Acronym Definition
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AQUM Approved Quality Use of Medicines
Medicine is the science and "" of maintaining and/or restoring human health
through the study, diagnosis, and treatment of patients. The term is derived
from the Latin ars medicina meaning the art of healing.
The modern practice of medicine occurs at the many interfaces between the art of
healing and various sciences. Medicine is directly connected to the health
sciences and biomedicine. Broadly speaking, the term 'Medicine' today refers to
the fields of clinical medicine, medical research and surgery, thereby covering
the challenges of disease and injury.
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The Rod of Asclepius, with its single snake, is an ancient Greek symbol
associated with medicine. The American Medical Association, the American
Osteopathic Association, the Royal Society of Medicine, the Australian Medical
Association, the British Medical Association, and the World Health Organization
display the Rod of Asclepius in their logos or emblems.
Overview
Since the 19th century, only those with a medical degree have been considered
eligible 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, Traditional 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.
History of medicine
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Physician treating a patient. Louvre Museum, Paris, France.
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 in ancient Egypt, India, China,
Greece, Persia, the Islamic world, medieval Europe, and elsewhere. Medicine as
it is now practiced largely developed during the 2nd millenium in Spain (Abulcasis,
11th century), Persia (Avicenna, 11th century), Syria (Ibn al-Nafis, 13th
century), England (William Harvey, 17th 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. 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 during the Black Death 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.
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Drug ampoules
Genomics 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 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 of these was arsphenamine
/ Salvarsan discovered by Paul Ehrlich in 1908 after he observed that bacteria
took up toxic dyes that human cells did not. The first major class of
antibiotics was the sulfa drugs, derived by French chemists 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 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
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Artificial biomedical insemination
The 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.[3]
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
Primary care medical services are provided by physicians or other health
professionals who have 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.
Patient-physician-relationship
The examples and perspective in this article or section may not represent a
worldwide view of the subject.
This kind of 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
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.[4]
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 (DHx): 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
profession also besides medical practitioners are involved in the delivery of
modern health care. Some examples include: nurse(s) emergency medical
technicians and paramedics, laboratory scientists, (pharmacy, pharmacists), (physiotherapy,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. The original focus of veterinary medicine was primarily the
health care of domestic animals. In recent years the discipline has broadened to
include all vertebrate animals and even some of the more economically valuable
or scientifically interesting invertebrates. Veterinary and human medicine had
similar origins but diverged in the West largely under the influence of
Christian doctrine which emphasized a fundamental difference between humans and
all other species. The two disciplines re-converged to some degree after the
Renaissance when scientific study of anatomy and physiology revealed undeniable
similarities between humans and other animals. The similarities further extend
into pathology and disease control leading the early pioneer in scientific
pathology Rudolph Virchow to proclaim the doctrine of "one medicine."
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 role 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
* Anesthesiology (AE) or anaesthesia (BE) is the clinical discipline concerned
with providing anesthesia. Pain medicine is often practiced by specialised
anesthesiologists/anesthetists.
* 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
* Critical Care
* Endocrinology
* Gastroenterology
* Hematology
* Infectious Diseases
* Intensive care medicine
* Nephrology
* Oncology
* Pulmonology
* Rheumatology
* Urology
* 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.
* Disaster medicine deals with medical aspects of emergency preparedness,
disaster mitigation and management.
* 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.
* Keraunomedicine is the medical study of lightning casualties.
* 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, medical information 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.
* Occupational Medicine deals with medical problems related to work and the
working environment.
* Osteopathic medicine claims that much disease results from problems with bones
and joints.
* Pharmacogenomics is a form of individualized medicine.
* Sports medicine deals with the treatment and preventive care of athletes,
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 http://www.britannica.com/eb/article-9106176?query=Therapeutics&ct=.
* Travel medicine or emporiatrics deals with health problems of international
travelers or travelers across highly different environments.
Medical education
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.
Presently, in England, a typical medicine course at university is 5 years (4 if
the student already holds a degree). Amongst some institutions and for some
students, it may be 6 years (including the selection of an intercalated BSc -
taking one year - at some point after the pre-clinical studies). This is
followed by 2 Foundation years afterwards, namely F1 and F2. Students register
with the UK General Medical Council at the end of F1. At the end of F2, they may
pursue further years of study.
In the USA, a potential medical student must first complete an undergraduate
degree (Typically a BSc with a major in biology, biochemistry or medical
science), before applying to a graduate medical school to pursue the M.D.
In Australia, students have two options. They can choose to take a six-year
undergraduate Bachelor of Medicine/Bachelor of Surgery (MBBS) straight from high
school, or complete a undergraduate degree and then a four year Bachelor of
Medicine/Bachelor of Surgery (BMBS) program.
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.
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.
The noted anarchist Ivan Illich heavily criticized modern medicine. 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.[5] 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 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 some 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. Some physicians combine alternative medicine with
orthodox approaches.
