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Medicine is the
science Science () is a systematic enterprise that builds and organizes knowledge Knowledge is a familiarity or awareness, of someone or something, such as facts A fact is something that is truth, true. The usual test for a statement of ...

science
and practice of caring for a patient, managing the
diagnosis Diagnosis is the identification of the nature and cause of a certain phenomenon. Diagnosis is used in many different academic discipline, disciplines, with variations in the use of logic, analytics, and experience, to determine "causality, cause a ...
,
prognosis Prognosis (Greek#REDIRECT Greek Greek may refer to: Greece Anything of, from, or related to Greece Greece ( el, Ελλάδα, , ), officially the Hellenic Republic, is a country located in Southeast Europe. Its population is approximately ...
,
prevention Prevention may refer to: Health and medicine * Preventive healthcare Preventive healthcare, or prophylaxis, consists of measures taken for disease prevention.Hugh R. Leavell and E. Gurney Clark as "the science and art of preventing diseas ...
,
treatment Treatment may refer to: * Treatment (song), "Treatment" (song), a 2012 song by * Film treatment, a prose telling of a story intended to be turned into a screenplay * Medical treatment or therapy * Sewage treatment * Surface treatment or surface fi ...
, palliation of their
injury Injury, also known as physical trauma, is damage to the body caused by an external force. This may be caused by accidents, falls, hits, weapons, and other causes. Major trauma is injury that has the potential to cause prolonged disability or ...

injury
or
disease A disease is a particular abnormal condition that negatively affects the structure A structure is an arrangement and organization of interrelated elements in a material object or system A system is a group of Interaction, interactin ...
, and promoting their health. Medicine encompasses a variety of
health care Healthcare is the maintenance or improvement of health Health, according to the , is "a state of complete physical, and social and not merely the absence of and ".. (2006)''Constitution of the World Health Organization''– ''Basic Docume ...

health care
practices evolved to maintain and restore
health Health, according to the World Health Organization The World Health Organization (WHO) is a specialized agency of the United Nations United Nations Specialized Agencies are autonomous organizations working with the United Nations and each ...

health
by the
prevention Prevention may refer to: Health and medicine * Preventive healthcare Preventive healthcare, or prophylaxis, consists of measures taken for disease prevention.Hugh R. Leavell and E. Gurney Clark as "the science and art of preventing diseas ...
and
treatment Treatment may refer to: * Treatment (song), "Treatment" (song), a 2012 song by * Film treatment, a prose telling of a story intended to be turned into a screenplay * Medical treatment or therapy * Sewage treatment * Surface treatment or surface fi ...
of
illness A disease is a particular abnormal condition that negatively affects the structure A structure is an arrangement and organization of interrelated elements in a material object or system A system is a group of Interaction, interactin ...
. Contemporary medicine applies
biomedical sciences Biomedical sciences are a set of sciences applying portions of natural science Natural science is a branch A branch ( or , ) or tree branch (sometimes referred to in botany Botany, also called , plant biology or phytology, is ...
,
biomedical research Medical research (or biomedical research), also known as experimental medicine, encompasses a wide array of research, extending from "basic research Basic research, also called pure research or fundamental research, is a type of scientific r ...
,
genetics Genetics is a branch of biology Biology is the natural science that studies life and living organisms, including their anatomy, physical structure, Biochemistry, chemical processes, Molecular biology, molecular interactions, Physiology, ...
, and
medical technology Health technology is defined by the World Health Organization The World Health Organization (WHO) is a specialized agency of the United Nations United Nations Specialized Agencies are autonomous organizations working with the United Nation ...
to
diagnose Diagnosis is the identification of the nature and cause of a certain phenomenon. Diagnosis is used in many different disciplines, with variations in the use of logic Logic is an interdisciplinary field which studies truth and reasoning Rea ...
, treat, and prevent injury and disease, typically through
pharmaceutical A medication (also called medicament, medicine, pharmaceutical drug, medicinal drug or simply drug) is a drug used to medical diagnosis, diagnose, cure, therapy, treat, or preventive medicine, prevent disease. Drug therapy (pharmacotherapy) ...
s or
surgery Surgery ''cheirourgikē'' (composed of χείρ, "hand", and ἔργον, "work"), via la, chirurgiae, meaning "hand work". is a medical or dental specialty that uses operative manual and instrumental techniques on a person to investigate or t ...
, but also through therapies as diverse as
psychotherapy Psychotherapy (also psychological therapy or talking therapy) is the use of Psychology, psychological methods, particularly when based on regular Conversation, personal interaction, to help a person change behavior, increase happiness, and ove ...
, external splints and traction,
medical device A medical device is any device intended to be used for medical purposes. Significant potential for hazard A hazard is a potential source of harm. Substances, events, or circumstances can constitute hazards when their nature would allow them, e ...
s,
biologics A biopharmaceutical, also known as a biologic(al) medical product, or biologic, is any pharmaceutical drug A medication (also called medicament, medicine, pharmaceutical drug, medicinal drug or simply drug) is a drug Uncoated tablets ...
, and
ionizing radiation Ionizing radiation (or ionising radiation), including nuclear radiation, consists of s or s that have sufficient to s or s by detaching s from them. The particles generally travel at a speed that is greater than 1% of , and the electromagnetic w ...
, amongst others. Medicine has been practiced since
prehistoric times Prehistory, also known as pre-literary history, is the period of human history Human history, or world history, is the narrative of Human, humanity's past. It is understood through archaeology, anthropology, genetics, and linguistics, ...
, during most of which it was an art (an area of skill and knowledge) frequently having connections to the
religious Religion is a social Social organisms, including humans, live collectively in interacting populations. This interaction is considered social whether they are aware of it or not, and whether the exchange is voluntary/involuntary. Etymology ...

religious
and
philosophical Philosophy (from , ) is the study of general and fundamental questions, such as those about existence, reason Reason is the capacity of consciously applying logic Logic is an interdisciplinary field which studies truth and reasoning ...

philosophical
beliefs of local culture. For example, a
medicine man A medicine man or medicine woman is a traditional healer and spiritual leader who serves a community of Indigenous peoples of the Americas, Indigenous people of the Americas. Individual cultures have their own names, in their respective Indigen ...

medicine man
would apply
herbs In general use, herbs are a widely distributed and widespread group of plants, excluding vegetables Vegetables are parts of plants that are consumed by humans or other animals as food. The original meaning is still commonly used and is app ...

herbs
and say
prayer Prayer is an invocation or act that seeks to activate a rapport with an object of worship through deliberate communication. In the narrow sense, the term refers to an act of supplication or intercession directed towards a deity or a deified an ...

prayer
s for healing, or an ancient
philosopher A philosopher is someone who practices philosophy Philosophy (from , ) is the study of general and fundamental questions, such as those about Metaphysics, existence, reason, Epistemology, knowledge, Ethics, values, Philosophy of mind, mi ...

philosopher
and
physician A physician (American English), medical practitioner (English in the Commonwealth of Nations, Commonwealth English), medical doctor, or simply doctor, is a professional who practices medicine, which is concerned with promoting, maintainin ...

physician
would apply
bloodletting Bloodletting (or blood-letting) is the withdrawal of blood Blood is a body fluid Body fluids, bodily fluids, or biofluids are liquid A liquid is a nearly incompressible In fluid mechanics or more generally continuum mechanics, i ...

bloodletting
according to the theories of
humorism Humorism, the humoral theory, or humoralism, was a system of medicine detailing a supposed makeup and workings of the human body, adopted by Ancient Greek Ancient Greek includes the forms of the Greek language Greek ( el, label=Mo ...

humorism
. In recent centuries, since the
advent of modern science
advent of modern science
, most medicine has become a combination of
art Art is a diverse range of (products of) human activities Humans (''Homo sapiens'') are the most populous and widespread species of primates, characterized by bipedality, opposable thumbs, hairlessness, and intelligence allowing the use ...

art
and
science Science () is a systematic enterprise that builds and organizes knowledge Knowledge is a familiarity or awareness, of someone or something, such as facts A fact is something that is truth, true. The usual test for a statement of ...

