Friday, August 19, 2005

Some background on medicine

Medicine is a branch of health science concerned with maintaining health and restoring it by treating disease. Medicine is both an area of knowledge (a science of body systems, diseases and their treatment), and the application of that knowledge (by the medical profession and other health professionals such as nurses, physiotherapists etc.) The various specialized branches of the science of medicine correspond to equally specialized medical professions dealing with particular organs or diseases. The medical profession refers to the social structure of the group of people formally trained to apply medical knowledge to treat disease. Many countries have legal limitations as to who may practice medicine.
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Systems of medical and healthcare practices have existed since at least the dawn of recorded history. These systems have developed differently in differing cultures and regions. The medicine practiced in the Western world has an almost exclusive Western tradition. Many other traditions of medicine and healthcare are still widely practiced throughout the world, most of which are still considered to be separate and distinct from biomedicine or Western medicine. The most highly developed systems of medicine outside the Western system (sometimes termed the Hippocratic tradition) are the Ayurvedic tradition of India and traditional Chinese medicine. Veterinary medicine is the medicine practice specialized for other animal species.
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Medicine as it is practiced now is rooted in various traditions, but developed mainly in the late 18th and early 19th century in Germany (Rudolf Virchow) and France (Jean-Martin Charcot, Claude Bernard and others). The new, "scientific" medicine replaced more traditional views based on the "four humours". The development of clinical medicine shifted to the United Kingdom and the USA during the early 1900s (Sir William Osler, Harvey Cushing).
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Evidence-based medicine is the recent movement to link the practice and the science of medicine more closely through the use of the scientific method and modern information science.
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Genomics is already having a large influence on medical practice, as most monogenic genetic disorders have now been linked to causative genes, and molecular biological techniques are influencing medical decision-making.
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The medical encounter or patient-doctor relationship is central to medicine. A person with a health problem or concern sees a doctor for help. The practice of medicine combines both science and art. Science and technology are the evidence base for many clinical problems for the general population at large. The art of medicine is the application of this medical knowledge in combination with intuition and clinical judgment to determine the proper diagnoses and treatment plan for this unique patient and to treat the patient accordingly. Other health professionals similarly establish a relationship with a patient and may perform interventions from their perspective, e.g. nurses, radiographers and therapists.
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The doctor-patient relationship and interaction is a central process in the practice of medicine. There are many perspectives from which to understand and describe it.
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An idealized physician's perspective, such as is taught in medical school, sees the core aspects of the process as the physician learning from the patient his symptoms, concerns and values; in response the physician examines the patient, interprets the symptoms, and formulates a diagnosis to explain the symptoms and their cause to the patient and to propose a treatment. In more detail, the patient presents a set of complaints or concerns about his health to the doctor, who then obtains further information about the patient's symptoms, previous state of health, living conditions, and so forth, and then formulates a diagnosis and enlists the patient's agreement to a treatment plan. Importantly, during this process the doctor educates the patient about the causes, progression, outcomes, and possible treatments of his ailments, as well as often providing advice for maintaining health. This teaching relationship is the basis of calling the physician doctor, which originally meant "teacher" in Latin. The patient-doctor relationship is additionally complicated by the patient's suffering (patient derives from the Latin patiens, "suffering") and limited ability to relieve it on his own. The doctor's expertise comes from his knowledge about, or experience with, other people who have suffered similar symptoms, and his presumed ability to relieve it with medicines or other therapies about which the patient may initially have little knowledge.
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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, and justice are achieved. Many other values and ethical issues can be added to these. In different societies, periods, and cultures, different values may be assigned different priorities. For example, in the last 30 years medical care in the Western World has increasingly emphasized patient autonomy in decision making.
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The relationship and process can also be analyzed in terms of social power relationships (e.g., by Michel Foucault), or economic transactions. Physicians have been accorded gradually higher status and respect over the last century, and they have been entrusted with control of access to prescription medicines as a public health measure. This represents a concentration of power and carries both advantages and disadvantages to particular kinds of patients with particular kinds of conditions. A further twist has occurred in the last 25 years as costs of medical care have risen, and a third party (an insurance company or government agency) now often insists upon a share of decision-making power for a variety of reasons, reducing freedom of choice of both doctors and patients in many ways.
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The quality of the patient-doctor relationship is important to both parties. The better the relationship in terms of mutual respect, knowledge, trust, shared values and perspectives about disease and life, and time available, the better will be the amount and quality of information about the patient's disease transferred in both directions, enhancing accuracy of diagnosis and increasing the patient's knowledge about the disease.
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In some settings, e.g. the hospital ward, the patient-doctor relationship is much more complex, and many other people are involved when somebody is ill: relatives, neighbors, rescue specialists, nurses, technical personnel, social workers and others.