Overview
Since the nineteenth century, only those with a medical degree have been
considered to practice medicine. Clinicians (licensed professionals who deal
with patients) can be physicians, physical therapists, physician assistants,
nurses or others. The medical profession is the social and occupational
structure of the group of people formally trained and authorized to apply
medical knowledge. Many countries and legal jurisdictions have legal limitations
on who may practice medicine.
Medicine comprises various specialized sub-branches, such as cardiology,
pulmonology, neurology, or other fields such as sports medicine, research or
public health.
Human societies have had various different systems of health care practice since
at least the beginning of recorded history. Medicine, in the modern period, is
the mainstream scientific tradition which developed in the Western world since
the early Renaissance (around 1450). Many other traditions of health care are
still practiced throughout the world; most of these are separate from Western
medicine, which is also called biomedicine, allopathic medicine or the
Hippocratic tradition. The most highly developed of these are traditional
Chinese medicine, Tibetan medicine and the Ayurvedic traditions of India and Sri
Lanka. Various non-mainstream traditions of health care have also developed in
the Western world. These systems are sometimes considered companions to
Hippocratic medicine, and sometimes are seen as competition to the Western
tradition. Few of them have any scientific confirmation of their tenets, because
if they did they would be brought into the fold of Western medicine.
"Medicine" is also often used amongst medical professionals as shorthand for
internal medicine. Veterinary medicine is the practice of health care in animal
species other than human beings.
Osteopathic medicine is another approach to disease and treatment. Osteopathy
claims that much disease results from problems with bones and joints. Treatment
consists in the main of various manipulations. A practitioner of osteopathic
medicine receives a D.O. degree (doctor of osteopathy).
History of Western medicine
Physician treating a patient. Louvre Museum, Paris, France.Main article: History
of medicine
Writing about various aspects of Western medicine often starts with a brief
historical overview. Such historical introductions often take little account of
up-to-date theoretical developments amongst professional medical historians, and
tend to reproduce the style and content of obsolete histories. They also often
include a goal-driven, "Whig version of history", and a focus on the European
tradition to the exclusion of the history of medicine in Africa, Asia, or the
early Americas, and an assumption of a distinction between apparently rational
forms of healing and other forms of healing such as folk or alternative
medicine. The reader is referred to the History of Medicine where the topic is
developed in more depth.
The earliest type of medicine in most cultures was the use of plants (Herbalism)
and animal parts. This was usually in concert with 'magic' of various kinds in
which: animism (the notion of inanimate objects having spirits); spiritualism
(here meaning an appeal to gods or communion with ancestor spirits); shamanism
(the vesting of an individual with mystic powers); and divination (the supposed
obtaining of truth by magic means), played a major role.
The practice of medicine developed gradually, and separately, in ancient Egypt,
India, China, Greece, Persia and elsewhere. Medicine as it is practiced now
developed largely in the late eighteenth century and early nineteenth century in
England (William Harvey, seventeenth century), Germany (Rudolf Virchow) and
France (Jean-Martin Charcot, Claude Bernard and others). The new, "scientific"
medicine (where results are testable and repeatable) replaced early Western
traditions of medicine, based on herbalism, the Greek "four humours" and other
pre-modern theories.[citation needed] The focal points of development of
clinical medicine shifted to the United Kingdom and the USA by the early 1900s
(Canadian-born)Sir William Osler, Harvey Cushing). Possibly the major shift in
medical thinking was the gradual rejection in the 1400s 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
- see Copernicus's rejection of Ptolemy's theories on astronomy). People like
Vesalius led the way in improving upon or indeed rejecting the theories of great
authorities from the past such as Galen, Hippocrates, and Avicenna/Ibn Sina, all
of whose theories were in time almost totally discredited. Such new attitudes
were also only made possible by the weakening of the Roman Catholic church's
power in society, especially in the Republic of Venice.