science
(both
basic BASIC (Beginners' All-purpose Symbolic Instruction Code) is a family of general-purpose, high-level programming language In computer science Computer science deals with the theoretical foundations of information, algorithms and the ar ...
and applied, under the
umbrella An umbrella or parasol is a folding canopy Canopy may refer to: Plants * Canopy (biology), aboveground portion of plant community or crop (including forests) * Canopy (grape), aboveground portion of grapevine Religion and ceremonies * Baldac ...
of medical science). While stitching technique for
sutures Suture, literally meaning "seam", may refer to: Arts, entertainment, and media * Suture (album), ''Suture'' (album), a 2000 album by American Industrial rock band Chemlab * Suture (film), ''Suture'' (film), a 1993 film directed by Scott McGehee and ...

sutures
is an art learned through practice, the knowledge of what happens at the cellular and
molecular A molecule is an electrically Electricity is the set of physical phenomena associated with the presence and motion Image:Leaving Yongsan Station.jpg, 300px, Motion involves a change in position In physics, motion is the phenomenon ...
level in the tissues being stitched arises through science. Prescientific forms of medicine are now known as
traditional medicine Traditional medicine (also known as indigenous Indigenous may refer to: *Indigenous peoples Indigenous peoples, also referred to as First people, Aboriginal people, Native people, or autochthonous people, are culturally distinct ethnic gr ...

traditional medicine
or ''folk medicine'', which remains commonly used in the absence of scientific medicine, and are thus called
alternative medicine Alternative medicine is any practice that aims to achieve the healing effects of medicine, but which lacks biological plausibility and is Argument from ignorance, untested, Pseudoscience, untestable or proven ineffective. Complementary medicin ...
. Alternative treatments outside of scientific medicine having safety and efficacy concerns are termed
quackery Quackery, often synonymous with health fraud, is the promotion of fraud In law Law is a system A system is a group of Interaction, interacting or interrelated elements that act according to a set of rules to form a unified whole. ...
.


Etymology

Medicine (, ) is the
science Science () is a systematic enterprise that builds and organizes knowledge Knowledge is a familiarity or awareness, of someone or something, such as facts A fact is something that is truth, true. The usual test for a statement of ...

science
and practice of the
diagnosis Diagnosis is the identification of the nature and cause of a certain phenomenon. Diagnosis is used in many different academic discipline, disciplines, with variations in the use of logic, analytics, and experience, to determine "causality, cause a ...
,
prognosis Prognosis (Greek#REDIRECT Greek Greek may refer to: Greece Anything of, from, or related to Greece Greece ( el, Ελλάδα, , ), officially the Hellenic Republic, is a country located in Southeast Europe. Its population is approximately ...
,
treatment Treatment may refer to: * Treatment (song), "Treatment" (song), a 2012 song by * Film treatment, a prose telling of a story intended to be turned into a screenplay * Medical treatment or therapy * Sewage treatment * Surface treatment or surface fi ...
, and
prevention Prevention may refer to: Health and medicine * Preventive healthcare Preventive healthcare, or prophylaxis, consists of measures taken for disease prevention.Hugh R. Leavell and E. Gurney Clark as "the science and art of preventing diseas ...
of
disease A disease is a particular abnormal condition that negatively affects the structure A structure is an arrangement and organization of interrelated elements in a material object or system A system is a group of Interaction, interactin ...
. The word "medicine" is derived from
Latin Latin (, or , ) is a classical language belonging to the Italic languages, Italic branch of the Indo-European languages. Latin was originally spoken in the area around Rome, known as Latium. Through the power of the Roman Republic, it became ...

Latin
''medicus'', meaning "a physician".


Clinical practice

Medical availability and clinical practice varies across the world due to regional differences in culture and technology. Modern scientific medicine is highly developed in the
Western world The Western world, also known as the West, refers to various regions, nations and state (polity), states, depending on the context, most often consisting of the majority of Europe, Northern America, and Australasia.
, while in
developing countries A developing country is a sovereign state with a less developed Industrial sector, industrial base and a low Human Development Index (HDI) relative to other countries. However, this definition is not universally agreed upon. There is also no ...
such as parts of Africa or Asia, the population may rely more heavily on
traditional medicine Traditional medicine (also known as indigenous Indigenous may refer to: *Indigenous peoples Indigenous peoples, also referred to as First people, Aboriginal people, Native people, or autochthonous people, are culturally distinct ethnic gr ...

traditional medicine
with limited evidence and efficacy and no required formal training for practitioners. In the
developed world A developed country (or industrialized country, high-income country, more economically developed country (MEDC), advanced country) is a sovereign state that has a high quality of life, developed economy and advanced technological infrastructu ...
,
evidence-based medicine Evidence-based medicine (EBM) is "the conscientious, explicit and judicious use of current best evidence in making decisions about the care of individual patients." The aim of EBM is to integrate the experience of the clinician, the values of th ...
is not universally used in clinical practice; for example, a 2007 survey of literature reviews found that about 49% of the interventions lacked sufficient evidence to support either benefit or harm. In modern clinical practice,
physicians A physician (American English American English (AmE, AE, AmEng, USEng, en-US), sometimes called United States English or U.S. English, is the set of varieties of the English language native to the United States. Currently, America ...

physicians
and
physician assistants A physician assistant or physician associate (PA) is a type of Mid-level practitioner, mid-level provider. PAs may diagnose illnesses, develop and manage treatment plans, prescribe medications, and may serve as a patient’s principal healthcare p ...
personally assess patients in order to
diagnose Diagnosis is the identification of the nature and cause of a certain phenomenon. Diagnosis is used in many different disciplines, with variations in the use of logic Logic is an interdisciplinary field which studies truth and reasoning Rea ...
, prognose, treat, and prevent disease using clinical judgment. The doctor-patient relationship typically begins an interaction with an examination of the patient's
medical history The medical history, case history, or anamnesis (from Greek: ἀνά, ''aná'', "open", and μνήσις, ''mnesis'', "memory") of a patient A patient is any recipient of health care services that are performed by Health professional, healthc ...
and
medical record The terms medical record, health record, and medical chart are used somewhat interchangeably to describe the systematic documentation of a single patient A patient is any recipient of health care services that are performed by Health profession ...

medical record
, followed by a medical interview and a
physical examination In a physical examination, medical examination, or clinical examination, a medical practitioner examines a patient A patient is any recipient of health care services that are performed by Health professional, healthcare professionals. The pati ...

physical examination
. Basic diagnostic
medical device A medical device is any device intended to be used for medical purposes. Significant potential for hazard A hazard is a potential source of harm. Substances, events, or circumstances can constitute hazards when their nature would allow them, e ...
s (e.g.
stethoscope The stethoscope is an acoustic medical Medicine is the science and Praxis (process) , practice of caring for a patient, managing the diagnosis, prognosis, Preventive medicine, prevention, therapy, treatment, Palliative care , palliation o ...

stethoscope
,
tongue depressor A tongue depressor (sometimes called spatula) is a tool used in medical practice to depress the tongue to allow for examination of the mouth and throat. The most common modern tongue depressors are flat, thin, wooden blades, smoothed and rounded at ...
) are typically used. After examination for signs and interviewing for
symptoms Signs and symptoms are the observed or detectable signs, and experienced symptoms of an illness, injury, or condition. A sign for example may be a higher or lower temperature than normal, raised or lowered blood pressure or an abnormality show ...

symptoms
, the doctor may order
medical test A medical test is a medical procedureA medical procedure is a course of action intended to achieve a result in the delivery of healthcare. A medical procedure with the intention of determining, measuring, or diagnosing a patient condition or pa ...
s (e.g.
blood test A blood test is a laboratory A laboratory (; ; colloquially lab) is a facility that provides controlled conditions in which or technological research, s, and may be performed. Laboratory services are provided in a variety of settings: ...

blood test
s), take a
biopsy A biopsy is a medical test A medical test is a medical procedureA medical procedure is a course of action intended to achieve a result in the delivery of healthcare. A medical procedure with the intention of determining, measuring, or diagno ...

