Lake,_Minnesota
Medicine_Lake,_MN
Medicine_Lake,_Montana
Medicine_Lake,_MT
Medicine_Lake_Volcano
Medicine_Lake_Volcano
Medicine_Lodge
Medicine_Lodge,_Kansas
Medicine_Lodge,_KS
Medicine_Lodge_Treaty
Medicine_Man
Medicine_man
Medicine_man
Medicine_men
Medicine_Park
Medicine_Park,_OK
Medicine_Park,_Oklahoma
Medicine_show
Medicine_standards
Medicine_stubs
Medicine_wheel
These materials are based on Wikipedia and licensed under the GNU FDL
YouTube.com videos better site than Turbo Tax 2007