Evidence-based medicine is a recent movement to establish the most effective
algorithms of practice (ways of doing things) through the use of the scientific
method and modern global information science by collating all the evidence and
developing standard protocols which are then disseminated to healthcare
providers. One problem with this 'best practice' approach is that it could be
seen to stifle novel approaches to treatment.
Drug ampoulesGenomics and knowledge of human genetics is already having some
influence on medicine, as the causative genes of most monogenic genetic
disorders have now been identified, and the development of techniques in
molecular biology and genetics are influencing medical practice and
decision-making.
Pharmacology has developed from herbalism and many drugs are still derived from
plants (atropine, ephedrine, warfarin, aspirin, digoxin, vinca alkaloids, taxol,
hyoscine, etc). The modern era really began with Robert Koch's discoveries
around 1880 of the transmission of disease by bacteria, and then the discovery
of antibiotics shortly thereafter around 1900. The first major class of
antibiotics was the sulfa drugs, derived originally from azo dyes. Throughout
the twentieth century, major advances in the treatment of infectious diseases
were observable in (Western) societies. The medical establishment is now
developing drugs that are targeted towards one particular disease process. Thus
drugs are being developed to minimise the side effects of prescribed drugs, to
treat cancer, geriatric problems, long-term problems (such as high cholesterol),
chronic diseases type 2 diabetes, lifestyle and degenerative diseases such as
arthritis and Alzheimer's disease....
Practice of medicine
Artificial biomedical inseminationThe practice of medicine combines both science
as the evidence base and art in the application of this medical knowledge in
combination with intuition and clinical judgment to determine the treatment plan
for each patient.
Central to medicine is the patient-physician relationship established when a
person with a health concern seeks a physician's help; the 'medical encounter'.
Other health professionals similarly establish a relationship with a patient and
may perform various interventions, e.g. nurses, radiographers and therapists.
As part of the medical encounter, the healthcare provider needs to:
develop a relationship with the patient
gather data (medical history, systems enquiry, and physical examination,
combined with laboratory or imaging studies (investigations))
analyze and synthesize that data (assessment and/or differential diagnoses), and
then:
develop a treatment plan (further testing, therapy, watchful observation,
referral and follow-up)
treat the patient accordingly
assess the progress of treatment and alter the plan as necessary (management).
The medical encounter is documented in a medical record, which is a legal
document in many jurisdictions.[2]
Health care delivery systems
Medicine is practiced within the medical system, which is a legal, credentialing
and financing framework, established by a particular culture or government. The
characteristics of a health care system have significant effect on the way
medical care is delivered.
Financing has a great influence as it defines who pays the costs. Aside from
tribal cultures, the most significant divide in developed countries is between
universal health care and market-based health care (such as practiced in the
U.S.). Universal health care might allow or ban a parallel private market. The
latter is described as single-payer system.
Transparency of information is another factor defining a delivery system. Access
to information on conditions, treatments, quality and pricing greatly affects
the choice by patients / consumers and therefore the incentives of medical
professionals. While US health care system has come under fire for lack of
openness, 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.
Health care delivery
See also: clinic, hospital, and hospice
Paint of Henriette BrowneMedical care delivery is classified into primary,
secondary and tertiary care.
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 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 and health education for all ages and both
sexes.
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 first diagnosed or treated the patient. Referrals are
made for those patients who required the expertise or procedures performed by
specialists. These include both ambulatory care and inpatient 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 provided by specialist hospitals or regional
centers equipped with diagnostic and treatment facilities not generally
available at local hospitals. These include trauma centers, burn treatment
centers, advanced neonatology unit services, organ transplants, high-risk
pregnancy, radiation oncology, etc.
Modern medical care also depends on information - still delivered in many health
care settings on paper records, but increasingly nowadays by electronic means.
Physician-patient relationship
The physician-patient relationship and interaction is a central process in the
practice of medicine. There are many perspectives from which to understand and
describe it.
An idealized physician's perspective, such as is taught in medical school, sees
the core aspects of the process as the physician learning the patient's
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. The job of a physician is
similar to a human biologist: that is, to know the human frame and situation in
terms of normality. Once the physician knows what is normal and can measure the
patient against those norms, he or she can then determine the particular
departure from the normal and the degree of departure. This is called the
diagnosis.