biopsy
, or prescribe
pharmaceutical drug A medication (also called medicament, medicine, pharmaceutical drug, medicinal drug or simply drug) is a drug Uncoated tablets, consisting of about 90% acetylsalicylic acid, along with a minor amount of inert fillers and binders. Aspir ...
s or other therapies.
Differential diagnosis In healthcare, a differential diagnosis (abbreviated DDx) is a method of analysis of a patient's history and physical examination to arrive at the correct diagnosis. It involves distinguishing a particular disease A disease is a parti ...
methods help to rule out conditions based on the information provided. During the encounter, properly informing the patient of all relevant facts is an important part of the relationship and the development of trust. The medical encounter is then documented in the medical record, which is a legal document in many jurisdictions. Follow-ups may be shorter but follow the same general procedure, and specialists follow a similar process. The diagnosis and treatment may take only a few minutes or a few weeks depending upon the complexity of the issue. The components of the medical interview and encounter are: * Chief complaint (CC): the reason for the current medical visit. These are the '
symptom Signs and symptoms are the observed or detectable signs, and experienced symptoms of an illness, injury, or condition. A sign for example may be a higher or lower temperature than normal, raised or lowered blood pressure or an abnormality show ...
s.' They are in the patient's own words and are recorded along with the duration of each one. Also called 'chief concern' or 'presenting complaint'. * History of present
illness A disease is a particular abnormal condition that negatively affects the structure A structure is an arrangement and organization of interrelated elements in a material object or system A system is a group of Interaction, interactin ...
(HPI): the chronological order of events of symptoms and further clarification of each symptom. Distinguishable from history of previous illness, often called past medical history (PMH).
Medical history The medical history, case history, or anamnesis (from Greek: ἀνά, ''aná'', "open", and μνήσις, ''mnesis'', "memory") of a patient A patient is any recipient of health care services that are performed by Health professional, healthc ...
comprises HPI and PMH. * Current activity: occupation, hobbies, what the patient actually does. *
Medication A medication (also called medicament, medicine, pharmaceutical drug, medicinal drug or simply drug) is a drug used to medical diagnosis, diagnose, cure, therapy, treat, or preventive medicine, prevent disease. Drug therapy (pharmacotherapy) ...

Medication
s (Rx): what drugs the patient takes including prescribed,
over-the-counter Over-the-counter (OTC) drugs are medicine Medicine is the science Science () is a systematic enterprise that builds and organizes knowledge Knowledge is a familiarity, awareness, or understanding of someone or something, such as ...
, and
home remedies Traditional medicine (also known as indigenous Indigenous may refer to: *Indigenous peoples Indigenous peoples, also referred to as First people, Aboriginal people, Native people, or autochthonous people, are culturally distinct ethnic gr ...
, as well as alternative and herbal medicines or remedies.
Allergies Allergies, also known as allergic diseases, are a number of conditions caused by hypersensitivity Hypersensitivity (also called hypersensitivity reaction or intolerance) refers to undesirable reactions produced by the normal immune system, ...

Allergies
are also recorded. * Past medical history (PMH/PMHx): concurrent medical problems, past hospitalizations and operations, injuries, past
infectious disease An infection is the invasion of an organism's body tissues by disease-causing agents, their multiplication, and the reaction of host A host is a person responsible for guests at an event or for providing hospitality during it. Host may ...
s or
vaccination Vaccination is the administration of a vaccine A vaccine is a biological preparation that provides active to a particular . A vaccine typically contains an agent that resembles a disease-causing microorganism and is often made from we ...

vaccination
s, history of known allergies. * Social history (SH): birthplace, residences, marital history, social and economic status, habits (including
diet Diet may refer to: Food * Diet (nutrition) In nutrition Nutrition is the biochemical Biochemistry or biological chemistry, is the study of chemical processes within and relating to living organisms. A sub-discipline of both chemistr ...
, medications,
tobacco Tobacco is the common name of several plants in the genus Genus /ˈdʒiː.nəs/ (plural genera /ˈdʒen.ər.ə/) is a taxonomic rank In biological classification In biology, taxonomy () is the scientific study of naming, defini ...

tobacco
, alcohol). *
Family history Genealogy (from el, γενεαλογία ' "study of family trees") is the study of families In human society, family (from la, familia) is a Social group, group of people related either by consanguinity (by recognized birth) or Affinit ...
(FH): listing of diseases in the family that may impact the patient. A
family tree A family tree, also called a genealogy Genealogy (from el, γενεαλογία ' "study of family trees") is the study of , family history, and the tracing of their lineages. Genealogists use oral interviews, historical records, genetic a ...

family tree
is sometimes used. * Review of systems (ROS) or ''systems inquiry'': a set of additional questions to ask, which may be missed on HPI: a general enquiry (have you noticed any
weight loss Weight loss, in the context of medicine, health, or physical fitness Physical fitness is a state of health Health, according to the World Health Organization, is "a state of complete physical, Mental health, mental and social well-bein ...

weight loss
, change in sleep quality, fevers, lumps and bumps? etc.), followed by questions on the body's main organ systems (
heart The heart is a muscular MUSCULAR (DS-200B), located in the United Kingdom The United Kingdom of Great Britain and Northern Ireland, commonly known as the United Kingdom (UK) or Britain,Usage is mixed. The Guardian' and Telegraph' use ...

heart
,
lungs The lungs are the primary organs of the respiratory system The respiratory system (also respiratory apparatus, ventilatory system) is a biological system consisting of specific organs and structures used for gas exchange in animal ...
,
digestive tract The gastrointestinal tract (GI tract, digestive tract, alimentary canal) is the tract or passageway of the digestive system that leads from the mouth to the anus. The GI tract contains all the major organ (biology), organs of the digestive syst ...
,
urinary tract The urinary system, also known as the renal system or urinary tract, consists of the kidneys The kidneys are two reddish-brown bean-shaped organs found in vertebrate Vertebrates () comprise all species of animal Animals (also ca ...

urinary tract
, etc.). The
physical examination In a physical examination, medical examination, or clinical examination, a medical practitioner examines a patient A patient is any recipient of health care services that are performed by Health professional, healthcare professionals. The pati ...

physical examination
is the examination of the patient for
medical sign Signs and symptoms are the observed or detectable signs, and experienced symptoms of an illness, injury, or condition. A sign for example may be a higher or lower temperature than normal, raised or lowered blood pressure or an abnormality show ...
s of disease, which are objective and observable, in contrast to symptoms that are volunteered by the patient and not necessarily objectively observable. The healthcare provider uses sight, hearing, touch, and sometimes smell (e.g., in infection,
uremia Uremia is the condition of having high levels of urea in the blood. Urea is one of the primary components of urine. It can be defined as an excess of amino acid and protein metabolism end products, such as urea and creatinine, in the blood that w ...
,
diabetic ketoacidosis Diabetic ketoacidosis (DKA) is a potentially life-threatening complication of diabetes mellitus Diabetes mellitus (DM), commonly known as diabetes, is a group of metabolic disorders characterized by a high blood sugar level over a prolonged p ...
). Four actions are the basis of physical examination:
inspection An inspection is, most generally, an organized examination Examination may refer to: * Physical examination, a medical procedure * Questioning and more specific forms thereof, for example in law: ** Cross-examination ** Direct examination * Tes ...
,
palpation Palpation is the process of using one's hands to check the body, especially while perceiving/diagnosing a disease or illness. Usually performed by a health care Healthcare is the maintenance or improvement of health Health is a state of phy ...

palpation
(feel),
percussion A percussion instrument is a musical instrument that is sounded by being struck or scraped by a beater (percussion), beater including attached or enclosed beaters or Rattle (percussion beater), rattles struck, scraped or rubbed by hand or ...
(tap to determine resonance characteristics), and
auscultation :''For the ancient monasterial worker, see Auscultare'' Auscultation (based on the Latin verb ''auscultare'' "to listen") is listening to the internal sounds of the body, usually using a stethoscope The stethoscope is an acoustic medical ...

auscultation
(listen), generally in that order although auscultation occurs prior to percussion and palpation for abdominal assessments. The clinical examination involves the study of: * Vital signs including height, weight, body temperature,
blood pressure Blood pressure (BP) is the pressure Pressure (symbol: ''p'' or ''P'') is the force In physics, a force is an influence that can change the motion (physics), motion of an Physical object, object. A force can cause an object with mas ...

blood pressure
,
pulse In medicine Medicine is the science Science () is a systematic enterprise that builds and organizes knowledge Knowledge is a familiarity, awareness, or understanding of someone or something, such as facts ( descriptive knowledge) ...

pulse
, respiration rate, and hemoglobin
oxygen saturation Oxygen saturation (symbol SO2) is a relative measure of the concentration of oxygen Oxygen is the chemical element Image:Simple Periodic Table Chart-blocks.svg, 400px, Periodic table, The periodic table of the chemical elements In c ...
* General appearance of the patient and specific indicators of disease (nutritional status, presence of jaundice, pallor or clubbing) *
Skin Skin is the layer of usually soft, flexible outer tissue covering the body of a vertebrate animal, with three main functions: protection, regulation, and sensation. Other cuticle, animal coverings, such as the arthropod exoskeleton, have differ ...

