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Medicine is the science and practice of caring for , managing the diagnosis, prognosis, prevention, therapy and Palliative care of their injury or disease, while Health promotion. Medicine encompasses a variety of health care practices which evolved to maintain and restore health through the prevention and treatment of illness. Contemporary medicine applies biomedical sciences, biomedical research, medical genetics, and medical technology to diagnose, treat, and prevent injury and disease, typically through various or surgery, but also through therapies such as psychotherapy, external splints and traction, , biologics, and ionizing radiation, amongst others.
Medicine has been practiced since prehistoric times, and for most of this time it was an art (an area of creativity and skill), frequently having connections to the religion and philosophy beliefs of local culture. For example, a medicine man would apply herbs and say for healing, or an ancient philosopher and physician would apply bloodletting according to the theories of humorism, or the four humors. In recent centuries, since the advent of modern science, most medicine has become a combination of art and science (both basic and applied science, under the umbrella term of medical science). For example, while stitching technique for surgical suture is an art learned through practice, knowledge of what happens at the cytology and molecular level in the tissues being stitched arises through science.
Prescientific forms of medicine, now known as traditional medicine or folk medicine, remain commonly used in the absence of scientific medicine and are thus called alternative medicine. Alternative treatments outside of scientific medicine with ethical, safety and efficacy concerns are termed quackery or being based on Fringe science
In the developed world, evidence-based medicine (EBM) is not universally applied in clinical practice; for example, a 2007 survey of literature reviews found that about 49% of medical interventions lacked sufficient evidence to support either benefit or harm. However, medical practitioners who apply an intervention with uncertain efficacy without adequate justification, transparency, or patient consent may violate the Bioethics principle of non-maleficence, a core tenet of biomedical ethics historically associated with the Hippocratic Oath, which emphasizes a primary duty to "first, do no harm."
In modern clinical practice, physicians and mid-level practitioners such as physician assistants personally assess patients to diagnose, prognose, treat, and prevent disease using clinical judgment. An initial medical encounter with a patient typically begins with a review of the patient's medical history and medical record, followed by a medical interview (2026). 9780803612464, F. A. Davis. ISBN 9780803612464 and a physical examination. Basic diagnostic (e.g., stethoscope, tongue depressor) are typically used. After examining for Medical sign and interviewing for symptoms, the doctor may order (e.g., ), take a biopsy, or prescribe pharmaceutical drugs or other therapies. Differential diagnosis methods help to rule out conditions based on the information provided. During the encounter, properly informing the patient of all relevant facts is an important part of the relationship and the development of trust within the context of the doctor-patient relationship. The medical encounter is then documented in the medical record, which is a legal document in many jurisdictions. Follow-up encounters may be shorter but follow the same general procedure, and specialists follow a similar process. The diagnosis and treatment may take only a few minutes or a few weeks, depending on the complexity of the issue.
The components of the medical interview and encounter are:
The physical examination is the examination of the patient for medical signs of disease that are objective and observable, in contrast to symptoms that are volunteered by the patient and are not necessarily objectively observable. The healthcare provider uses sight, hearing, touch, and sometimes smell (e.g., in infection, uremia, diabetic ketoacidosis). Four actions are the basis of physical examination: inspection, palpation (feel), percussion (tap to determine resonance characteristics), and auscultation (listen), generally in that order, although auscultation occurs prior to percussion and palpation for abdominal assessments.
The clinical examination involves the study of:
It is to likely focus on areas of interest highlighted in the medical history and may not include everything listed above.
The treatment plan may include ordering additional medical laboratory tests and medical imaging studies, starting therapy, referral to a specialist, or watchful observation. A follow-up may be advised. Depending upon the health insurance plan and the managed care system, various forms of "utilization review", such as prior authorization of tests, may place barriers on accessing expensive services.
