Medicine has been practiced sinceprehistoric times, and for most of this time it was anart (an area of creativity and skill), frequently having connections to thereligious andphilosophical beliefs of local culture. For example, amedicine man would applyherbs and sayprayers for healing, or an ancientphilosopher andphysician would applybloodletting according to the theories ofhumorism. In recent centuries, since theadvent of modern science, most medicine has become a combination of art and science (bothbasic andapplied, under theumbrella ofmedical science). For example, while stitching technique forsutures is an art learned through practice, knowledge of what happens at thecellular andmolecular level in the tissues being stitched arises through science.
Prescientific forms of medicine, now known astraditional medicine orfolk medicine, remain commonly used in the absence of scientific medicine and are thus calledalternative medicine. Alternative treatments outside of scientific medicine with ethical, safety and efficacy concerns are termedquackery.
Medical availability and clinical practice vary across the world due to regional differences inculture andtechnology. Modern scientific medicine is highly developed in theWestern world, while indeveloping countries such as parts of Africa or Asia, the population may rely more heavily ontraditional medicine with limited evidence and efficacy and no required formal training for practitioners.[9]
In thedeveloped world,evidence-based medicine 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.[10]
In modern clinical practice,physicians andphysician assistants personally assess patients todiagnose, prognose, treat, and prevent disease using clinical judgment. Thedoctor-patient relationship typically begins with an interaction with an examination of the patient'smedical history andmedical record, followed by a medical interview[11] and aphysical examination. Basic diagnosticmedical devices (e.g.,stethoscope,tongue depressor) are typically used. After examining forsigns and interviewing forsymptoms, the doctor may ordermedical tests (e.g.,blood tests), take abiopsy, or prescribepharmaceutical drugs or other therapies.Differential diagnosis 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.[12] 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 on the complexity of the issue.
The components of the medical interview[11] and encounter are:
Chief complaint (CC): the reason for the current medical visit. These are thesymptoms. They are in the patient's own words and are recorded along with the duration of each one. Also calledchief concern orpresenting complaint.
Current activity: occupation, hobbies, what the patient actually does.
Family history (FH): listing of diseases in the family that may impact the patient. Afamily tree is sometimes used.
History of presentillness (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 comprises HPI and PMH.
Past medical history (PMH/PMHx): concurrent medical problems, past hospitalizations and operations, injuries, pastinfectious diseases orvaccinations, history of known allergies.
Review of systems (ROS) orsystems inquiry: a set of additional questions to ask, which may be missed on HPI: a general enquiry (have you noticed anyweight loss, change in sleep quality, fevers, lumps and bumps? etc.), followed by questions on the body's main organ systems (heart,lungs,digestive tract,urinary tract, etc.).
Social history (SH): birthplace, residences, marital history, social and economic status, habits (includingdiet, medications,tobacco, alcohol).
The physical examination is the examination of the patient for medical signs of disease that are objective and observable, in contrast to symptoms that are volunteered by the patient and are not necessarily objectively observable.[13] The healthcare provider uses sight, hearing, touch, and sometimes smell (e.g., in infection,uremia,diabetic ketoacidosis). Four actions are the basis of physical examination:inspection,palpation (feel),percussion (tap to determine resonance characteristics), andauscultation (listen), generally in that order, although auscultation occurs prior to percussion and palpation for abdominal assessments.[14]
The clinical examination involves the study of:[15]
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 additionalmedical laboratory tests andmedical imaging studies, starting therapy, referral to aspecialist, or watchful observation. A follow-up may be advised. Depending upon thehealth insurance plan and themanaged care system, various forms of "utilization review", such as prior authorization of tests, may place barriers on accessing expensive services.[16]
The medical decision-making (MDM) process includes the analysis and synthesis of all the above data to come up with a list of possible diagnoses (the 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, lab or imaging results, or specialistconsultations.
Contemporary medicine is, in general, conducted withinhealth 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 a 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 theCatholic Church today remains the largest non-government provider of medical services in the world.[17] Advanced industrial countries (with the exception of theUnited States)[18][19] and many developing countries provide medical services through a system ofuniversal health care that aims to guarantee care for all through asingle-payer health care system or compulsory private or cooperative 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, state-owned hospitals and clinics, or charities, most commonly a combination of all three.
Mosttribal societies provide no guarantee of healthcare for the population as a whole. In such societies, healthcare is available to those who can afford to pay for it, have self-insured it (either directly or as part of an employment contract), or may be covered by care financed directly by the government or tribe.
Transparency of information is another factor defining a delivery system. Access to information on conditions, treatments, quality, and pricing greatly affects the choice of patients/consumers and, therefore, the incentives of medical professionals. While the US healthcare system has come under fire for its lack of openness,[20] 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.