Skin
* Head, eye, ear, nose, and throat (HEENT examination, HEENT) * Cardiovascular (heart and blood vessels) * Respiratory (large airways and Human lung, lungs) * Abdomen and rectum * Genitalia (and pregnancy if the patient is or could be pregnant) * Musculoskeletal (including spine and extremities) * Neurological (consciousness, awareness, brain, vision, cranial nerves, spinal cord and Peripheral nervous system, peripheral nerves) * Psychiatry, Psychiatric (orientation, mental state examination, mental state, mood, evidence of abnormal perception or thought). It is to likely focus on areas of interest highlighted in the medical history and may not include everything listed above. The treatment plan may include ordering additional medical laboratory tests and medical imaging studies, starting therapy, referral to a specialist, or watchful observation. Follow-up may be advised. Depending upon the health insurance plan and the managed care system, various forms of "utilization review", such as prior authorization of tests, may place barriers on accessing expensive services. The medical decision-making (MDM) process involves analysis and synthesis of all the above data to come up with a list of possible diagnoses (the differential diagnosis, differential diagnoses), along with an idea of what needs to be done to obtain a definitive diagnosis that would explain the patient's problem. On subsequent visits, the process may be repeated in an abbreviated manner to obtain any new history, symptoms, physical findings, and lab or imaging results or specialist consultations.


Institutions

Contemporary medicine is in general conducted within health care systems. Legal, credentialing and financing frameworks are established by individual governments, augmented on occasion by international organizations, such as churches. The characteristics of any given health care system have significant impact on the way medical care is provided. From ancient times, Christian emphasis on practical charity gave rise to the development of systematic nursing and hospitals and the Catholic Church today remains the largest non-government provider of medical services in the world. Advanced industrial countries (with the exception of the United States) and many Developing country, developing countries provide medical services through a system of universal health care that aims to guarantee care for all through a single-payer health care system, or compulsory private or co-operative health insurance. This is intended to ensure that the entire population has access to medical care on the basis of need rather than ability to pay. Delivery may be via private medical practices or by state-owned hospitals and clinics, or by charities, most commonly by a combination of all three. Most tribe, tribal societies provide no guarantee of healthcare for the population as a whole. In such societies, healthcare is available to those that can afford to pay for it or have self-insured it (either directly or as part of an employment contract) or who may be covered by care financed by the government or tribe directly. Transparency of information is another factor defining a delivery system. Access to information on conditions, treatments, quality, and pricing greatly affects the choice by patients/consumers and, therefore, the incentives of medical professionals. While the US healthcare system has come under fire for lack of openness, new legislation may encourage greater openness. There is a perceived tension between the need for transparency on the one hand and such issues as patient confidentiality and the possible exploitation of information for commercial gain on the other. The Health professional, health professionals who provide care in medicine comprise multiple Profession, professions such as Doctor of Medicine, medics, Nursing, nurses, Physical therapy, physio therapists, and Psychologist, psychologists. These professions will have their own Professional ethics, ethical standards, professional education, and bodies. The medical profession have been conceptualized from a Medical sociology#The%20Medical%20Profession, sociological perspective.


Delivery

Provision of medical care is classified into primary, secondary, and tertiary care categories. Primary care medical services are provided by
physician A physician (American English), medical practitioner (English in the Commonwealth of Nations, Commonwealth English), medical doctor, or simply doctor, is a professional who practices medicine, which is concerned with promoting, maintainin ...

physician
s, physician assistants, nurse practitioners, or other health professionals who have first contact with a patient seeking medical treatment or care. These occur in physician offices, clinics, nursing homes, schools, home visits, and other places close to patients. About 90% of medical visits can be treated by the primary care provider. These include treatment of acute and chronic illnesses, preventive care and health education for all ages and both sexes. Secondary care medical services are provided by medical specialists in their offices or clinics or at local community hospitals for a patient referred by a primary care provider who first diagnosed or treated the patient. Referrals are made for those patients who required the expertise or procedures performed by specialists. These include both ambulatory care and inpatient services, Emergency departments, intensive care medicine, surgery services, physical therapy, childbirth, labor and delivery, endoscopy units, diagnostic Medical laboratory, laboratory and medical imaging services, Hospice care, 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), burn treatment centers, advanced neonatology unit services, organ transplants, high-risk pregnancy, radiation therapy, radiation oncology, etc. Modern medical care also depends on information – still delivered in many health care settings on paper records, but increasingly nowadays by Electronic health record, electronic means. In low-income countries, modern healthcare is often too expensive for the average person. International healthcare policy researchers have advocated that "user fees" be removed in these areas to ensure access, although even after removal, significant costs and barriers remain. Separation of prescribing and dispensing is a practice in medicine and pharmacy in which the
physician A physician (American English), medical practitioner (English in the Commonwealth of Nations, Commonwealth English), medical doctor, or simply doctor, is a professional who practices medicine, which is concerned with promoting, maintainin ...

physician
who provides a medical prescription is independent from the pharmacist who provides the prescription drug. In the
Western world The Western world, also known as the West, refers to various regions, nations and state (polity), states, depending on the context, most often consisting of the majority of Europe, Northern America, and Australasia.
there are centuries of tradition for separating pharmacists from physicians. In Asian countries, it is traditional for physicians to also provide drugs.


Branches

Working together as an interdisciplinary team, many highly trained health professionals besides medical practitioners are involved in the delivery of modern health care. Examples include: nurses, emergency medical technicians and paramedics, laboratory scientists, pharmacists, podiatry, podiatrists, physiotherapists, respiratory therapists, speech therapy, speech therapists, occupational therapy, occupational therapists, radiographers, dietitians, and bioengineering, bioengineers, medical physics, surgeons, surgeon's assistant, surgical technologist. The scope and sciences underpinning human medicine overlap many other fields. Dentistry, while considered by some a separate discipline from medicine, is a medical field. A patient admitted to the hospital is usually under the care of a specific team based on their main presenting problem, e.g., the cardiology team, who then may interact with other specialties, e.g., surgical, radiology, to help diagnose or treat the main problem or any subsequent complications/developments. Physicians have many specializations and subspecializations into certain branches of medicine, which are listed below. There are variations from country to country regarding which specialties certain subspecialties are in. The main branches of medicine are: * Basic sciences of medicine; this is what every physician is educated in, and some return to in Biomedical research#Preclinical research, biomedical research * Medical specialties * Interdisciplinary sub-specialties of medicine, Interdisciplinary fields, where different medical specialties are mixed to function in certain occasions.


