Medicine

• 1. Introduction

  ›

  Medicine has been practiced since prehistoric times, and for most of that span it was an art rather than a science. A medicine man would apply herbs and say prayers for healing. An ancient philosopher and physician would draw blood according to the theories of humorism, the four humors. These practices carried deep ties to the religious and philosophical beliefs of local culture. Today medicine is the science and practice of caring for patients. It manages the diagnosis, prognosis, prevention, treatment, and palliation of injury or disease, while promoting health. How did a craft of prayers and bloodletting become a discipline that designs drugs to fit the human body? Who decides what counts as real medicine and what gets dismissed as quackery? And when so much of practice still rests on uncertain evidence, how do healers honor the oldest promise of their trade, to first do no harm? The word itself comes from Latin, meaning a physician, and the journey from that single word to a global system of care runs through Ebla, Egypt, Greece, and far beyond.

• 2. The Clinical Encounter

  ›

  An initial medical encounter usually opens with the chief complaint, the reason for the visit, recorded in the patient's own words along with how long each symptom has lasted. From there the doctor builds a fuller picture: history of present illness, past medical history, family history, medications including over-the-counter and herbal remedies, allergies, and a social history covering birthplace, habits, diet, tobacco, and alcohol. A review of systems sweeps the heart, lungs, digestive tract, and urinary tract for anything the interview missed. The physical examination hunts for medical signs, the objective and observable, as opposed to symptoms that the patient volunteers. Four actions form its basis: inspection, palpation to feel, percussion to tap for resonance, and auscultation to listen. The order shifts for the abdomen, where auscultation comes before percussion and palpation. The provider relies on sight, hearing, touch, and sometimes smell, which can betray infection, uremia, or diabetic ketoacidosis. Vital signs anchor the exam, including height, weight, body temperature, blood pressure, pulse, respiration rate, and hemoglobin oxygen saturation. After examining signs and interviewing for symptoms, the doctor may order blood tests, take a biopsy, or prescribe drugs and other therapies. Differential diagnosis methods help rule conditions out from the information gathered. The whole process may take a few minutes or a few weeks, depending on how complex the issue proves to be.

• 3. Primary, Secondary, Tertiary

  ›

  About 90% of medical visits can be handled effectively by a primary care provider. Primary care is the first contact for a patient seeking treatment, delivered in offices, clinics, nursing homes, schools, and patients' homes, places geographically close to where people live, work, or study. It covers minor, acute, and chronic illnesses, preventive care, and health education for patients of all ages and sexes. Secondary care begins with a referral. Specialists in their offices or at local community hospitals take patients sent by the primary provider who first diagnosed or treated them, when the case demands particular expertise or specific procedures. This tier spans ambulatory and inpatient services, emergency departments, some intensive care, certain surgeries, physical therapy, labor and delivery, endoscopy units, diagnostic laboratories, imaging, and hospice centers. Tertiary care escalates further still. Specialist teams work in larger, more specialized hospitals or regional medical centers, equipped with diagnostic and treatment facilities that smaller local hospitals lack. Here belong burn and trauma centers, advanced neonatology, organ transplants, high-risk pregnancy and delivery, and radiation oncology, the realm of the most complex, urgent, and serious conditions. One thread runs through every tier: the keeping and use of patient information, still recorded on paper in many settings but increasingly held by electronic means.

• 4. Branches Of The Body

  ›

  Anatomy is the study of the physical structure of organisms, with cytology and histology turning to the microscopic where gross anatomy stops. Beneath it lies a sprawl of basic sciences that every physician is educated in. Biochemistry tracks the chemistry of living organisms. Physiology studies the body's normal functioning and its regulatory mechanisms. Pathology examines disease itself, its causes, course, progression, and resolution. Pharmacology studies drugs and their actions, while toxicology covers the hazardous effects of drugs and poisons. Epidemiology maps the demographics of disease, and biostatistics, fundamental to it and to evidence-based medicine, applies statistics to biological fields. Within medical circles, specialties usually fall into two broad camps, Medicine and Surgery. Medicine refers to non-operative practice, most of whose subspecialties demand preliminary training in Internal Medicine. Surgery refers to operative practice, requiring General Surgery first. In the UK, that traditionally meant passing the Membership of the Royal College of Physicians or, on the surgical side, the Royal College of Surgeons of England. Internal medicine itself, dealing with adult diseases, splits into cardiology, gastroenterology, nephrology, hematology, oncology, and many more. Surgery branches into bariatric, colorectal, pediatric, plastic, transplant, trauma, and vascular work, among others. Some fields fit neither camp cleanly, such as radiology, pathology, and anesthesia. Anaesthesia in fact began as a faculty of the Royal College of Surgeons before becoming the Royal College of Anaesthetists, the prestige of administering one's own examination marking the birth of a new specialty.