Primary care medical services are provided byphysicians,physician assistants,nurse practitioners, or other health professionals who have first contact with a patient seeking medical treatment or care.[23] 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 andhealth education for all ages and both sexes.
Secondary care medical services are provided bymedical 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.[24] Referrals are made for those patients who required the expertise or procedures performed by specialists. These include bothambulatory care andinpatient services,emergency departments,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 provided by specialist hospitals or regional centers equipped with diagnostic and treatment facilities not generally available at local hospitals. These includetrauma centers,burn treatment centers, advancedneonatology unit services,organ transplants, high-risk pregnancy,radiationoncology, etc.
Modern medical care also depends on information – still delivered in many health care settings on paper records, but increasingly nowadays byelectronic 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.[25]
Separation of prescribing and dispensing is a practice in medicine and pharmacy in which the physician who provides amedical prescription is independent from thepharmacist who provides theprescription drug. In the Western world there are centuries of tradition for separating pharmacists from physicians. In Asian countries, it is traditional for physicians to also provide drugs.[26]
The scope and sciences underpinning human medicine overlap many other fields. 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 inbiomedical research.
Interdisciplinary fields, where different medical specialties are mixed to function in certain occasions.
Anatomy is the study of the physical structure oforganisms. In contrast tomacroscopic orgross anatomy,cytology andhistology 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 ofMechanics.
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 toepidemiology and evidence-based medicine.
Cytology is the microscopic study of individualcells.
Nutrition science (theoretical focus) anddietetics (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 fordiabetes,cardiovascular diseases, weight and eatingdisorders, allergies,malnutrition, andneoplastic 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.
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 theRoyal 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 theRoyal 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 afaculty of the Royal College of Surgeons (for which MRCS/FRCS would have been required) before becoming theRoyal 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).
Surgery is an ancient medical specialty that uses operative manual and instrumental techniques on a patient to investigate or treat apathological condition such as disease orinjury, to help improve bodily function or appearance or to repair unwanted ruptured areas (for example,a perforated ear drum). Surgeons must also manage pre-operative, post-operative, and potential surgical candidates on the hospital wards. 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 asophthalmology anddermatology, 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.
Surgical subspecialties include those a physician may specialize in after undergoing general surgery residency training as well as several surgical fields with separate residency training. Surgical subspecialties that one may pursue following general surgery residency training:[27]
Internal medicine is themedical specialty dealing with the prevention, diagnosis, and treatment of adult diseases.[28] According to some sources, an emphasis on internal structures is implied.[29] In North America, specialists in internal medicine are commonly called "internists". Elsewhere, especially inCommonwealth nations, such specialists are often calledphysicians.[30] These terms,internist orphysician (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; suchgeneral 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,gastroenterologists andnephrologists specialize respectively in diseases of the gut and the kidneys.[31]
In the Commonwealth of Nations and some other countries, specialistpediatricians andgeriatricians are also described asspecialist 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 ofprimary care.
There are many subspecialities (or subdisciplines) ofinternal medicine:
Training in internal medicine (as opposed to surgical training), varies considerably across the world: see the articles onmedical education 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.
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 includeelectroencephalography,electromyography,evoked potential,nerve conduction study andpolysomnography. Sometimes these tests are performed by techs without a medical degree, but the interpretation of these tests is done by a medical professional.
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 agamma 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.
The following are some major medical specialties that do not directly fit into any of the above-mentioned groups:
Anesthesiology (also known asanaesthetics): 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.
Emergency medicine is concerned with the diagnosis and treatment of acute or life-threatening conditions, includingtrauma, surgical, medical, pediatric, and psychiatric emergencies.
Family medicine,family practice,general practice orprimary 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.
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.
Obstetrics andgynecology (often abbreviated asOB/GYN (American English) orObs & Gynae (British English)) are concerned respectively with childbirth and the female reproductive and associated organs.Reproductive medicine andfertility medicine are generally practiced by gynecological specialists.
Pediatrics (AE) orpaediatrics (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.
Forensic medicine deals with medical questions inlegal 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.
Hospital medicine is the general medical care of hospitalized patients. Physicians whose primary professional focus is hospital medicine are calledhospitalists in the United States andCanada. 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.
Nosokinetics is the science/subject of measuring and modelling the process of care in health and social care systems.
Nosology is the classification of diseases for various purposes.
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 calledpain medicine, oralgiatry) is the medical discipline concerned with the relief of pain.
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.[32]
Travel medicine oremporiatrics 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.