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. * ''Biomechanics'' is the study of the structure and function of biological systems by means of the methods of Mechanics. * ''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. * ''Biophysics'' is an interdisciplinary science that uses the methods of physics and physical chemistry to study biological systems. * ''Cell biology, Cytology'' is the microscopic study of individual cell (biology), cells. * ''Embryology'' is the study of the early development of organisms. * ''Endocrinology'' is the study of hormones and their effect throughout the body of animals. * ''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 microscope, electron microscopy and immunohistochemistry. * ''Immunology'' is the study of the immune system, which includes the innate and adaptive immune system in humans, for example. * ''Medical physics'' is the study of the applications of physics principles in medicine. * ''Microbiology'' is the study of microorganisms, including protozoa, bacterium, bacteria, fungus, fungi, and viruses. * ''Molecular biology'' is the study of molecular underpinnings of the process of DNA replication, replication, Transcription (genetics), transcription and Translation (biology), translation of the genetic material. * ''Neuroscience'' includes those disciplines of science that are related to the study of the nervous system. A main focus of neuroscience is the biology and physiology of the human brain and spinal cord. Some related clinical specialties include neurology, neurosurgery and psychiatry. * ''Nutrition science'' (theoretical focus) and ''dietetics'' (practical focus) is the study of the relationship of food and drink to health and disease, especially in determining an optimal diet. Medical nutrition therapy is done by dietitians and is prescribed for diabetes, cardiovascular diseases, weight and eating mental illness, disorders, allergies, malnutrition, and neoplasia, neoplastic diseases. * ''Pathology as a science'' is the study of disease—the causes, course, progression and resolution thereof. * ''Pharmacology'' is the study of drugs and their actions. * ''Gynecology'' is the study of female reproductive system. * ''Photobiology'' is the study of the interactions between non-ionizing radiation and living organisms. * ''Physiology'' is the study of the normal functioning of the body and the underlying regulatory mechanisms. * ''Radiobiology'' is the study of the interactions between ionizing radiation and living organisms. * ''Toxicology'' is the study of hazardous effects of drugs and poisons.


Specialties

In the broadest meaning of "medicine", there are many different specialties. In the UK, most specialities have their own body or college, which has its own entrance examination. These are collectively known as the Royal Colleges, although not all currently use the term "Royal". The development of a speciality is often driven by new technology (such as the development of effective anaesthetics) or ways of working (such as emergency departments); the new specialty leads to the formation of a unifying body of doctors and the prestige of administering their own examination. Within medical circles, specialities usually fit into one of two broad categories: "Medicine" and "Surgery". "Medicine" refers to the practice of non-operative medicine, and most of its subspecialties require preliminary training in Internal Medicine. In the UK, this was traditionally evidenced by passing the examination for the Membership of the Royal College of Physicians (MRCP) or the equivalent college in Scotland or Ireland. "Surgery" refers to the practice of operative medicine, and most subspecialties in this area require preliminary training in General Surgery, which in the UK leads to membership of the Royal College of Surgeons of England (MRCS). At present, some specialties of medicine do not fit easily into either of these categories, such as radiology, pathology, or anesthesia. Most of these have branched from one or other of the two camps above; for example anaesthesia developed first as a Faculty (teaching staff), faculty of the Royal College of Surgeons (for which MRCS/FRCS would have been required) before becoming the Royal College of Anaesthetists and membership of the college is attained by sitting for the examination of the Fellowship of the Royal College of Anesthetists (FRCA).


Surgical specialty

Surgery is an ancient medical specialty that uses operative manual and instrumental techniques on a patient to investigate or treat a pathological condition such as
disease A disease is a particular abnormal condition that negatively affects the structure A structure is an arrangement and organization of interrelated elements in a material object or system A system is a group of Interaction, interactin ...
or
injury Injury, also known as physical trauma, is damage to the body caused by an external force. This may be caused by accidents, falls, hits, weapons, and other causes. Major trauma is injury that has the potential to cause prolonged disability or ...

injury
, to help improve bodily function or appearance or to repair unwanted ruptured areas (for example, Perforated eardrum, a perforated ear drum). Surgeons must also manage pre-operative, post-operative, and potential surgical candidates on the hospital wards. Surgery has many sub-specialties, including ''general surgery, Ophthalmic Surgery, ophthalmic surgery, cardiovascular surgery, colorectal surgery, neurosurgery, oral and maxillofacial surgery, oncologic surgery, orthopedic surgery, otolaryngology, plastic surgery, podiatric surgery, transplant surgery, trauma surgery, urology, vascular surgery, and pediatric surgery''. In some centers, anesthesiology is part of the division of surgery (for historical and logistical reasons), although it is not a surgical discipline. Other medical specialties may employ surgical procedures, such as ophthalmology and dermatology, but are not considered surgical sub-specialties per se. Surgical training in the U.S. requires a minimum of five years of residency after medical school. Sub-specialties of surgery often require seven or more years. In addition, fellowships can last an additional one to three years. Because post-residency fellowships can be competitive, many trainees devote two additional years to research. Thus in some cases surgical training will not finish until more than a decade after medical school. Furthermore, surgical training can be very difficult and time-consuming.


Internal medicine specialty

Internal medicine is the medical specialty dealing with the prevention, diagnosis, and treatment of adult diseases. According to some sources, an emphasis on internal structures is implied. In North America, specialists in internal medicine are commonly called "internists". Elsewhere, especially in Commonwealth of Nations, Commonwealth nations, such specialists are often called
physician A physician (American English), medical practitioner (English in the Commonwealth of Nations, Commonwealth English), medical doctor, or simply doctor, is a professional who practices medicine, which is concerned with promoting, maintainin ...

physician
s. These terms, ''internist'' or ''physician'' (in the narrow sense, common outside North America), generally exclude practitioners of gynecology and obstetrics, pathology, psychiatry, and especially surgery and its subspecialities. Because their patients are often seriously ill or require complex investigations, internists do much of their work in hospitals. Formerly, many internists were not subspecialized; such ''general physicians'' would see any complex nonsurgical problem; this style of practice has become much less common. In modern urban practice, most internists are subspecialists: that is, they generally limit their medical practice to problems of one organ system or to one particular area of medical knowledge. For example, gastroenterology, gastroenterologists and nephrology, nephrologists specialize respectively in diseases of the gut and the kidneys. In the Commonwealth of Nations and some other countries, specialist Pediatrics, pediatricians and Geriatrics, geriatricians are also described as ''specialist physicians'' (or internists) who have subspecialized by age of patient rather than by organ system. Elsewhere, especially in North America, general pediatrics is often a form of primary care physician, primary care. There are many subspecialities (or subdisciplines) of internal medicine: :*''Angiology/Vascular Medicine'' :*''Bariatrics'' :*''Cardiology'' :*''Critical care medicine'' :*''Endocrinology'' :*''Gastroenterology'' :*''Geriatrics'' :*''Hematology'' :*''Hepatology'' :*''Infectious disease (medical specialty), Infectious disease'' :*''Nephrology'' :*''Neurology'' :*''Oncology'' :*''Pediatrics'' :*''Pulmonology/Pneumology/Respirology/chest medicine'' :*''Rheumatology'' :*''Sports Medicine'' Training in internal medicine (as opposed to surgical training), varies considerably across the world: see the articles on ''medical education'' and ''
physician A physician (American English), medical practitioner (English in the Commonwealth of Nations, Commonwealth English), medical doctor, or simply doctor, is a professional who practices medicine, which is concerned with promoting, maintainin ...

physician
'' for more details. In North America, it requires at least three years of residency training after medical school, which can then be followed by a one- to three-year fellowship in the subspecialties listed above. In general, resident work hours in medicine are less than those in surgery, averaging about 60 hours per week in the US. This difference does not apply in the UK where all doctors are now required by law to work less than 48 hours per week on average.


