- See drugs, medication, and pharmacology for substances that treat patients. This article is about medical practice.
Medicine is both an area of knowledge (a science), and the application of that knowledge (the medical profession). The various specialized branches of the science of medicine correspond to equally specialized medical professions dealing with particular organs or diseases. The science of medicine is the body of knowledge about body systems and diseases, while the profession of medicine refers to the social structure of the group of people formally trained to apply that knowledge to treat disease.
There are traditional and schools of healing which are usually not considered to be part of (Western) medicine in a strict sense (see health science for an overview). The most highly developed systems of medicine outside of the Western or Hippocratic tradition are the Ayurvedic school (of India) and traditional Chinese medicine. The remainder of this article focuses on modern (Western) medicine.
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History of medicineSee the main articles History of medicine and Timeline of medicine and medical technology
Medicine as it is practiced now is rooted in various traditions, but developed mainly in the late 18th and early 19th century in Germany (Rudolf Virchow) and France (Jean-Martin Charcot and others). The new, "scientific" medicine replaced more traditional views based on the "Four humours". The development of clinical medicine shifted to the United Kingdom and the USA during the early 1900s (Sir William Osler, Harvey Cushing).
Genomics is already having a large influence on medical practice, as most monogenic genetic disorders have now been linked to causative genes, and molecular biological techniques are influencing medical decision-making.
Medical sciences and health professionsThe delivery of modern health care depends, not just on medical practitioners, but on an expanding group of highly trained professionals coming together as an interdisciplinary team. A full list is given on the health profession page. Some examples include: nurses, laboratory scientists, pharmacists, physiotherapists, speech therapists, occupational therapists, dieteticians and bioengineers.
The scope and sciences underpinning human medicine overlap many other fields. Dentistry and psychology, while separate disciplines from medicine, are sometimes also considered medical fields. Physician assistants, nurse practitioners and midwives treat patients and prescribe medication in many legal jurisdictions. Veterinary medicine applies similar techniques to the care of animals.
Medical doctors have many specializations and subspecializations which are listed below.
Basic, supplementary, and related sciences
- Anatomy is the study of the physical structure of organisms. In contrast to macroscopic or gross anatomy, cytology and histology 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.
- Bioethics is a field of study which concerns the relationship between biology, science, medicine and ethics, philosophy and theology.
- 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 to epidemiology and evidence-based medicine.
- Cytology is the microscopic study of individual cells.
- Embryology is the study of the early development of organisms.
- Epidemiology is the study of the demographics of disease processes, and includes, but is not limited to, the study of epidemics.
- Genetics is the study of genes, and their role in biological inheritance.
- Histology is the study of the structures of biological tissues by light microscopy, electron microscopy and histochemistry.
- Immunology is the study of the immune system, which includes the innate and adaptive immune system in human, for example.
- Microbiology is the study of microorganisms, including protozoa, bacteria, fungi, and viruses.
- Neuroscience is a comprehensive term for those disciplines of science that are related to the study of the nervous system. A main focus of neuroscience is the biology and physiology of the human brain.
- Pathology is the study of disease - the causes, course, progression and resolution thereof.
- Pharmacology is the study of drugs and their actions.
- Physiology is the study of the normal functioning of the body and the underlying regulatory mechanisms.
- Toxicology is the study of hazardous effects of drugs and poisons.
Diagnostic and imaging 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 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.
- Transfusion medicine is concerned with the transfusion of blood and blood component, including the maintenance of a "blood bank".
- Cellular pathology is concerned with diagnosis using samples from patients taken as tissues and cells using histology and cytology.
- Clinical chemistry is concerned with diagnosis by making biochemical analysis of blood, body fluids and tissues.
- Hematology is concerned with diagnosis by looking at changes in the cellular composition of the blood and bone marrow as well as the coagulation system in the blood.
- Clinical microbiology is concerned with the in vitro diagnosis of diseases caused by bacteria, viruses, fungi, and parasites.
- Clinical immunology is concerned with disorders of the immune system and related body defenses. It also deals with diagnosis of allergy.
