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
Patient-doctor reationship
The doctor-patient relationship and interaction is a central process
in the practice of medicine. There are many perspectives from which
understand and desribe 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 isymptoms,
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, 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 The patient-doctor
relationship is additionally complicated by the patient's 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 ethical concerns, in terms of how well the goals
of non-maleficence, beneficence, autonomy, ande 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 years medical care
in the Western World has increasingly emphasized patient autonomy
decision making.The relationship and process can also be analyzed
in terms of social power relationships or economic transactions.
Physicians have been accorded gradually higher status and respect
the last century, and they have been entrusted with control of access
to prescription medicines as a 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 years as costs of medical care
have risen, and a third party 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 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-ctor 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: Medical hisory, Physical examination.A
complete medical evaluation includes a medical history,
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 the reason
for the current medical visit.
History of present illness the chronological order of
events of symptoms. A mnemonic 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
ristory - birthplace, residences, marital history, social
and economic status, habits
Family history- 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 made redundant by the
availability of modern lab tests Four chief methods are used: inspection,
palpation, percussion, and auscultation; smelling may be useful
infection, uremia, diabetic ketoacidosis. The clinical examination
involves study of:Vital signs include height, weight, body temperature,
blood pressure, pulse, respiration rate, hemoglobin oxygen saturation
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 firsiagnosed or treated
the patien Referrals are made for those patients who required the
expertise or procedures performed by specialists. These include
both ambulatory care and inpatiet services, emergency rooms, intensive
care medicine, surgery services, physical therapy, labor and delivery,
endoscopy units, diagnostic laboratory and medical imaging services,
hospice centers, etc. Some primary care providers may also take
care of hospitalized patients and deliver babies in a secondary
care setting.
Tertiary care medical services are proved by specialist
hospitals or regional centers equipped with diagnostic and treatment
facilities not generally available at local hospitals. These include
trauma centers, burn t centers, advnced neonatology unit sevices,
organ transplants, high-risk pregnancy, radiation oncology, et.Modermedical
care also depends on information - still delivered in many health
care settingson paper records, but increasingly nowadays by electronic
means.
Branches of medicine
Working together as an interdisciplinary team, many highly trained
health professionals besides medical practitioners are involved
in the delivery of modern health care. Some examples include: nses,
laboratory scientists, pharmacists, physiotherapists, speech therapists,
occupational therapists, dietitians and bioengineers.The scope and
sciences underpinning human medicine overlap many other fields.
Dentist and psychology, while separate disciplnes from medicine,
are someties also considered medical fields. Physician assstants,
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, espcially 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 cells.
ology and physiology of the human brain.
Nutrition is the study of the relationship of food anrink
to health and disease, especially in determining an
optimal diet. Medical nutrition therapy is done by dietitians
and is prescribed for diabetes, cardiovascular diseases,
weight and eating disorders, allergies, malnutrition
and neoplastic diseases.
Pathology is the study of disease - the causes, course,
progression and resolution thereof.
Pharmacology is the study of drugs and their actions.
Physiology is the studyof 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 mcal technology degree, who actually perform the 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 diagnis using samples
from ptients taken as tissues and cells using histology
and cytology.
Clinical chemistry is ncerned with diosis 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 microbiologconcerned with disorders of 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 biopsies, 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.
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