• 5. Six Values In Conflict

  ›

  Truthfulness in medicine was not heavily emphasized before the HIV era, and informed consent gained importance only after the historical events of the Doctors' Trial of the Nuremberg trials, the Tuskegee syphilis experiment, and others. Medical ethics is a system of moral principles applying values and judgments to practice. Six values commonly frame its discussions. Autonomy gives the patient the right to refuse or choose treatment, captured in the Latin Voluntas aegroti suprema lex. Beneficence asks the practitioner to act in the patient's best interest. Justice concerns the distribution of scarce health resources, the decision of who gets what treatment. Non-maleficence is the duty to first, do no harm, primum non-nocere. Respect for persons holds that patient and practitioner alike deserve to be treated with dignity. These values do not dictate how to act in any single case. They offer a framework for understanding conflict. When moral values collide, the result may be an ethical dilemma or crisis, and sometimes no good solution exists. The principles of autonomy and beneficence clash, for instance, when patients refuse blood transfusions that others consider life-saving. The same tension echoes in clinical practice itself, where a 2007 survey of literature reviews found that about 49% of medical interventions lacked sufficient evidence to support either benefit or harm.

• 6. From Ebla To Avicenna

  ›

  The earliest known medical texts in the world were found in the ancient Syrian city of Ebla and date back to 2500 BCE. In Egypt, Imhotep of the 3rd millennium BCE is the first physician in history known by name. The Edwin Smith Papyrus from 1600 BCE is an early work on surgery, while the Ebers Papyrus of 1500 BCE reads like a textbook on medicine. In India, the surgeon Sushruta wrote the Sushruta Samhita, the oldest known surgical text, describing numerous operations including the earliest forms of plastic surgery and methods of sterilizing instruments. In Greece, Hippocrates, the father of modern medicine, laid the foundation for a rational approach. He introduced the Hippocratic Oath still in use today, and was the first to categorize illnesses as acute, chronic, endemic, and epidemic. The Greek physician Galen ranked among the greatest surgeons of the ancient world, performing audacious brain and eye operations. After the fall of the Western Roman Empire, the Greek tradition declined in Western Europe but continued uninterrupted in the Eastern Roman, or Byzantine, Empire. There the concept of the hospital as a place to offer a cure, rather than merely a place to die, took shape from the ideals of Christian charity. After 750 CE the Muslim world had Hippocrates, Galen, and Sushruta translated into Arabic. The Persian polymath Avicenna, also called a father of medicine, wrote The Canon of Medicine, a standard text at many medieval European universities. The Persian physician Rhazes, called a doctor's doctor and the father of pediatrics, was among the first to question the Greek theory of humorism and the first to recognize the pupil's reaction to light.

• 7. The Turn To Science

  ›

  Vesalius authored De humani corporis fabrica, an important book on human anatomy, and improved upon or disproved theories handed down from the past. The major shift in medical thinking was the gradual rejection, especially during the Black Death of the 14th and 15th centuries, of the traditional authority approach. Under that old view, if some prominent person in the past said a thing must be so, anything observed to the contrary was treated as an anomaly. The same break paralleled Copernicus's rejection of Ptolemy in astronomy. Bacteria and microorganisms were first observed with a microscope by Antonie van Leeuwenhoek in 1676, opening the field of microbiology. The modern era truly began with Edward Jenner's discovery of the smallpox vaccine at the end of the 18th century, inspired by the method of variolation that originated in ancient China. Robert Koch's discoveries around 1880 revealed the transmission of disease by bacteria, and antibiotics followed around 1900. The first antibiotic was arsphenamine, or Salvarsan, discovered by Paul Ehrlich in 1908 after he observed that bacteria took up toxic dyes that human cells did not. Veterinary medicine was truly separated from human medicine in 1761, when the French veterinarian Claude Bourgelat founded the world's first veterinary school in Lyon. Before that, medical doctors treated both humans and other animals. Evidence-based medicine now seeks the most effective practices through systematic reviews and meta-analysis, a movement led by the Cochrane Collaboration. A 2001 review of 160 Cochrane systematic reviews found that 21.3% concluded insufficient evidence, 20% concluded no effect, and 22.5% concluded a positive effect.

• 8. Care At A Distance

  ›

  Telenursing is experiencing significant growth worldwide, driven by the need to cut healthcare costs, an aging and chronically ill population, and the push to extend coverage to distant, rural, and sparsely populated regions. It can ease nurse shortages, reduce travel, and lower hospital admissions. Telemedicine as a whole delivers preventive, promotive, and curative care remotely, spanning diagnosis, monitoring, administration, and provider education. Telepalliative care works to relieve suffering for people with serious, complex, and often fatal illnesses, using video conferencing, follow-up messaging, and digital symptom questionnaires that generate alerts for professionals. The World Health Organization recommends integrating palliative care as early as possible for any chronic and fatal illness. Telepharmacy carries pharmaceutical care to patients where direct contact with a pharmacist is difficult, and telepsychiatry brings remote care to people with mental health conditions. Teleneurotherapy reaches further into the experimental, using devices such as tablets with headphones to deliver systematic physical stimuli, with research suggesting these may modulate neuronal plasticity in injured nervous systems. The same digital reach that once held medicine to paper records now stretches care across the distances that herbs and prayers were first meant to cross.