- Radiology is concerned with imaging of the human body, e.g. by x-ray, x-ray computed tomography, ultrasonography, and nuclear magnetic resonance tomography.
- Interventional radiology is concerned with using imaging of the human body, usually from CT, ultrasound, or fluoroscopy, to do biopsies, place certain tubes, and perform intravascular procedures.
- Nuclear Medicine uses radioactive substances for in vivo and in vitro diagnosis using either imaging of the location of radioactive substances placed into a patient, or using in vitro diagnostic tests utilizing radioactive substances.
Disciplines of clinical medicine
- Anesthesiology (AE), 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.
- Emergency medicine is concerned with the diagnosis and treatment of acute or life-threatening conditions, including trauma, surgical, medical, pediatric, and psychiatric emergencies.
- General practice or family medicine or primary care is, in many countries, the first port-of-call for patients with non-emergency medical problems. Family doctors are usually able to treat over 90% of all complaints without referring to specialists.
- Intensive care medicine is concerned with the therapy of patients with serious and life-threatening disease or injury. Intensive care medicine employs invasive diagnostic techniques and (temporary) replacement of organ functions by technical means.
- Internal medicine is concerned with diseases of inner organs and systemic dieseases of adults, i.e. such that affect the body as a whole. There are several subdisciplines of internal medicine:
- Cardiology is concerned with the heart and cardiovascular system and their diseases.
- Clinical pharmacology is concerned with how systems of therapeutics interact with patients.
- Gastroenterology is concerned with the organs of digestion.
- Endocrinology is concerned with the endocrine system, i.e. endocrine glands and hormones.
- Hematology (or haematology) is concerned with the blood and its diseases.
- Infectious diseases is concerned with the study, diagnosis and treatment of diseases caused by biological agents.
- Nephrology is concerned with diseases of the kidneys.
- Oncology is devoted to the study, diagnosis and treatment of cancer and other malignant diseases.
- Pulmonology (or chest medicine, respiratory medicine or lung medicine) is concerned with diseases of the lungs and the respiratory system.
- Rheumatology is devoted to the diagnosis and treatment of inflammatory diseases of the joints and other organ systems.
- Neurology is concerned with the diagnosis and treatment of nervous system diseases.
- Obstetrics and gynecology are concerned respectively with childbirth and the female reproductive and associated organs. Reproductive medicine and fertility medicine is 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 disease (cancer, heart failure).
- Pediatrics (or paediatrics) is devoted to the care of children, and adolescents. Like internal medicine, there are many pediatric supspecialities 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, and pediatric oncology.
- Physical medicine and rehabilitation (or physiatry) is concerned with functional improvement after injury, illness, or congenital abnormality.
- Preventive medicine
- Community health care or public health
- Occupational medicine
- Psychiatry is a branch of medicine that studies and treats mental disorders. Related non-medical fields are psychotherapy and clinical psychology.
- Radiation therapy is concerned with the therapeutic use of ionizing radiation and high energy elementary particle beams in patient treatment.
- Surgical specialties - there are many medical disciplines that employ operative treatment. Some of these are highly specialized and are often not considered subdisciplines of surgery, although their naming might suggest so.
- General surgery is the specialty of surgery of the skin, locomotor system, and abdominal organs. In the past, it was deemed the pre-requisite training prior to progression to other sub-specialty training, but lately has evolved into its own sub-specialty.
- Cardiovascular surgery is the surgical specialty that is concerned with the heart and major blood vessels of the chest.
- Neurosurgery is concerned with the operative treatment of diseases of the nervous system.
- Oromaxillofacial surgery (technically a subspeciality of dentistry)
- Ophthalmology deals with the diseases of the eye and their treatment.
- Orthopedic surgery, surgery of the locomotor system, is generally practiced together with trauma surgery and/or traumatology.
- Otolaryngology (or otorhinolaryngology or ENT/ear-nose-throat) is concerned with treatment of ear, nose and throat disorders.
- Pediatric surgery
- Plastic surgery includes aesthetic surgery (operations that are done for other than medical purposes) as well as reconstructive surgery (operations to restore function and/or appearance after traumatic or operative mutilation).