The four great cornerstones of diagnostic medicine are anatomy (structure: what
is there), physiology (how the structure/s work), pathology (what goes wrong
with the anatomy and physiology) and psychology (mind and behavior). In
addition, the physician should consider the patient in their 'well' context
rather than simply as a walking medical condition. This means the
socio-political context of the patient (family, work, stress, beliefs) should be
assessed as it often offers vital clues to the patient's condition and further
management. In more detail, the patient presents a set of complaints (the
symptoms) to the physician, who then obtains further information about the
patient's symptoms, previous state of health, living conditions, and so forth.
The physician then makes a review of systems (ROS) or systems inquiry, which is
a set of ordered questions about each major body system in order: general (such
as weight loss), endocrine, cardio-respiratory, etc. Next comes the actual
physical examination; the findings are recorded, leading to a list of possible
diagnoses. These will be in order of probability. The next task is to enlist the
patient's agreement to a management plan, which will include treatment as well
as plans for follow-up. Importantly, during this process the healthcare provider
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-physician relationship is
additionally complicated by the patient's suffering (patient derives from the
Latin patior, "suffer") and limited ability to relieve it on his/her own. The
physician's expertise comes from his knowledge of what is healthy and normal
contrasted with knowledge and experience of other people who have suffered
similar symptoms (unhealthy and abnormal), and the proven ability to relieve it
with medicines (pharmacology) or other therapies about which the patient may
initially have little knowledge.
The physician-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.
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 healthcare
providers and patients in many ways.
The quality of the patient-physician 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. Where such a relationship is poor the
physician's ability to make a full assessment is compromised and the patient is
more likely to distrust the diagnosis and proposed treatment. In these
circumstances and also in cases where there is genuine divergence of medical
opinions, a second opinion from another physician may be sought.
In some settings, e.g. the hospital ward, the patient-physician 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 history and Physical examination
A complete medical evaluation includes a medical history, a systems enquiry, a
physical examination, appropriate laboratory or imaging studies, analysis of
data and medical decision making to obtain diagnoses, and a treatment plan.[3]
The components of the medical history are:
Chief complaint (CC): the reason for the current medical visit. These are the
'symptoms.' They are in the patient's own words and are recorded along with the
duration of each one. Also called 'presenting complaint.'
History of present illness / complaint (HPI): the chronological order of events
of symptoms and further clarification of each symptom.
Current activity: occupation, hobbies, what the patient actually does.
Medications: what drugs the patient takes including prescribed,
over-the-counter, and home remedies, as well as alternative and herbal
medicines/herbal remedies such as St. John's Wort. Allergies are also recorded.
Past medical history (PMH/PMHx): concurrent medical problems, past
hospitalizations and operations, injuries, past infectious diseases and/or
vaccinations, history of known allergies.
Social history (SH): birthplace, residences, marital history, social and
economic status, habits (including diet, medications, tobacco, alcohol).
Family history (FH): listing of diseases in the family that may impact the
patient. A family tree is sometimes used.
Review of systems (ROS) or systems inquiry: a set of additional questions to ask
which may be missed on HPI: a general enquiry (have you noticed any weight loss,
fevers, lumps and bumps? etc), followed by questions on the body's main organ
systems (heart, lungs, digestive tract, urinary tract, etc).
The physical examination is the examination of the patient looking for signs of
disease ('Symptoms' are what the patient volunteers, 'Signs' are what the
healthcare provider detects by examination). The healthcare provider uses the
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 (feel), percussion (tap to determine resonance
characteristics), and auscultation (listen); smelling may be useful (e.g.
infection, uremia, diabetic ketoacidosis). The clinical examination involves
study of:
Vital signs including height, weight, body temperature, blood pressure, pulse,
respiration rate, hemoglobin oxygen saturation
General appearance of the patient and specific indicators of disease
(nutritional status, presence of jaundice, pallor or clubbing)
Skin
Head, eye, ear, nose, and throat (HEENT)
Cardiovascular (heart and blood vessels)
Respiratory (large airways and lungs)
Abdomen and rectum
Genitalia (and pregnancy if the patient is or could be pregnant)
Musculoskeletal (spine and extremities)
Neurological (consciousness, awareness, brain, cranial nerves, spinal cord and
peripheral nerves)
Psychiatric (orientation, mental state, evidence of abnormal perception or
thought)
Laboratory and imaging studies results may be obtained, if necessary.