Diagnostic specialties

* ''Clinical laboratory sciences'' are the clinical diagnostic services that apply laboratory techniques to diagnosis and management of patients. In the United States, these services are supervised by a pathologist. The personnel that work in these medical laboratory departments are technically trained staff who do not hold medical degrees, but who usually hold an undergraduate
medical technology Health technology is defined by the World Health Organization The World Health Organization (WHO) is a specialized agency of the United Nations United Nations Specialized Agencies are autonomous organizations working with the United Nation ...
degree, who actually perform the medical test, tests, assays, and procedures needed for providing the specific services. Subspecialties include transfusion medicine, cellular pathology, clinical chemistry, hematology, clinical microbiology and clinical immunology. * ''Pathology as a medical specialty'' is the branch of medicine that deals with the study of diseases and the morphologic, physiologic changes produced by them. As a diagnostic specialty, pathology can be considered the basis of modern scientific medical knowledge and plays a large role in
evidence-based medicine Evidence-based medicine (EBM) is "the conscientious, explicit and judicious use of current best evidence in making decisions about the care of individual patients." The aim of EBM is to integrate the experience of the clinician, the values of th ...
. Many modern molecular tests such as flow cytometry, polymerase chain reaction (PCR), immunohistochemistry, cytogenetics, gene rearrangements studies and fluorescent in situ hybridization (FISH) fall within the territory of pathology. * ''Diagnostic radiology'' is concerned with imaging of the body, e.g. by x-rays, x-ray computed tomography, ultrasonography, and nuclear magnetic resonance tomography. Interventional radiologists can access areas in the body under imaging for an intervention or diagnostic sampling. * ''Nuclear medicine'' is concerned with studying human organ systems by administering radiolabelled substances (radiopharmaceuticals) to the body, which can then be imaged outside the body by a gamma camera or a PET scanner. Each radiopharmaceutical consists of two parts: a tracer that is specific for the function under study (e.g., neurotransmitter pathway, metabolic pathway, blood flow, or other), and a radionuclide (usually either a gamma-emitter or a positron emitter). There is a degree of overlap between nuclear medicine and radiology, as evidenced by the emergence of combined devices such as the PET/CT scanner. * ''Clinical neurophysiology'' is concerned with testing the physiology or function of the central and peripheral aspects of the nervous system. These kinds of tests can be divided into recordings of: (1) spontaneous or continuously running electrical activity, or (2) stimulus evoked responses. Subspecialties include electroencephalography, electromyography, evoked potential, nerve conduction study and polysomnography. Sometimes these tests are performed by techs without a medical degree, but the interpretation of these tests is done by a medical professional.


Other major specialties

The following are some major medical specialties that do not directly fit into any of the above-mentioned groups: * ''Anesthesiology'' (also known as ''anaesthetics''): concerned with the perioperative management of the surgical patient. The anesthesiologist's role during surgery is to prevent derangement in the vital organs' (i.e. brain, heart, kidneys) functions and postoperative pain. Outside of the operating room, the anesthesiology physician also serves the same function in the labor and delivery ward, and some are specialized in critical medicine. * ''Dermatology'' is concerned with the skin and its diseases. In the UK, dermatology is a subspecialty of general medicine. * ''Emergency medicine'' is concerned with the diagnosis and treatment of acute or life-threatening conditions, including physical trauma, trauma, surgical, medical, pediatric, and psychiatric emergencies. * ''Family medicine'', ''family practice'', ''general practice'' or ''primary care'' is, in many countries, the first port-of-call for patients with non-emergency medical problems. Family physicians often provide services across a broad range of settings including office based practices, emergency department coverage, inpatient care, and nursing home care. * ''Obstetrics and gynecology'' (often abbreviated as ''OB/GYN'' (American English) or ''Obs & Gynae'' (British English)) are concerned respectively with childbirth and the female reproductive and associated organs. Reproductive medicine and fertility medicine are generally practiced by gynecological specialists. * ''Medical genetics'' is concerned with the diagnosis and management of hereditary disorders. * ''Neurology'' is concerned with diseases of the nervous system. In the UK, neurology is a subspecialty of general medicine. * ''Ophthalmology'' is exclusively concerned with the eye and ocular adnexa, combining conservative and surgical therapy. * ''Pediatrics'' (AE) or ''paediatrics'' (BE) is devoted to the care of infants, children, and adolescents. Like internal medicine, there are many pediatric subspecialties for specific age ranges, organ systems, disease classes, and sites of care delivery. * ''Pharmaceutical medicine'' is the medical scientific discipline concerned with the discovery, development, evaluation, registration, monitoring and medical aspects of marketing of medicines for the benefit of patients and public health. * ''Physical medicine and rehabilitation'' (or ''physiatry'') is concerned with functional improvement after injury, illness, or congenital disorders. * ''Podiatric medicine'' is the study of, diagnosis, and medical & surgical treatment of disorders of the foot, ankle, lower limb, hip and lower back. * ''Psychiatry'' is the branch of medicine concerned with the biopsychosocial, bio-psycho-social study of the etiology, diagnosis, treatment and prevention of cognitive, perceptual, emotional and behavioral disorders. Related fields include
psychotherapy Psychotherapy (also psychological therapy or talking therapy) is the use of Psychology, psychological methods, particularly when based on regular Conversation, personal interaction, to help a person change behavior, increase happiness, and ove ...
and clinical psychology. * ''Preventive medicine'' is the branch of medicine concerned with preventing disease. ** ''Community health'' or ''public health'' is an aspect of health services concerned with threats to the overall health of a community based on population health analysis.


Interdisciplinary fields

Some interdisciplinary sub-specialties of medicine include: * ''Aerospace medicine'' deals with medical problems related to flying and Human spaceflight, space travel. * ''Addiction medicine'' deals with the treatment of addiction. * ''Medical ethics'' deals with ethical and moral principles that apply values and judgments to the practice of medicine. * ''Biomedical Engineering'' is a field dealing with the application of engineering principles to medical practice. * ''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. * ''Disaster medicine'' deals with medical aspects of emergency preparedness, disaster mitigation and management. * ''Diving medicine'' (or hyperbaric medicine) is the prevention and treatment of diving-related problems. * ''Evolutionary medicine'' is a perspective on medicine derived through applying Evolution, evolutionary theory. * ''Forensic medicine'' deals with medical questions in legal context, such as determination of the time and cause of death, type of weapon used to inflict trauma, reconstruction of the facial features using remains of deceased (skull) thus aiding identification. * ''Gender-based medicine'' studies the biological and physiological differences between the human sexes and how that affects differences in disease. * ''Hospice and Palliative Medicine'' is a relatively modern branch of clinical medicine that deals with pain and symptom relief and emotional support in patients with terminal illnesses including cancer and heart failure. * ''Hospital medicine'' is the general medical care of hospitalized patients. Physicians whose primary professional focus is hospital medicine are called hospitalists in the United States and Canada. The term Most Responsible Physician (MRP) or attending physician is also used interchangeably to describe this role. * ''Laser medicine'' involves the use of lasers in the diagnostics or treatment of various conditions. * ''Medical humanities'' 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. * ''Health informatics'' is a relatively recent field that deal with the application of computers and information technology to medicine. * ''Nosology'' is the classification of diseases for various purposes. * ''Nosokinetics'' is the science/subject of measuring and modelling the process of care in health and social care systems. * ''Occupational medicine'' is the provision of health advice to organizations and individuals to ensure that the highest standards of health and safety at work can be achieved and maintained. * ''Pain management'' (also called ''pain medicine'', or ''algiatry'') is the medical discipline concerned with the relief of pain. * ''Pharmacogenomics'' is a form of ''individualized medicine''. * ''Podiatry, Podiatric medicine'' is the study of, diagnosis, and medical treatment of disorders of the foot, ankle, lower limb, hip and lower back. * ''Sexual medicine'' is concerned with diagnosing, assessing and treating all disorders related to sexuality. * ''Sports medicine'' deals with the treatment and prevention and rehabilitation of sports/exercise injuries such as muscle spasms, muscle tears, injuries to ligaments (ligament tears or ruptures) and their repair in sportsperson, athletes, amateur and professional. * ''Therapeutics'' is the field, more commonly referenced in earlier periods of history, of the various remedies that can be used to treat disease and promote health. * ''Travel medicine'' or ''emporiatrics'' deals with health problems of international travelers or travelers across highly different environments. * ''Tropical medicine'' deals with the prevention and treatment of tropical diseases. It is studied separately in temperate climates where those diseases are quite unfamiliar to medical practitioners and their local clinical needs. * ''Urgent care'' focuses on delivery of unscheduled, walk-in care outside of the hospital emergency department for injuries and illnesses that are not severe enough to require care in an emergency department. In some jurisdictions this function is combined with the emergency department. * Veterinary medicine; veterinarians apply similar techniques as physicians to the care of animals. * ''Wilderness medicine (practice), Wilderness medicine'' entails the practice of medicine in the wild, where conventional medical facilities may not be available. * Many other health science fields, e.g. dietetics