The medical decision-making (MDM) process includes the analysis and synthesis of all the above data to come up with a list of possible diagnoses (the differential diagnoses), along with an idea of what needs to be done to obtain a definitive diagnosis that would explain the patient's problem.
On subsequent visits, the process may be repeated in an abbreviated manner to obtain any new history, symptoms, physical findings, lab or imaging results, or specialist consultations.
From ancient times, Christian emphasis on practical charity gave rise to the development of systematic nursing and hospitals, and the Catholic Church today remains the largest non-government provider of medical services in the world. Advanced industrial countries (with the exception of the United States) and many developing countries provide medical services through a system of universal health care that aims to guarantee care for all through a single-payer health care system or compulsory private or cooperative health insurance. This is intended to ensure that the entire population has access to medical care on the basis of need rather than ability to pay. Delivery may be via private medical practices, state-owned hospitals and clinics, or charities, most commonly a combination of all three.
Most tribe societies provide no guarantee of healthcare for the population as a whole. In such societies, healthcare is available to those who can afford to pay for it, have self-insured it (either directly or as part of an employment contract), or may be covered by care financed directly by the government or tribe.
Transparency of information is another factor defining a delivery system. Access to information on conditions, treatments, quality, and pricing greatly affects the choice of patients/consumers and, therefore, the incentives of medical professionals. While the US healthcare system has come under fire for its lack of openness, 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.
The health professionals who provide care in medicine comprise multiple , such as medics, Nursing, Physical therapy, and . These professions will have their own ethical standards, professional education, and bodies. The medical profession has been conceptualized from a sociological perspective.
Primary care medical services are provided by , physician assistants, nurse practitioners, or other health professionals who have first contact with a patient seeking medical treatment or care. These occur in physician offices, medical practices, , , schools, patients' homes, and in other places that are typically geographically close to where patients live, work or study. About 90% of medical visits can be satisfactorily and effectively dealt with by primary care provider(s). Primary care visits might include treatment of minor, acute or chronic illnesses, preventive care, and health education. Primary care is directed to the health of entire populations and thus providers care for patients of all ages and sexes.
Secondary care medical services are provided by medical specialists in their offices, practices or clinics, or at local community hospitals, to patients referred by the primary care provider who first diagnosed or treated the patient. 'Referrals' are made of those patients who required the particular expertise of, or specific procedures performed by, specialists. Secondary care services include both ambulatory care and inpatient services, emergency departments, some intensive care medicine, some surgeries and related services, physical therapy, childbirth, endoscopy units, diagnostic laboratory and medical imaging services, Hospice care centers, and others depending on the health services systems within which the care is being delivered. 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 teams of providers in larger, more specialised hospitals or regional medical centers, which are equipped with diagnostic and treatment facilities not typically available at local (often smaller) hospitals. This allows for the treatment and care of patients with more complex or urgent or serious medical conditions, which in turn may require more expertise (including multi-disciplinary teams) and resources (facilities, staff, bed days) to effectively treat. Tertiary care may include that provided at burn treatment or , advanced neonatology unit services, , high-risk pregnancy and child delivery, radiation oncology, and very many other forms of specialist and intensive care.
Modern medical care also depends on the keeping and use of information, including about a particular patient—still kept in many health care settings on paper 'medical records', but increasingly nowadays by electronic means.
In low-income countries, modern healthcare is often too expensive for the average person. International healthcare policy researchers have advocated that "user fees" be removed in these areas to ensure access; however, even with removal of patient fee obligations, significant costs and barriers remain for the poor and the sick in accessing sufficient care.
Separation of prescribing and dispensing is a practice in medicine and pharmacy in which the physician who provides a medical prescription is different from the pharmacist who provides the prescription drug to the patient. In the Western world there are centuries of tradition and practice differentiating pharmacists from physicians, and two quite separate professions developed. In many Asian countries, on the other hand, it is traditional for physicians to also deliver drugs directly to patients, at least in some cases. This model is also being used increasingly in the west: especially for simply-treated conditions (eg, those needing general antibiotics), in remote locations, with vulnerable communities of patients, and in small or integrated medical facilities.
