Amedical doctor, also known as aphysician (American andCanadian English) ormedical practitioner (British English), is ahealth professional who practicesmedicine, which is concerned with promoting, maintaining or restoring health through thestudy,diagnosis,prognosis andtreatment ofdisease,injury, and other physical and mental impairments. Doctors may focus their practice on certain disease categories, types of patients, and methods of treatment—known asspecialities—or they may assume responsibility for the provision of continuing and comprehensive medical care to individuals, families, and communities—known asgeneral practice.[2] Medical practice properly requires both a detailedknowledge of theacademic disciplines, such asanatomy andphysiology,underlying diseases, and their treatment, which is the science of medicine, and a decentcompetence in its applied practice, which is the art orcraft of the profession.
Both the role of doctors and the meaning of the word itself vary around the world. Degrees and other qualifications vary widely, but there are some common elements, such asmedical ethics requiring that doctors show consideration, compassion, and benevolence for their patients.
The termdoctor commonly refers to medical practitioners across the world, but may also be applied to holders of non-medicaldoctoral degrees. While the termphysician is used in North America to refer to medical practitioners in a general sense, in theUnited Kingdom and countries influenced by British English this word refers tospecialists ininternal medicine specifically.
British and Commonwealth
The British meaning of the termphysician is the original one, and is used in opposition tosurgeon, which refers to a specialist insurgery. This meaning of physician conveys a sense of expertise in treatment withdrugs, rather than with the manual procedures used by a surgeon.[4] The English wordphysician is at least nine hundred years old: physicians and surgeons were once members of separate professions, and traditionally were rivals. TheShorter Oxford English Dictionary, third edition, gives aMiddle English quotation making this contrast, from as early as 1400: "O Lord, whi is it so greet difference betwixe a cirugian and a physician."[5]Henry VIII granted a charter to the LondonRoyal College of Physicians in 1518. It was not until 1540 that he granted theCompany of Barber-Surgeons (ancestor of theRoyal College of Surgeons) its separate charter. In the same year, the English monarch established theRegius Professorship of Physic at theUniversity of Cambridge.[6] Newer universities would probably describe such an academic as a professor ofinternal medicine. Hence, in the 16th century,physic meant roughly what internal medicine does now.
In the United States and Canada, the termphysician describes all medical practitioners holding a professional medical degree. TheAmerican Medical Association (AMA), established in 1847, as well as theAmerican Osteopathic Association, founded in 1897, both currently use the termphysician to describe members. The AMA advocates for the definition of aphysician as "an individual possessing degree of either aDoctor of Medicine orDoctor of Osteopathic Medicine."[11] However, theAmerican College of Physicians, established in 1915, use the termphysician in its original sense. Specialists in internal medicine may be described as aninternist. Another term,hospitalist, was introduced in 1996,[12] to describe US specialists ininternal medicine who work largely or exclusively in hospitals. Such "hospitalists" now make up about 19% of all USgeneral internists,[13] who are often calledgeneral physicians inCommonwealth countries. In North America, community-oriented providers ofprimary care are calledfamily doctors orprimary care physicians.
The vast majority ofphysicians trained in the United States have aDoctor of Medicine degree, and use the initials M.D. A smaller number attendosteopathicmedical schools and have aDoctor of Osteopathic Medicine degree and use the initialsD.O.[14] TheWorld Directory of Medical Schools lists both MD and DO granting schools asmedical schools located in the United States. After completion ofmedical school, physicians complete aresidency in the specialty in which they will practice. Subspecialties require the completion of afellowship after residency. Both MD and DO physicians participate in theNational Resident Matching Program (NRMP) and attendACGME-accredited residencies and fellowships across all medicalspecialties to obtain licensure. All boards of certification now require that physicians demonstrate, by examination, continuing mastery of the core knowledge and skills for a chosen specialty. Recertification varies by particular specialty between every seven and every ten years.
Around the world, the combined termphysician and surgeon is used to describe either a general practitioner or any medical practitioner irrespective of specialty.[4][5] This usage still shows the original meaning of physician and preserves the old difference between a physician, as a practitioner ofphysic, and a surgeon. The term may be used by state medical boards in the United States, and by equivalent bodies in Canadian provinces, to describe any medical practitioner.
WithinWestern culture and over recent centuries, medicine has become increasingly based on scientificreductionism andmaterialism. This style of medicine is now dominant throughout the industrialized world, and is often termedbiomedicine bymedical anthropologists.[18] Biomedicine "formulates the human body and disease in a culturally distinctive pattern",[19] and is aworld view learnt by medical students. Within this tradition, themedical model is a term for the complete "set of procedures in which all doctors are trained",[20] including mental attitudes. A particularly clear expression of this world view, currently dominant among conventional doctors, isevidence-based medicine. Within conventional medicine, most doctors still pay heed to their ancient traditions:
The critical sense and sceptical attitude of the Hippocratic school ... the emancipation of medicine from the shackles of priestcraft and of caste;secondly, the conception of medicine as an art based on accurate observation, and as a science, an integral part of the science of man and of nature;thirdly, the high moral ideals, expressed in that most "memorable of human documents" (Gomperz), theHippocratic oath; andfourthly, the conception and realization of medicine as the profession of a cultivated gentleman.