Education and legal controls

Medical education and training varies around the world. It typically involves entry level education at a university medical school, followed by a period of supervised practice or medical intern, internship, or residency (medicine), residency. This can be followed by postgraduate vocational training. A variety of teaching methods have been employed in medical education, still itself a focus of active research. In Canada and the United States of America, a Doctor of Medicine degree, often abbreviated M.D., or a Osteopathic medicine in the United States, Doctor of Osteopathic Medicine degree, often abbreviated as D.O. and unique to the United States, must be completed in and delivered from a recognized university. Since knowledge, techniques, and medical technology continue to evolve at a rapid rate, many regulatory authorities require continuing medical education. Medical practitioners upgrade their knowledge in various ways, including medical journals, seminars, conferences, and online programs. A database of objectives covering medical knowledge, as suggested by national societies across the United States, can be searched at http://data.medobjectives.marian.edu/. In most countries, it is a legal requirement for a medical doctor to be licensed or registered. In general, this entails a medical degree from a university and accreditation by a medical board or an equivalent national organization, which may ask the applicant to pass exams. This restricts the considerable legal authority of the medical profession to physicians that are trained and qualified by national standards. It is also intended as an assurance to patients and as a safeguard against charlatans that practice inadequate medicine for personal gain. While the laws generally require medical doctors to be trained in "evidence based", Western, or Hippocratic Medicine, they are not intended to discourage different paradigms of health. In the European Union, the profession of doctor of medicine is regulated. A profession is said to be regulated when access and exercise is subject to the possession of a specific professional qualification. The regulated professions database contains a list of regulated professions for doctor of medicine in the EU member states, EEA countries and Switzerland. This list is covered by the Directive 2005/36/EC. Doctors who are negligent or intentionally harmful in their care of patients can face charges of medical malpractice and be subject to civil, criminal, or professional sanctions.


Medical ethics

Medical ethics is a system of moral principles that apply values and judgments to the practice of medicine. As a scholarly discipline, medical ethics encompasses its practical application in clinical settings as well as work on its history, philosophy, theology, and sociology. Six of the values that commonly apply to medical ethics discussions are: * Autonomy#Medicine, autonomy – the patient has the right to refuse or choose their treatment. (''Voluntas aegroti suprema lex''.) * Beneficence (ethics), beneficence – a practitioner should act in the best interest of the patient. (''Salus aegroti suprema lex''.) * Justice (ethics), justice – concerns the distribution of scarce health resources, and the decision of who gets what treatment (fairness and equality). * Primum non nocere, non-maleficence – "first, do no harm" (''primum non-nocere''). * respect for persons – the patient (and the person treating the patient) have the right to be treated with dignity. * truthfulness and honesty – the concept of informed consent has increased in importance since the historical events of the Doctors' Trial of the Nuremberg trials, Tuskegee syphilis experiment, and others. Values such as these do not give answers as to how to handle a particular situation, but provide a useful framework for understanding conflicts. When moral values are in conflict, the result may be an ethical dilemma or crisis. Sometimes, no good solution to a dilemma in medical ethics exists, and occasionally, the values of the medical community (i.e., the hospital and its staff) conflict with the values of the individual patient, family, or larger non-medical community. Conflicts can also arise between health care providers, or among family members. For example, some argue that the principles of autonomy and beneficence clash when patients refuse blood transfusions, considering them life-saving; and truth-telling was not emphasized to a large extent before the HIV era.


History


Ancient world

Prehistoric medicine incorporated plants (herbalism), animal parts, and minerals. In many cases these materials were used ritually as magical substances by priests, shamans, or medicine man, medicine men. Well-known spiritual systems include animism (the notion of inanimate objects having spirits), spiritualism (an appeal to gods or communion with ancestor spirits); shamanism (the vesting of an individual with mystic powers); and divination (magically obtaining the truth). The field of medical anthropology examines the ways in which culture and society are organized around or impacted by issues of health, health care and related issues. Early records on medicine have been discovered from ancient Egyptian medicine, Babylonian Medicine, Ayurveda, Ayurvedic medicine (in the Indian subcontinent), classical Chinese medicine (predecessor to the modern traditional Chinese medicine), and ancient Greek medicine and Medicine in ancient Rome, Roman medicine. In Egypt, Imhotep (3rd millennium BCE) is the first physician in history known by name. The oldest Egyptian medical papyri, Egyptian medical text is the ''Kahun Gynaecological Papyrus'' from around 2000 BCE, which describes gynaecological diseases. The ''Edwin Smith Papyrus'' dating back to 1600 BCE is an early work on surgery, while the ''Ebers Papyrus'' dating back to 1500 BCE is akin to a textbook on medicine. In China, archaeological evidence of medicine in Chinese dates back to the Bronze Age Shang Dynasty, based on seeds for herbalism and tools presumed to have been used for surgery. The ''Huangdi Neijing'', the progenitor of Chinese medicine, is a medical text written beginning in the 2nd century BCE and compiled in the 3rd century. In India, the surgeon Sushruta described numerous surgical operations, including the earliest forms of plastic surgery. Earliest records of dedicated hospitals come from Mihintale in Sri Lanka where evidence of dedicated medicinal treatment facilities for patients are found. In Greece, the Ancient Greek medicine, Greek physician Hippocrates, the "father of modern medicine",The father of modern medicine: the first research of the physical factor of tetanus
, European Society of Clinical Microbiology and Infectious Diseases
laid the foundation for a rational approach to medicine. Hippocrates introduced the Hippocratic Oath for physicians, which is still relevant and in use today, and was the first to categorize illnesses as Acute (medical), acute, Chronic (medicine), chronic, Endemic (epidemiology), endemic and epidemic, and use terms such as, "exacerbation, relapse, resolution, crisis, paroxysm, peak, and convalescence". The Greek physician Galen was also one of the greatest surgeons of the ancient world and performed many audacious operations, including brain and eye surgeries. After the fall of the Western Roman Empire and the onset of the Early Middle Ages, the Greek tradition of medicine went into decline in Western Europe, although it continued uninterrupted in the Eastern Roman Empire, Eastern Roman (Byzantine) Empire. Most of our knowledge of ancient Hebrew medicine during the 1st millennium BC, 1st millennium BC comes from the Torah, i.e. the Five Books of Moses, which contain various health related laws and rituals. The Hebrew contribution to the development of modern medicine started in the Byzantine Era, with the physician Asaph the Jew.


Middle Ages

The concept of hospital as institution to offer medical care and possibility of a cure for the patients due to the ideals of Christian charity, rather than just merely a place to die, appeared in the Byzantine Empire. Although the concept of uroscopy was known to Galen, he did not see the importance of using it to localize the disease. It was under the Byzantines with physicians such of Theophilus Protospatharius that they realized the potential in uroscopy to determine disease in a time when no microscope or stethoscope existed. That practice eventually spread to the rest of Europe. After 750 CE, the Muslim world had the works of Hippocrates, Galen and Sushruta translated into Arabic, and Islamic medicine, Islamic physicians engaged in some significant medical research. Notable Islamic medical pioneers include the Persians, Persian polymath, Avicenna, who, along with Imhotep and Hippocrates, has also been called the "father of medicine". He wrote ''The Canon of Medicine'' which became a standard medical text at many medieval European University, universities, considered one of the most famous books in the history of medicine. Others include Abu al-Qasim al-Zahrawi, Abulcasis, Ibn Zuhr, Avenzoar, Ibn al-Nafis, and Averroes. Persian physician Muhammad ibn Zakarīya Rāzi, Rhazescopy
was one of the first to question the Greek theory of
humorism Humorism, the humoral theory, or humoralism, was a system of medicine detailing a supposed makeup and workings of the human body, adopted by Ancient Greek Ancient Greek includes the forms of the Greek language Greek ( el, label=Mo ...