The scope and sciences underpinning human medicine overlap many other fields. A patient admitted to the hospital is usually under the care of a specific team based on their main presenting problem, e.g., the cardiology team, who then may interact with other specialties, e.g., surgical, radiology, to help diagnose or treat the main problem or any subsequent complications/developments.
Physicians have many specializations and sub specializations into certain branches of medicine, which are listed below. There are variations from country to country regarding which specialties certain subspecialties are in.
The main branches of medicine are:
Within medical circles, specialities usually fit into one of two broad categories: "Medicine" and "Surgery". "Medicine" refers to the practice of non-operative medicine, and most of its subspecialties require preliminary training in Internal Medicine. In the UK, this was traditionally evidenced by passing the examination for the Membership of the Royal College of Physicians (MRCP) or the equivalent college in Scotland or Ireland. "Surgery" refers to the practice of operative medicine, and most subspecialties in this area require preliminary training in General Surgery, which in the UK leads to membership of the Royal College of Surgeons of England (MRCS). At present, some specialties of medicine do not fit easily into either of these categories, such as radiology, pathology, or anesthesia. Most of these have branched from one or other of the two camps above; for example anaesthesia developed first as a faculty of the Royal College of Surgeons (for which MRCS/FRCS would have been required) before becoming the Royal College of Anaesthetists and membership of the college is attained by sitting for the examination of the Fellowship of the Royal College of Anesthetists (FRCA).
Surgical training in the U.S. requires a minimum of five years of residency after medical school. Sub-specialties of surgery often require seven or more years. In addition, fellowships can last an additional one to three years. Because post-residency fellowships can be competitive, many trainees devote two additional years to research. Thus in some cases surgical training will not finish until more than a decade after medical school. Furthermore, surgical training can be very difficult and time-consuming.
Surgical subspecialties include those a physician may specialize in after undergoing general surgery residency training as well as several surgical fields with separate residency training. Surgical subspecialties that one may pursue following general surgery residency training:
Other surgical specialties within medicine with their own individual residency training:
Because their patients are often seriously ill or require complex investigations, internists do much of their work in hospitals. Formerly, many internists were not subspecialized; such general physicians would see any complex nonsurgical problem; this style of practice has become much less common. In modern urban practice, most internists are subspecialists: that is, they generally limit their medical practice to problems of one organ system or to one particular area of medical knowledge. For example, gastroenterology and nephrology specialize respectively in diseases of the gut and the kidneys.
In the Commonwealth of Nations and some other countries, specialist Pediatrics and Geriatrics are also described as specialist physicians (or internists) who have subspecialized by age of patient rather than by organ system. Elsewhere, especially in North America, general pediatrics is often a form of primary care.
There are many subspecialities (or subdisciplines) of internal medicine:
Training in internal medicine (as opposed to surgical training), varies considerably across the world: see the articles on medical education for more details. In North America, it requires at least three years of residency training after medical school, which can then be followed by a one- to three-year fellowship in the subspecialties listed above. In general, resident work hours in medicine are less than those in surgery, averaging about 60 hours per week in the US. This difference does not apply in the UK where all doctors are now required by law to work less than 48 hours per week on average.
Since knowledge, techniques, and medical technology continue to evolve at a rapid rate, many regulatory authorities require continuing medical education. Medical practitioners upgrade their knowledge in various ways, including , seminars, conferences, and online programs. A database of objectives covering medical knowledge, as suggested by national societies across the United States, can be searched at http://data.medobjectives.marian.edu/ .
In most countries, it is a legal requirement for a medical doctor to be licensed or registered. In general, this entails a medical degree from a university and accreditation by a medical board or an equivalent national organization, which may ask the applicant to pass exams. This restricts the considerable legal authority of the medical profession to physicians that are trained and qualified by national standards. It is also intended as an assurance to patients and as a safeguard against 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.