In this Western tradition, doctors are considered to be members of a learnedprofession, and enjoy highsocial status, often combined with expectations of a high and stable income andjob security. However, medical practitioners often work long and inflexible hours, with shifts at unsociable times. Their high status is partly from their extensive training requirements, and also because of their occupation's specialethical andlegal duties. The term traditionally used by doctors to describe a person seeking their help is the wordpatient (although one whovisits a doctor for a routinecheck-up may also be so described). This wordpatient is an ancient reminder of medical duty, as it originally meant 'one who suffers'. The English noun comes from theLatin wordpatiens, thepresent participle of thedeponent verb,patior, meaning 'I am suffering', and akin to theGreek verbπάσχειν (romanized:paschein,lit. to suffer) and its cognate nounπάθος (pathos, suffering).[5][22]
Alternative medicine
While contemporary biomedicine has distanced itself from its ancient roots in religion and magic, many forms oftraditional medicine[23] andalternative medicine continue to espousevitalism in various guises: "As long as life had its own secret properties, it was possible to have sciences and medicines based on those properties".[24] The USNational Center for Complementary and Alternative Medicine (NCCAM) classifiescomplementary and alternative medicine therapies into five categories or domains, including:[25] alternative medical systems, or complete systems of therapy and practice;mind-body interventions, or techniques designed to facilitate the mind's effect on bodily functions and symptoms; biologically based systems includingherbalism; and manipulative and body-based methods such aschiropractic and massage therapy.
In considering these alternate traditions that differ from biomedicine (see above),medical anthropologists emphasize that all ways of thinking about health and disease have a significant cultural content, including conventional western medicine.[18][19][26][27]
Some commentators have argued that doctors have duties to serve as role models for the general public in matters of health, for example by not smoking cigarettes.[28] Indeed, in most western nations relatively few doctors smoke, and their professional knowledge does appear to have a beneficial effect on their health and lifestyle. According to a study of male doctors in the United States,[29]life expectancy is slightly higher for doctors (73 years for white and 69 years for black) than lawyers or many other highly educated professionals. Causes of death which are less likely to occur in doctors than the general population include respiratory disease (includingpneumonia,pneumoconioses,COPD, but excludingemphysema and otherchronic airway obstruction), alcohol-related deaths,rectosigmoid andanal cancers, and bacterial diseases.[29]
Doctors do experience exposure tooccupational hazards, and there is a well-known aphorism that "doctors make the worst patients".[30] Causes of death that are shown to be higher in doctors includesuicide among doctors andself-inflicted injury, drug-related causes, traffic accidents, and cerebrovascular and ischaemic heart disease.[29] Doctors are also prone tooccupational burnout. This manifests as a long-term stress reaction characterized by poorer quality of care towards patients, emotional exhaustion, a feeling of decreased personal achievement, and others. A study by theAgency for Healthcare Research and Quality reported that time pressure was the greatest cause of burnout; a survey from theAmerican Medical Association reported that more than half of all respondents chose "too many bureaucratic tasks" as the leading cause of burnout.[31][32]
Medical education and career pathways for doctors vary considerably across the world.
In all developed countries, entry-level medical education programs aretertiary-levelcourses, undertaken at amedical school attached to auniversity. Depending on jurisdiction and university, entry may follow directly fromsecondary school or require pre-requisiteundergraduate education. The former commonly takes five or six years to complete. Programs that require previous undergraduate education (typically a three- or four-year degree, often in science) are usually four or five years in length. Hence, gaining a basic medical degree may typically take from five to eight years, depending on jurisdiction and university.
Following the completion of entry-level training, newly graduated medical practitioners are often required to undertake a period of supervised practice before full registration is granted, typically one or two years. This may be referred to as an "internship", as the "foundation" years in the UK, or as "conditional registration". Some jurisdictions, including the United States, require residencies for practice.
Medical practitioners hold a medical degree specific to the university from which they graduated. This degree qualifies the medical practitioner to becomelicensed or registered under the laws of that particular country, and sometimes of several countries, subject to requirements for an internship or conditional registration.
Regulation
In most jurisdictions, doctors need government permission to practice. Such permission is intended to promote public safety, and often to protect government spending, as medical care is commonly subsidized by national governments.
In some jurisdictions such as inSingapore, it is common for medical practitioners to inflate their qualifications with the title "Dr" in correspondence or namecards, even if their qualifications are limited to a basic (e.g., bachelor level) degree. In other countries such asGermany, only medical practitioners holding an academic doctorate may call themselves "doctor" – on the other hand, theEuropean Research Council has decided that the German medical doctorate does not meet the international standards of a PhD research degree.[dubious –discuss][33][34]
Licensing
Among the English-speaking countries, this process is known either aslicensure as in the United States, or asregistration in theUnited Kingdom, otherCommonwealth countries, andIreland. Synonyms in use elsewhere includecolegiación inSpain,ishi menkyo inJapan,autorisasjon inNorway,Approbation inGermany, andάδεια εργασίας in Greece. InFrance,Italy andPortugal, doctors must be members of a national order of medical practitioners.