The medical decision-making (MDM) process involves 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.
The treatment plan may include ordering additional laboratory tests and studies,
starting therapy, referral to a specialist, or watchful observation. Follow-up
may be advised.
This process is used by primary care providers as well as specialists. It may
take only a few minutes if the problem is simple and straightforward. On the
other hand, it may take weeks in a patient who has been hospitalized with
bizarre symptoms or multi-system problems, with involvement by several
specialists.
On subsequent visits, the process may be repeated in an abbreviated manner to
obtain any new history, symptoms, physical findings, and lab or imaging results
or specialist consultations.
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: nurses, emergency medical technicians
and paramedics, laboratory scientists, pharmacists, physiotherapists,
respiratory therapists, speech therapists, occupational therapists,
radiographers, dietitians and bioengineers.
The scope and sciences underpinning human medicine overlap many other fields.
Dentistry and psychology, while separate disciplines from medicine, are
considered medical fields.
Midlevel Practitioners
Nurse practitioners, midwives and physician assistants, treat patients and
prescribe medication in many legal jurisdictions.
Veterinary Medicine
Veterinarians apply similar techniques as physicians to the care of animals.
Physicians have many specializations and subspecializations which are listed
below. There are variations from country to country regarding which specialties
certain subspecialities are in.
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 medical technology degree, who actually perform the tests,
assays, and procedures needed for providing the specific services.
Pathology is the branch of medicine that deals with the study of diseases and
the morphologic, physiologic changes produced by them. As a diagnostic
specialty, pathology can be considered the basis of modern scientific medical
knowledge and plays a large rôle in evidence-based medicine. Many modern
molecular tests such as flow cytometry, polymerase chain reaction (PCR),
immunohistochemistry, cytogenetics, gene rearragements studies and fluorescent
in situ hybridization (FISH) fall within the territory of pathology.
Radiology is concerned with imaging of the human body, e.g. by x-rays, x-ray
computed tomography, ultrasonography, and nuclear magnetic resonance tomography.
Clinical disciplines
Surgery being performedAnesthesiology (AE) or anaesthesia (BE) is the clinical
discipline concerned with providing anesthesia. Pain medicine is often practiced
by specialised anesthesiologists.
Dermatology is concerned with the skin and its diseases. In the UK, dermatology
is a subspeciality of general medicine.
Emergency medicine is concerned with the diagnosis and treatment of acute or
life-threatening conditions, including trauma, surgical, medical, pediatric, and
psychiatric emergencies.
Gender-based medicine studies the biological and physiological differences
between the human sexes and how that affects differences in disease.
General practice, family practice, family medicine or primary care is, in many
countries, the first port-of-call for patients with non-emergency medical
problems. Family practitioners are usually able to treat over 90% of all
complaints without referring to specialists.
Geriatrics focuses on health promotion and the prevention and treatment of
disease and disability in later life.
Hospital medicine is the general medical care of hospitalized patients.
Physicians whose primary professional focus is hospital medicine are called
hospitalists in the USA.
Internal medicine is concerned with systemic diseases of adults, i.e. those
diseases that affect the body as a whole (restrictive, current meaning), or with
all adult non-operative somatic medicine (traditional, inclusive meaning), thus
excluding pediatrics, surgery, gynaecology and obstetrics, and psychiatry. There
are several subdisciplines of internal medicine:
Cardiology
Endocrinology
Gastroenterology
Hematology
Infectious Diseases
Intensive care medicine
Nephrology
Oncology
Pulmonology
Rheumatology
Neurology is concerned with the diagnosis and treatment of nervous system
diseases. It is a subspeciality of general medicine in the UK.