In the European Union, the profession of doctor of medicine is regulated. A profession is said to be regulated when access and exercise is subject to the possession of a specific professional qualification. The regulated professions database contains a list of regulated professions for doctor of medicine in the EU member states, EEA countries and Switzerland. This list is covered by the Directive 2005/36/EC.
Doctors who are negligent or intentionally harmful in their care of patients can face charges of medical malpractice and be subject to civil, criminal, or professional sanctions.
Values such as these do not give answers as to how to handle a particular situation, but provide a useful framework for understanding conflicts. When moral values are in conflict, the result may be an ethical dilemma or crisis. Sometimes, no good solution to a dilemma in medical ethics exists, and occasionally, the values of the medical community (i.e., the hospital and its staff) conflict with the values of the individual patient, family, or larger non-medical community. Conflicts can also arise between health care providers, or among family members. For example, some argue that the principles of autonomy and beneficence clash when patients refuse blood transfusions, considering them life-saving; and truth-telling was not emphasized to a large extent before the HIV era.
The earliest known medical texts in the world were found in the ancient city of Ebla and date back to 2500 BCE.
In Egypt, Imhotep (3rd millennium BCE) is the first physician in history known by name. The oldest Egyptian medical text is the Kahun Gynaecological Papyrus from around 2000 BCE, which describes gynaecological diseases. The Edwin Smith Papyrus dating back to 1600 BCE is an early work on surgery, while the Ebers Papyrus dating back to 1500 BCE is akin to a textbook on medicine.
In China, archaeological evidence of medicine in Chinese dates back to the Bronze Age Shang dynasty, based on seeds for herbalism and tools presumed to have been used for surgery. The Huangdi Neijing, the progenitor of Chinese medicine, is a medical text written beginning in the 2nd century BCE and compiled in the 3rd century.
In India, the oldest known surgical text, the Sushruta Samhita written by the surgeon Sushruta, described numerous surgical operations, including the earliest forms of plastic surgery as well as methods of sterilization for surgical instruments. The earliest records of dedicated hospitals come from Mihintale in Sri Lanka where evidence of dedicated medicinal treatment facilities for patients are found.
In Greece, the ancient Greek physician Hippocrates, the "father of modern medicine", The father of modern medicine: the first research of the physical factor of tetanus , European Society of Clinical Microbiology and Infectious Diseases laid the foundation for a rational approach to medicine. Hippocrates introduced the Hippocratic Oath for physicians, which is still relevant and in use today, and was the first to categorize illnesses as acute, chronic, endemic and epidemic, and use terms such as, "exacerbation, relapse, resolution, crisis, paroxysm, peak, and convalescence". The Greek physician Galen was also one of the greatest surgeons of the ancient world and performed many audacious operations, including brain and eye surgeries. After the fall of the Western Roman Empire and the onset of the Early Middle Ages, the Greek tradition of medicine went into decline in Western Europe, although it continued uninterrupted in the Eastern Roman (Byzantine) Empire.
Most of our knowledge of ancient Hebrew medicine during the 1st millennium BC comes from the Torah, i.e. the Five Books of Moses, which contain various health related laws and rituals. The Hebrew contribution to the development of modern medicine started in the Byzantine Era, with the physician Asaph the Jew.
Although the concept of uroscopy was known to Galen, he did not see the importance of using it to localize the disease. It was under the Byzantines with physicians such of Theophilus Protospatharius that they realized the potential in uroscopy to determine disease in a time when no microscope or stethoscope existed. That practice eventually spread to the rest of Europe.