- Surgical Oncology is concerned with ablative and palliative surgical approaches to cancer treatment
- Urology focuses on the urinary tracts of males and females, and on the male reproductive system. It is often practiced together with andrology ("men's health").
- Vascular surgery is surgery of the blood vessels, usually outside of the chest.
Interdisciplinary medical fieldsInterdisciplinary sub-specialties of medicine are:
- Aerospace medicine deals with medical problems related to flying and space travel.
- Diving medicine (or "hyperbaric medicine") is the prevention and treatment of diving-related problems.
- Forensic medicine deals with medical questions in legal context, such as determination of the time and cause of death.
- Medical informatics and medical computer science are relatively recent fields that deal with the application of computers and information technology to medicine.
- Nosology is the classification of diseases for various purposes.
Settings where medical care is deliveredSee also clinic, hospital, and hospice
Medicine is a diverse field and the provision of medical care is therefore provided in a variety of locations. In addition to inpatient hospital settings, medical services are often provided in locations such as emergency departements, endoscopy departments, outpatients department, operating theaters, and birth suites. Modern medical care also depends on information still delivered in many health care settings on paper records, but with increasing frequency by electronic means.
Teaching of medicineSee also the main articles Medical doctor (BE) and Physician (AE)
Medical training is involves several years of university study followed by several more years of residential practice at a hospital. Entry to a medical degree in some countries (such as the United States) requires the completion of another degree first, while in other countries (such as the United Kingdom) medical training can be commenced as an undergraduate degree immediately after secondary education. Once graduated from medical school most physicians begin their residency training, where skills in a speciality of medicine are learned, supervised by more experienced doctors. The first year of residency is known as the "intern" year. The duration of residency training depends on the speciality.
In the USA, physician training generally follows the following timeline (with age of completion):
- Finish high school at 18
- College/university, 4 years, graduate at 22
- Medical school, 4 years, graduate at 26 with M.D degree
- Residency (internship usually synonymous with first year of residency), 3 years, finish at 29. Physicians are generally eligible for independent licensure to practice primary care specialties at this point. Many surgical residencies are longer than 3 years.
- Fellowship, 3 year, finish at 32. Fellowships are taken to become eligible for board certification in subspecialties.
A medical graduate can then enter general practice and become a general practitioner (or primary care internist in the USA); training for these is generally shorter, while specialist training is typically longer.
Legal restrictionsIn most countries, it is prohibited to practice medicine without a proper degree in that field and doctors must be licensed by a medical board or some other equivalent organization. This is meant as a safeguard against charlatans. These laws are obstacles to those who would want to pretend to training and expertise they have not earned, such as practitioners of alternative medicine or faith healing.
CriticismCriticism against medicine has a long history. In the Middle Ages, it was not considered a profession suitable for Christians, as disease was considered Godsent, and interfering with the process a form of blasphemy. Barber-surgeons generally had a bad reputation that was not to improve until the development of academic surgery as a specialism of medicine, rather than an accessory field.
Through the course of the twentieth century, doctors naturally focused increasingly on the technology that was enabling them to make dramatic improvements in patients' health. This resulted in criticism for the loss of compassion and mechanistic, detached treatment. This issue started to reach collective professional consciousness in the 1970s and the profession had begun to respond by the 1980 and 1990s.
Perhaps the most devastating criticism came from Ivan Illich in his 1976 work Medical Nemesis. In his view, modern medicine only medicalises disease, causing loss of health and wellness, while generally failing to restore health by eliminating disease. The human being thus becomes a lifelong patient. 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.)
Criticism against 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 a large number of alternative approaches to health await scientific validation, many report improvement of symptoms after obtaining alternative therapies.
- Big killers
- Complementary and alternative medicine
- Health profession
- Healthcare system
- List of diseases
- List of medical abbreviations
- List of medical schools in the U.S
- Medical equipment
- Rare diseases
- The US National Library of Medicine
- Virtual Hospital - digital library of health information
- Online Medical Dictionary