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.
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More IJFG.COM Jokes, Pranks, Runescape and other cool games at IJFG.COM.
RuneScape is set in a medieval fantasy world, similar to "Guild Wars" or
"EverQuest", where players control character representations of themselves. As
with most massive multiplayer online roleplaying games (MMORPG), there is no
overall objective or end to the game. Players explore, form alliances, perform
optional tasks, and complete quests for rewards and to build character's skills.
RuneScape has often been one of
the top massive online role playing games. It is a unique game. But, with a
unique game, comes unique players. Players get bored, and then try to develop
cheats....autos or bots that will help them achieve success in their beloved
games of Runescape 2.
RuneScape is a virtual world which
is divided into two part: Members Areas and Non-Members areas. People who pay to
play (p2p), receive access to the special areas. They also have access to the
free areas. The members' places are much larger, offer "better" items for the
gameplay of rs2, and much, much more. The character that you create when you
first start playing runescape, moves around the game on foot; either by running,
or walking. Players are challenged to their utmost skills by fighting new
monsters, completing difficult quests, and manipulating marketing. As Runescape
2 is an RPG (Role playing game), there is no set path a person must take to play
rs. They can choose what to do, and when, whether it be training their
money-making skills, or fighting another player. Players usually interact with
each other by chatting through public chat, or private chat.Internet
Junction For Gamers, Runescape Market and More IJFG.COM IJFG.com was a
runescape 2 based site. They have now, however, taken another look....
Of course the king of all game
cheating websites is
trick
the trik (otherwise known as RPG Cheats Site), where you can find cheat
forums, mmorpg topsite, arcade games and any mmo game related topics.
The master of massive multiplayer
online role-playing games (MMORPG) cheats can be found at Trik.com
Trik.com; this site is one of the best today. The forum section,
Trik.com forum, originally came from IJFG.com (Internet Junction For
Gamers) , which was one of the best websites that discussed various gamers'
issues. The full name was Internet Junction For Gamers, Runescape Market and
More. This site had Jokes, Pranks, RuneScape and other cool games. RuneScape is
set in a medieval fantasy world, similar to "Guild Wars" or "EverQuest," where
players control character representations of themselves. As with most MMORPG,
there is no overall objective or end to the game. Players explore, form
alliances, perform optional tasks, and complete quests for rewards and to build
characters' skills.
Trik.com continues IJFG.com's
success, but Trik.com has more to offer. Trik Topsite can be found at
Trik Topsite; the TopSite is a great addition if you want to find the best
MMO RPG site(s) or raise your site in the rankings. Trik.com also has a
viciously competitive Arcade. If you want to be the #1 Arcade on Trik, then come
prove yourself at Trik.com arcade:
Trik arcade. Trik.com ?Trik.com/topsite ?Trik.com/forum/arcade.php
With the rising popularity of
commercial MMORPG games came the desire from ardent players of these games to
run their own servers beside the ones run by the game's creator. Since the
original server software is not usually available, the behavior of the server
has to be re-engineered. This can be done by analyzing the data stream with the
original server, or by disassembling and analyzing the client which is
available.
Ultima Online was one of the first
large MMORPGs. Due to its openness in implementation, server emulators arose
very quickly, even during the beta stage of development. The destination to
which the client connects was changeable by simply editing a text file. In beta
stage the client-server data stream was not encrypted yet. The term server
emulator became known through Ultima Online server reimplementation such as UOX,
which was the pioneer. Many forks and reimplementations followed UOX, because
its source code was released under the GNU General Public License relatively
early. RunUO is today the most widely used UO-server emulator. After RuneScape
implemented anti-cheating measures, many gamers left and started their own
private servers. The best place to discuss the private server is at
Trik- The Master of Private Server.
Another useful site is
Rune
Web ruwb.com . This site is about more serious RuneScape gold trading,
account exchange, gold for real life cash and many services. It includes tips on
how to avoid getting lured/scammed while using the marketplace. For programming,
visual basics, java, C/C++, scar and all other languages such as PHP, HTML, ASP,
Delphi. There are also sections for graphics talents, plus many cool videos and
fun stuff.
A defining moment in internet
gaming history was when a group of gamers called (hygo 7) decided to start an
ultimate game forum, which they named
hygo.com. It has the best financial backing, the friendliest game community,
and the highest quality of information. Currently Hygo.com has entered a new
phase...Hygo.com is offering the best private server game. With thousands of
members, Hygo.com is your next place to visit, as they have an amazing game with
a community and economy.
Hygo.com - The Online Adventure Game. is definitely one of the top sites you
want to join right now!
EZud is another popular site.
ezud.com. It has the best runescape bug abuse, bugs and trik.
ezud.com - The runescape bugs. is definitely one of the best sites you want
to join right now!
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