In some countries, including the United Kingdom and Ireland, the medical profession largely regulates itself, with the government affirming the regulating body's authority. The best-known example of this is probably theGeneral Medical Council of Britain. In all countries, the regulating authorities will revoke permission to practice in cases ofmalpractice or serious misconduct.
In the large English-speaking federations (United States,Canada,Australia), the licensing or registration of medical practitioners is done at a state or provincial level, or nationally as in New Zealand. Australian states usually have a "Medical Board", which has now been replaced by theAustralian Health Practitioner Regulation Agency (AHPRA) in most states, while Canadian provinces usually have a "College of Physicians and Surgeons". All American states have an agency that is usually called the "Medical Board", although there are alternate names such as "Board of Medicine", "Board of Medical Examiners", "Board of Medical Licensure", "Board of Healing Arts" or some other variation.[35] After graduating from a first-professional school, physicians who wish to practice in the US usually take standardized exams, such as theUSMLE for a Doctor in Medicine.
Performance and professionalism supervision
The issue ofmedical errors, drug abuse, and other issues in a doctors' professional behavior received significant attention across the world,[36] in particular following a critical 2000 report[37] which "arguably launched" the patient-safety movement.[38] In the US, as of 2006 there were few organizations that systematically monitored performance. In the US, only theDepartment of Veterans Affairs randomly drug tests doctors, in contrast to drug testing practices for other professions that have a major impact on public welfare. Licensing boards at the US state-level depend upon continuing education to maintain competence.[39] Through the use of theNational Practitioner Data Bank,Federation of State Medical Boards' disciplinary report, and American Medical Association Physician Profile Service, the 67 State Medical Boards continually self-report any adverse/disciplinary actions taken against a licensed doctor so that the other Medical Boards in which the doctor holds or is applying for a medical license will be properly notified so that corrective, reciprocal action can be taken against the offending doctor.[40] In Europe, as of 2009 the health systems are governed according to various national laws, and can also vary according to regional differences similar to the United States.[41]
^In 1949, Fildes' paintingThe Doctor was used by theAmerican Medical Association in a campaign against a proposal for nationalized medical care put forth by PresidentHarry S. Truman. The image was used in posters and brochures along with the slogan, "Keep Politics Out of this Picture" implying that involvement of the government in medical care would negatively affect the quality of care. 65,000 Posters ofThe Doctor were displayed, which helped to raise public skepticism for the nationalized healthcare campaign.
^Fowler, Henry W.; Burchfield, Robert W., eds. (2000).The new Fowler's modern English usage (3 ed.). Oxford: Oxford Univ. Press. p. 595.ISBN978-0-19-860263-7.
^"Policy Finder | AMA".policysearch.ama-assn.org.Archived from the original on 13 October 2021. Retrieved27 December 2021.
^Wachter R; Goldman L (1996). "The emerging role of "hospitalists" in the American health care system".N Engl J Med.335 (7):514–7.doi:10.1056/NEJM199608153350713.PMID8672160.
^Medline Plus (2012)."Doctor of Osteopathic Medicine". U.S. National Library of Medicine of National Institutes of Health.Archived from the original on 5 July 2016. Retrieved22 December 2012.
^abA. Gaines, R.A. Hahn, ed. (1985). "Chapter 1: Introduction (by editors)".Physicians of western medicine. Dordrecht (Netherlands): D. Reidel. pp. 3–22.ISBN90-277-1790-7.
^abGood, Byron J (1994). "Chapter (pbk)3".Medicine, rationality, and experience: an anthropological perspective (based on the Lewis Henry Morgan Lectures, at the University of Rochester, NY, in March 1990). Cambridge, UK: Cambridge University Press. pp. 65,65–87.ISBN0-521-42576-X.
^Laing, R.D. (1971).The politics of the family and other essays. London: Tavistock Publications.
^Osler, Sir William (1902). "Chauvinism in medicine: address to the Canadian Medical Association, Montreal (17 September 1902)".The Montreal Medical Journal.XXXI.
^Partridge, Eric (1966).Origins: a short etymological dictionary of modern English. New York: Macmillan.ISBN0-02-594840-7.
^Grossinger, Richard (1982) [1980].Planet medicine: from stone age shamanism to post-industrial healing (Revised ed.). Berkeley, California, US: North Atlantic Books. pp. 116–131.ISBN978-1-55643-369-6.
^Joralemon, DonaldJ (1999). "chapter 1: What's so cultural about disease? (pbk)".Exploring medical anthropology. Needham Heights, MA, US: Allyn and Bacon. pp. 1–15.ISBN0-205-27006-9.
^Committee on Quality of Health Care in America, Institute of Medicine. (2000). To Err is Human: Building A Safer Health System.National Academies Press.Free full-textArchived 12 November 2014 at theWayback Machine.