humorism
, which nevertheless remained influential in both medieval Western and medieval Islamic medicine. Some volumes of Muhammad ibn Zakarīya Rāzi, Rhazes's work ''Al-Mansuri'', namely "On Surgery" and "A General Book on Therapy", became part of the medical curriculum in European universities. Additionally, he has been described as a doctor's doctor, the father of pediatrics, and a pioneer of ophthalmology. For example, he was the first to recognize the reaction of the eye's pupil to light. The Persian Bimaristan hospitals were an early example of public hospitals. In Europe, Charlemagne decreed that a hospital should be attached to each cathedral and monastery and the historian Geoffrey Blainey likened the Catholic Church and health care, activities of the Catholic Church in health care during the Middle Ages to an early version of a welfare state: "It conducted hospitals for the old and orphanages for the young; hospices for the sick of all ages; places for the lepers; and hostels or inns where pilgrims could buy a cheap bed and meal". It supplied food to the population during famine and distributed food to the poor. This welfare system the church funded through collecting taxes on a large scale and possessing large farmlands and estates. The Benedictine order was noted for setting up hospitals and infirmaries in their monasteries, growing medical herbs and becoming the chief medical care givers of their districts, as at the great Abbey of Cluny. The Church also established a network of cathedral schools and universities where medicine was studied. The Schola Medica Salernitana in Salerno, looking to the learning of Greeks, Greek and Arab physicians, grew to be the finest medical school in Medieval Europe. However, the fourteenth and fifteenth century Black Death devastated both the Middle East and Europe, and it has even been argued that Western Europe was generally more effective in recovering from the pandemic than the Middle East. In the early modern period, important early figures in medicine and anatomy emerged in Europe, including Gabriele Falloppio and William Harvey. The major shift in medical thinking was the gradual rejection, especially during the Black Death in the 14th and 15th centuries, of what may be called the 'traditional authority' approach to science and medicine. This was the notion that because some prominent person in the past said something must be so, then that was the way it was, and anything one observed to the contrary was an anomaly (which was paralleled by a similar shift in European society in general – see Nicolaus Copernicus, Copernicus's rejection of Ptolemy's theories on astronomy). Physicians like Vesalius improved upon or disproved some of the theories from the past. The main tomes used both by medicine students and expert physicians were Materia Medica and Pharmacopoeia. Andreas Vesalius was the author of ''De humani corporis fabrica'', an important book on human anatomy. Bacteria and microorganisms were first observed with a microscope by Antonie van Leeuwenhoek in 1676, initiating the scientific field microbiology. Independently from Ibn al-Nafis, Michael Servetus rediscovered the pulmonary circulation, but this discovery did not reach the public because it was written down for the first time in the "Manuscript of Paris" in 1546, and later published in the theological work for which he paid with his life in 1553. Later this was described by Renaldus Columbus and Andrea Cesalpino. Herman Boerhaave is sometimes referred to as a "father of physiology" due to his exemplary teaching in Leiden and textbook 'Institutiones medicae' (1708). Pierre Fauchard has been called "the father of modern dentistry".


Modern

Veterinary medicine was, for the first time, truly separated from human medicine in 1761, when the French veterinarian Claude Bourgelat founded the world's first veterinary school in Lyon, France. Before this, medical doctors treated both humans and other animals. Modern scientific
biomedical research Medical research (or biomedical research), also known as experimental medicine, encompasses a wide array of research, extending from "basic research Basic research, also called pure research or fundamental research, is a type of scientific r ...
(where results are testable and reproducible) began to replace early Western traditions based on herbalism, the Greek "humorism, four humours" and other such pre-modern notions. The modern era really began with Edward Jenner's discovery of the smallpox vaccine at the end of the 18th century (inspired by the method of inoculation earlier practiced in Asia), Robert Koch's discoveries around 1880 of the transmission of disease by bacteria, and then the discovery of antibiotics around 1900. The post-18th century modernity period brought more groundbreaking researchers from Europe. From Germany and Austria, doctors Rudolf Virchow, Wilhelm Conrad Röntgen, Karl Landsteiner and Otto Loewi made notable contributions. In the United Kingdom, Alexander Fleming, Joseph Lister, 1st Baron Lister, Joseph Lister, Francis Crick and Florence Nightingale are considered important. Spain, Spanish doctor Santiago Ramón y Cajal is considered the father of modern neuroscience. From New Zealand and Australia came Maurice Wilkins, Howard Florey, and Frank Macfarlane Burnet. Others that did significant work include William Williams Keen, William Coley, James D. Watson (United States); Salvador Luria (Italy); Alexandre Yersin (Switzerland); Kitasato Shibasaburō (Japan); Jean-Martin Charcot, Claude Bernard, Paul Broca (France); Adolfo Lutz (Brazil); Nikolai Korotkov (Russia); William Osler, Sir William Osler (Canada); and Harvey Cushing (United States). As science and technology developed, medicine became more reliant upon medications. Throughout history and in Europe right until the late 18th century, not only animal and plant products were used as medicine, but also human body parts and fluids. Pharmacology developed in part from herbalism and some drugs are still derived from plants (atropine, ephedrine, warfarin, aspirin, digoxin, vinca alkaloid, ''vinca'' alkaloids, taxol, hyoscine hydrobromide, hyoscine, etc.). Vaccines were discovered by Edward Jenner and Louis Pasteur. The first antibiotic was arsphenamine (Salvarsan) discovered by Paul Ehrlich in 1908 after he observed that bacteria took up toxic dyes that human cells did not. The first major class of antibiotics was the Sulfonamide (medicine), sulfa drugs, derived by German chemists originally from azo dyes. Pharmacology has become increasingly sophisticated; modern biotechnology allows drugs targeted towards specific physiological processes to be developed, sometimes designed for compatibility with the body to reduce Side effect, side-effects. Genomics and knowledge of human genetics and human evolution is having increasingly significant influence on medicine, as the causative genes of most monogenic genetic disorders have now been identified, and the development of techniques in molecular biology, evolution, and genetics are influencing medical technology, practice and decision-making. Evidence-based medicine is a contemporary movement to establish the most effective algorithms of practice (ways of doing things) through the use of systematic reviews and meta-analysis. The movement is facilitated by modern global information science, which allows as much of the available evidence as possible to be collected and analyzed according to standard protocols that are then disseminated to healthcare providers. The Cochrane Collaboration leads this movement. A 2001 review of 160 Cochrane systematic reviews revealed that, according to two readers, 21.3% of the reviews concluded insufficient evidence, 20% concluded evidence of no effect, and 22.5% concluded positive effect.


Quality, efficiency, and access

Evidence-based medicine, prevention of medical error (and other "iatrogenesis"), and avoidance of unnecessary health care are a priority in modern medical systems. These topics generate significant political and public policy attention, particularly in the United States where healthcare is regarded as excessively costly but population health metrics lag similar nations. Globally, many Developing country, developing countries lack access to care and access to medicines. As of 2015, most wealthy developed countries provide Universal health care, health care to all citizens, with a few exceptions such as the United States where lack of health insurance coverage may limit access.


Traditional medicine

The World Health Organization (WHO) defines traditional medicine as "the sum total of the knowledge, skills, and practices based on the theories, beliefs, and experiences indigenous to different cultures, whether explicable or not, used in the maintenance of health as well as in the prevention, diagnosis, improvement or treatment of physical and mental illness." Practices known as traditional medicines include Ayurveda, Siddha medicine, Unani, Ancient Iranian Medicine, ancient Iranian medicine, Irani Traditional medicine, Irani, Medicine in medieval Islam, Islamic medicine, traditional Chinese medicine, traditional Korean medicine, acupuncture, Muti, Ifá, and traditional African medicine. The WHO stated that "inappropriate use of traditional medicines or practices can have negative or dangerous effects" and that "further research is needed to ascertain the efficacy and safety" of several of the practices and medicinal plants used by traditional medicine systems. As example, Indian Medical Association regard traditional medicine practices, such as Ayurveda and Siddha medicine, as
quackery Quackery, often synonymous with health fraud, is the promotion of fraud In law Law is a system A system is a group of Interaction, interacting or interrelated elements that act according to a set of rules to form a unified whole. ...
. Practitioners of traditional medicine are not authorized to practice medicine in India unless trained at a qualified medical institution, registered with the government, and listed as registered physicians annually in The Gazette of India. Identifying practitioners of traditional medicine, the Supreme Court of India stated in 2018 that "unqualified, untrained quacks are posing a great risk to the entire society and playing with the lives of people without having the requisite training and education in the science from approved institutions". Evidence on the effectiveness of the alternative medicine practice of acupuncture is "variable and inconsistent" for any condition, but is generally safe when done by an appropriately trained practitioner.


See also

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References

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