Medical education and training varies around the world. It typically involves entry level education at a universitymedical school, followed by a period of supervised practice orinternship, orresidency. 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 aDoctor 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 requirecontinuing medical education. Medical practitioners upgrade their knowledge in various ways, includingmedical 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 athttp://data.medobjectives.marian.edu/Archived 4 October 2018 at theWayback Machine.[33]
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 againstcharlatans that practice inadequate medicine for personal gain. While the laws generally require medical doctors to be trained in "evidence based", Western, orHippocratic 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 theDirective 2005/36/EC.
Doctors who are negligent or intentionally harmful in their care of patients can face charges ofmedical malpractice and be subject to civil, criminal, or professional sanctions.
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 – the patient has the right to refuse or choose their treatment. (Latin:Voluntas aegroti suprema lex.)
beneficence – a practitioner should act in the best interest of the patient. (Latin:Salus aegroti suprema lex.)
justice – concerns the distribution of scarce health resources, and the decision of who gets what treatment (fairness and equality).
non-maleficence – "first, do no harm" (Latin:primum non-nocere).
respect for persons – the patient (and the person treating the patient) have the right to be treated with dignity.
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 ethicaldilemma 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 refuseblood transfusions, considering them life-saving; and truth-telling was not emphasized to a large extent before the HIV era.
Prehistoric medicine incorporated plants (herbalism), animal parts, and minerals. In many cases these materials were used ritually as magical substances by priests,shamans, ormedicine men. Well-known spiritual systems includeanimism (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); anddivination (magically obtaining the truth). The field ofmedical anthropology examines the ways in which culture and society are organized around or impacted by issues of health, health care and related issues.
In Egypt,Imhotep (3rd millennium BCE) is the first physician in history known by name. The oldestEgyptian medical text is theKahun Gynaecological Papyrus from around 2000 BCE, which describes gynaecological diseases. TheEdwin Smith Papyrus dating back to 1600 BCE is an early work on surgery, while theEbers Papyrus dating back to 1500 BCE is akin to a textbook on medicine.[37]
In China, archaeological evidence of medicine in Chinese dates back to theBronze AgeShang dynasty, based on seeds for herbalism and tools presumed to have been used for surgery.[38] TheHuangdi Neijing, the progenitor of Chinese medicine, is a medical text written beginning in the 2nd century BCE and compiled in the 3rd century.[39]
In India, the surgeonSushruta described numerous surgical operations, including the earliest forms ofplastic surgery.[40][unreliable source?][citation needed]Earliest records of dedicated hospitals come from Mihintale inSri Lanka where evidence of dedicated medicinal treatment facilities for patients are found.[41][42]
In Greece, the ancient Greek physicianHippocrates, the "father of modern medicine",[43][44] laid the foundation for a rational approach to medicine. Hippocrates introduced theHippocratic Oath for physicians, which is still relevant and in use today, and was the first to categorize illnesses asacute,chronic,endemic and epidemic, and use terms such as, "exacerbation,relapse, resolution, crisis,paroxysm, peak, andconvalescence".[45][46] The Greek physicianGalen 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 theWestern Roman Empire and the onset of theEarly Middle Ages, the Greek tradition of medicine went into decline in Western Europe, although it continued uninterrupted in theEastern Roman (Byzantine) Empire.
Most of our knowledge of ancientHebrew medicine during the1st millennium BC comes from theTorah, i.e. the Five Books ofMoses, which contain various health related laws and rituals. The Hebrew contribution to the development of modern medicine started in theByzantine Era, with the physicianAsaph the Jew.[47]
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 theByzantine Empire.[48]
Although the concept ofuroscopy 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 ofTheophilus 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.[49]
After 750 CE, the Muslim world had the works of Hippocrates, Galen and Sushruta translated intoArabic, andIslamic physicians engaged in some significant medical research. Notable Islamic medical pioneers include the Persianpolymath,Avicenna, who, along with Imhotep and Hippocrates, has also been called the "father of medicine".[50] He wroteThe Canon of Medicine which became a standard medical text at many medieval Europeanuniversities,[51] considered one of the most famous books in the history of medicine.[52] Others includeAbulcasis,[53]Avenzoar,[54]Ibn al-Nafis,[55] andAverroes.[56]Persian physicianRhazes[57] was one of the first to question the Greek theory ofhumorism, which nevertheless remained influential in both medieval Western and medieval Islamic medicine.[58] Some volumes of Rhazes's workAl-Mansuri, namely "On Surgery" and "A General Book on Therapy", became part of the medical curriculum in European universities.[59] Additionally, he has been described as a doctor's doctor,[60] the father of pediatrics,[57][61] and a pioneer of ophthalmology. For example, he was the first to recognize the reaction of the eye's pupil to light.[61] The PersianBimaristan hospitals were an early example ofpublic hospitals.[62][63]
In Europe,Charlemagne decreed that a hospital should be attached to each cathedral and monastery and the historianGeoffrey Blainey likened theactivities 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. TheBenedictine 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 greatAbbey of Cluny. The Church also established a network ofcathedral schools and universities where medicine was studied. TheSchola Medica Salernitana in Salerno, looking to the learning ofGreek andArab physicians, grew to be the finest medical school in medieval Europe.[64]
Siena'sSanta Maria della Scala Hospital, one of Europe's oldest hospitals. During the Middle Ages, the Catholic Church established universities to revive the study of sciences, drawing on the learning of Greek and Arab physicians in the study of medicine.