Obstetrics and gynaecology (often abbreviated as Ob/Gyn) are concerned
respectively with childbirth and the female reproductive and associated organs.
Reproductive medicine and fertility medicine are generally practiced by
gynecological specialists.
Palliative care is a relatively modern branch of clinical medicine that deals
with pain and symptom relief and emotional support in patients with terminal
illnesses including cancer and heart failure.
Pediatrics (AE) or paediatrics (BE) is devoted to the care of infants, children,
and adolescents. Like internal medicine, there are many pediatric
subspecialities for specific age ranges, organ systems, disease classes, and
sites of care delivery. Most subspecialities of adult medicine have a pediatric
equivalent such as pediatric cardiology, pediatric endocrinology, pediatric
gastroenterology, pediatric hematology, pediatric oncology, pediatric
ophthalmology, and neonatology.
Physical medicine and rehabilitation (or physiatry) is concerned with functional
improvement after injury, illness, or congenital disorders.
Preventive medicine is the branch of medicine concerned with preventing disease.
Psychiatry is the branch of medicine concerned with the bio-psycho-social study
of the etiology, diagnosis, treatment and prevention of cognitive, perceptual,
emotional and behavioral disorders. Related non-medical fields include
psychotherapy and clinical psychology.
Radiation therapy is concerned with the therapeutic use of ionizing radiation
and high energy elementary particle beams in patient treatment.
Radiology is concerned with the interpretation of imaging modalities including
x-rays, ultrasound, radioisotopes, and MRI (Magnetic Resonance Imaging). A newer
branch of radiology, interventional radiology, is concerned with using medical
devices to access areas of the body with minimally invasive techniques.
Surgical specialties employ operative treatment. These include Orthopedics,
Urology, Ophthalmology, Neurosurgery, Plastic Surgery, Otolaryngology and
various subspecialties such as transplant and cardiothoracic. Some disciplines
are highly specialized and are often not considered subdisciplines of surgery,
although their naming might suggest so.
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.
Interdisciplinary fields
Interdisciplinary sub-specialties of medicine are:
Aerospace medicine deals with medical problems related to flying and space
travel.
Bioethics is a field of study which concerns the relationship between biology,
science, medicine and ethics, philosophy and theology.
Biomedical Engineering is a field dealing with the application of engineering
principles to medical practice.
Clinical pharmacology is concerned with how systems of therapeutics interact
with patients.
Conservation medicine studies the relationship between human and animal health,
and environmental conditions. Also known as ecological medicine, environmental
medicine, or medical geology.
Diving medicine (or hyperbaric medicine) is the prevention and treatment of
diving-related problems.
Evolutionary medicine is a perspective on medicine derived through applying
evolutionary theory.
Forensic medicine deals with medical questions in legal context, such as
determination of the time and cause of death.
Medical humanities includes the humanities (literature, philosophy, ethics,
history and religion), social science (anthropology, cultural studies,
psychology, sociology), and the arts (literature, theater, film, and visual
arts) and their application to medical education and practice.
Medical informatics, medical computer science, and eHealth are relatively recent
fields that deal with the application of computers and information technology to
medicine.
Naturopathic medicine is concerned with primary care, natural remedies, patient
education and disease prevention.
Nosology is the classification of diseases for various purposes.
Pharmacogenomics is a form of individualized medicine.
PanVascular Medicine is an approach to deal with the problems of highly
specialised but both, medical and economical inefficiently arranged human
resources and medical equipment in today's vascular care facilities
Sports medicine deals with the treatment and preventive care of athletics,
amateur and professional. The team includes specialty physicians and surgeons,
athletic trainers, physical therapists, coaches, other personnel, and, of
course, the athlete.
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 [1] [2].
Travel medicine or emporiatrics deals with health problems of international
travelers or travelers across highly different environments.