After 750 CE, the Muslim world had the works of Hippocrates, Galen and Sushruta translated into Arabic, and Islamic medicine engaged in some significant medical research. Notable Islamic medical pioneers include the Persian polymath, Avicenna, who, along with Imhotep and Hippocrates, has also been called the "father of medicine". He wrote The Canon of Medicine which became a standard medical text at many medieval European University, considered one of the most famous books in the history of medicine. Others include Abulcasis, Ibn Zuhr, Ibn al-Nafis, and Averroes. Persians physician Rhazes copy was one of the first to question the Greek theory of humorism, which nevertheless remained influential in both medieval Western and medieval Islamic medicine. Some volumes of Rhazes's work Al-Mansuri, namely "On Surgery" and "A General Book on Therapy", became part of the medical curriculum in European universities. Additionally, he has been described as a doctor's doctor, the father of pediatrics,
In Europe, Charlemagne decreed that a hospital should be attached to each cathedral and monastery and the historian Geoffrey Blainey likened the activities of the Catholic Church in health care during the Middle Ages to an early version of a welfare state: "It conducted hospitals for the old and orphanages for the young; hospices for the sick of all ages; places for the lepers; and hostels or inns where pilgrims could buy a cheap bed and meal". It supplied food to the population during famine and distributed food to the poor. This welfare system the church funded through collecting taxes on a large scale and possessing large farmlands and estates. The Benedictine order was noted for setting up hospitals and infirmaries in their monasteries, growing medical herbs and becoming the chief medical care givers of their districts, as at the great Abbey of Cluny. The Church also established a network of cathedral schools and universities where medicine was studied. The Schola Medica Salernitana in Salerno, looking to the learning of Greeks and Arab physicians, grew to be the finest medical school in medieval Europe.
However, the fourteenth and fifteenth century Black Death devastated both the Middle East and Europe, and it has even been argued that Western Europe was generally more effective in recovering from the pandemic than the Middle East. In the early modern period, important early figures in medicine and anatomy emerged in Europe, including Gabriele Falloppio and William Harvey.
The major shift in medical thinking was the gradual rejection, especially during the Black Death in the 14th and 15th centuries, of what may be called the "traditional authority" approach to science and medicine. This was the notion that because some prominent person in the past said something must be so, then that was the way it was, and anything one observed to the contrary was an anomaly (which was paralleled by a similar shift in European society in general – see Copernicus's rejection of Ptolemy's theories on astronomy). Physicians like Vesalius improved upon or disproved some of the theories from the past. The main tomes used both by medicine students and expert physicians were Materia Medica and Pharmacopoeia.
Andreas Vesalius was the author of De humani corporis fabrica, an important book on human anatomy. Bacteria and microorganisms were first observed with a microscope by Antonie van Leeuwenhoek in 1676, initiating the scientific field microbiology.
Modern scientific biomedical research (where results are testable and reproducible) began to replace early Western traditions based on herbalism, the Greek "four humours" and other such pre-modern notions. The modern era really began with Edward Jenner's discovery of the smallpox vaccine at the end of the 18th century (inspired by the method of variolation originated in ancient China), Robert Koch's discoveries around 1880 of the transmission of disease by bacteria, and then the discovery of around 1900.
The post-18th century modernity period brought more groundbreaking researchers from Europe. From Germany and Austria, doctors Rudolf Virchow, Wilhelm Conrad Röntgen, Karl Landsteiner and Otto Loewi made notable contributions. In the United Kingdom, Alexander Fleming, Joseph Lister, Francis Crick and Florence Nightingale are considered important. Spain doctor Santiago Ramón y Cajal is considered the father of modern neuroscience.
From New Zealand and Australia came Maurice Wilkins, Howard Florey, and Frank Macfarlane Burnet.
Others that did significant work include William Williams Keen, William Coley, James D. Watson (United States); Salvador Luria (Italy); Alexandre Yersin (Switzerland); Kitasato Shibasaburō (Japan); Jean-Martin Charcot, Claude Bernard, Paul Broca (France); Adolfo Lutz (Brazil); Nikolai Korotkov (Russia); William Osler (Canada); and Harvey Cushing (United States).