However, the fourteenth and fifteenth centuryBlack 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.[b] In the early modern period, important early figures in medicine and anatomy emerged in Europe, includingGabriele Falloppio andWilliam Harvey.
The major shift in medical thinking was the gradual rejection, especially during theBlack 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 – seeCopernicus's rejection ofPtolemy's theories on astronomy). Physicians likeVesalius improved upon or disproved some of the theories from the past. The main tomes used both by medicine students and expert physicians wereMateria Medica andPharmacopoeia.
Veterinary medicine was, for the first time, truly separated from human medicine in 1761, when the French veterinarianClaude Bourgelat founded the world's first veterinary school in Lyon, France. Before this, medical doctors treated both humans and other animals.
Modern scientificbiomedical research (where results are testable andreproducible) began to replace early Western traditions based on herbalism, the Greek "four humours" and other such pre-modern notions. The modern era really began withEdward Jenner's discovery of thesmallpox vaccine at the end of the 18th century (inspired by the method ofvariolation originated in ancient China),[70]Robert Koch's discoveries around 1880 of the transmission of disease by bacteria, and then the discovery ofantibiotics around 1900.
As science and technology developed, medicine became more reliant uponmedications. Throughout history and in Europe right until the late 18th century, not only plant products were used as medicine, but also animal (including human) body parts and fluids.[71]Pharmacology developed in part from herbalism and some drugs are still derived from plants (atropine,ephedrine,warfarin,aspirin,digoxin,vinca alkaloids,[72]taxol,hyoscine, etc.).[73]Vaccines were discovered by Edward Jenner andLouis Pasteur.
The first antibiotic wasarsphenamine (Salvarsan) discovered byPaul Ehrlich in 1908 after he observed that bacteria took up toxic dyes that human cells did not. The first major class of antibiotics was thesulfa drugs, derived by German chemists originally fromazo dyes.
Pharmacology has become increasingly sophisticated; modernbiotechnology allows drugs targeted towards specific physiological processes to be developed, sometimes designed for compatibility with the body to reduceside-effects.Genomics and knowledge ofhuman genetics andhuman evolution is having increasingly significant influence on medicine, as the causativegenes of most monogenicgenetic disorders have now been identified, and the development of techniques inmolecular biology,evolution, andgenetics are influencing medical technology, practice and decision-making.
Evidence-based medicine is a contemporary movement to establish the most effectivealgorithms of practice (ways of doing things) through the use ofsystematic reviews andmeta-analysis. The movement is facilitated by modern globalinformation 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. TheCochrane 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.[74]
Evidence-based medicine, prevention ofmedical error (and other "iatrogenesis"), and avoidance ofunnecessary 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 butpopulation health metrics lag similar nations.[75]
Globally, many developing countries lack access to care andaccess to medicines.[76] As of 2015[update], most wealthy developed countries provide health care to all citizens, with a few exceptions such as the United States where lack of health insurance coverage may limit access.[77]
^ Etymology:Latin:medicina, fromars medicina'the medical art', frommedicus'physician'.[6] Cf.mederi'to heal', etym.[clarification needed]'know the best course for', fromPIE base*med-'to measure, limit'. Cf.Greek:medos'counsel, plan',Avestan:vi-mad'physician'
^Michael Dols has shown that the Black Death was much more commonly believed by European authorities than by Middle Eastern authorities to be contagious; as a result, flight was more commonly counseled, and in urban Italy quarantines were organized on a much wider level than in urban Egypt or Syria.[65]
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^abCoulehan JL, Block MR (2005).The Medical Interview: Mastering Skills for Clinical Practice (5th ed.). F. A. Davis.ISBN978-0-8036-1246-4.OCLC232304023.
^Rana RE, Arora BS (2002). "History of plastic surgery in India".Journal of Postgraduate Medicine.48 (1):76–78.PMID12082339.
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