Medical education
An image of a 1901 examination in the faculty of medicine.Main articles: Medical
education and Medical school
Medical education is education connected to the practice of being a medical
practitioner, either the initial training to become a physician or further
training thereafter.
Medical education and training varies considerably across the world, however
typically involves entry level education at a university medical school,
followed by a period of supervised practice (Internship and/or Residency) and
possibly postgraduate vocational training. Continuing medical education is a
requirement of many regulatory authorities.
Various teaching methodologies have been utilised in medical education, which is
an active area of educational research.
Legal restrictions
In most countries, it is a legal requirement for medical doctors 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 against charlatans that practice inadequate medicine for personal
gain. While the laws generally require medical doctors to be trained in
"evidence based", Western, or Hippocratic Medicine, they are not intended to
discourage different paradigms of health.
Criticism
Criticism of medicine has a long history. In the Middle Ages, some people did
not consider it a profession suitable for Christians, as disease was often
considered God-sent. God was considered to be the 'divine physician' who sent
illness or healing depending on his will. However many monastic orders,
particularly the Benedictines, considered the care of the sick as their chief
work of mercy. Barber-surgeons generally had a bad reputation that was not to
improve until the development of academic surgery as a speciality of medicine,
rather than an accessory field. [citation needed]
Through the course of the twentieth century, healthcare providers focused
increasingly on the technology that was enabling them to make dramatic
improvements in patients' health. The ensuing development of a more mechanistic,
detached practice, with the perception of an attendant loss of patient-focused
care, known as the medical model of health, led to further criticisms. This
issue started to reach collective professional consciousness in the 1970s and
the profession had begun to respond by the 1980s and 1990s. [citation needed]
Perhaps the most devastating criticism of modern medicine came from Ivan Illich.
In his 1976 work Medical Nemesis, Illich stated that modern medicine only
medicalises disease and causes loss of health and wellness, while generally
failing to restore health by eliminating disease. This medicalisation of disease
forces the human to become a lifelong patient.[4]Other less radical philosophers
have voiced similar views, but none were as virulent as Illich. Another example
can be found in Technopoly: The Surrender of Culture to Technology by Neil
Postman, 1992, which criticises overreliance on technological means in medicine.
[citation needed]
Criticism of modern medicine has led to some improvements in the curricula of
medical schools, which now teach students systematically on medical ethics,
holistic approaches to medicine, the biopsychosocial model and similar concepts.
The inability of modern medicine to properly address many common complaints
continues to prompt many people to seek support from alternative medicine.
Although most alternative approaches lack scientific validation, some may be
effective in individual cases. The bioscience and alternative health care
paradigms may differ to such an extent that what constitutes scientific evidence
is contested.[citation needed] Many physicians practice alternative medicine
alongside "orthodox" approaches but the general body of medical practitioners is
often criticised for ignoring the purported value of alternative
medicine.[citation needed]
Medical errors and overmedication are also the focus of many complaints and
negative coverage. Practitioners of human factors engineering believe that there
is much that medicine may usefully gain by emulating concepts in aviation
safety, where it was long ago realized that it is dangerous to place too much
responsibility on one "superhuman" individual and expect him or her not to make
errors. Reporting systems and checking mechanisms are becoming more common in
identifying sources of error and improving practice.
Radical critics of certain medical traditions may hold that whole fields or
traditions of medicine are intrinsically harmful or ineffective. They would
reject any use or support of practices belonging to that tradition.[citation
needed] However, generally, there is a spectrum of efficacy on which all
traditions lie; some are more effective, some are less effective, but nearly all
contain some harmful practices and some effective ones. Naturally, though, most
individuals or groups seeking a health care practice to improve their own health
would seek a tradition with the maximum degree of efficacy. There is no doubt
whatsoever that Western Allopathic medicine, together with its cohorts of
improved hygiene and nutrition, have been collectively responsible for most of
the improvements in health worldwide over the last century or so, including:
increasing longevity, decreased child mortality, increasing population numbers,
better ability to monitor and halt disease spread and outbreaks, improved access
to health care for all strata of society.
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