As science and technology developed, medicine became more reliant upon . Throughout history and in Europe right until the late 18th century, not only plant products were used as medicine, but also animal (including human) body parts and fluids. Pharmacology developed in part from herbalism and some drugs are still derived from plants (atropine, ephedrine, warfarin, aspirin, digoxin, vinca alkaloid, , hyoscine, etc.). were discovered by Edward Jenner and Louis Pasteur.
The first antibiotic 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 German chemists originally from .
Pharmacology has become increasingly sophisticated; modern biotechnology allows drugs targeted towards specific physiological processes to be developed, sometimes designed for compatibility with the body to reduce Side effect. Genomics and knowledge of human genetics and human evolution is having increasingly significant influence on medicine, as the causative of most monogenic have now been identified, and the development of techniques in molecular biology, evolution, and genetics are influencing medical technology, practice and decision-making.
Evidence-based medicine is a contemporary movement to establish the most effective algorithms of practice (ways of doing things) through the use of systematic reviews and meta-analysis. The movement is facilitated by modern global information science, which allows as much of the available evidence as possible to be collected and analyzed according to standard protocols that are then disseminated to healthcare providers. The Cochrane Collaboration leads this movement. A 2001 review of 160 Cochrane systematic reviews revealed that, according to two readers, 21.3% of the reviews concluded insufficient evidence, 20% concluded evidence of no effect, and 22.5% concluded positive effect.
Health spending varies by country, which results in differences in access to care and access to medicines. Health care rationing varies by country. Most developed countries provide health care to all citizens, with a few exceptions such as the United States where restrictions on health insurance coverage may limit affordability.
(2026). 9789062992201, Kugler Publications. .
Other early records on medicine have been discovered from ancient Egyptian medicine, Babylonian Medicine, Ayurveda medicine (in the Indian subcontinent), classical Chinese medicine (Alternative medicine) predecessor to the modern traditional Chinese medicine), and ancient Greek medicine and Roman medicine.
Middle Ages
The concept of hospital as institution to offer medical care and possibility of a cure for the patients due to the ideals of Christian charity, rather than just merely a place to die, appeared in the Byzantine Empire.
(2026). 9781108015882, Cambridge. ISBN 9781108015882 and a pioneer of ophthalmology. For example, he was the first to recognize the reaction of the eye's pupil to light. The Persian Bimaristan hospitals were an early example of .
(2026). 9780131443297, Prentice Hall. ISBN 9780131443297 Independently from Ibn al-Nafis, Michael Servetus rediscovered the pulmonary circulation, but this discovery did not reach the public because it was written down for the first time in the "Manuscript of Paris" Michael Servetus Research Website with a graphical study on the Manuscript of Paris by Servetus in 1546, and later published in the theological work for which he paid with his life in 1553. Later this was described by Renaldus Columbus and Andrea Cesalpino. Herman Boerhaave is sometimes referred to as a "father of physiology" due to his exemplary teaching in Leiden and textbook 'Institutiones medicae' (1708). Pierre Fauchard has been called "the father of modern dentistry".
Modern
Veterinary medicine was, for the first time, truly separated from human medicine in 1761, when the French veterinarian Claude Bourgelat founded the world's first veterinary school in Lyon, France. Before this, medical doctors treated both humans and other animals.
Quality, efficiency, and access
Evidence-based medicine, prevention of medical error (and other "iatrogenesis"), and avoidance of unnecessary health care are a priority in modern medical systems. These topics generate significant political and public policy attention, particularly in the United States where healthcare is regarded as excessively costly but population health metrics lag similar nations.
Telemedicine
Telemedicine (also Telehealth) refers to preventive, promotive, and curative care delivery, including remote clinical services, such as diagnosis, monitoring, administration and provider education. The main categories of telehealth:
(2026). 9780787966188, John Wiley and Sons. ISBN 9780787966188
See also
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