Medicine

Medicine is the science and art of maintaining and 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.

History of medicine

The earliest type of medicine in most cultures was the use of empirical natural resources like plants (herbalism), animal parts and minerals. In all societies, including Western ones, there were also religious, ritual and magical resources. In aboriginal societies, there is a large scope of medical systems related to religious thinking, cultural experience, and natural resources. The religious ones more known are: 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). The field of medical anthropology studies the various medical systems and their interaction with society, while prehistoric medicine addresses diagnosis and treatment in prehistoric times.
The practice of medicine developed gradually in ancient Egypt, Babylonia, India, China, Greece, Persia, the Islamic world, medieval Europe and early modern period in Persia (Rhazes and Avicenna), Spain (Abulcasis and Avenzoar), Syria/Egypt (Ibn al-Nafis, 13th century), Italy (Gabriele Falloppio, 16th century), England (William Harvey, 17th century). Medicine as it is now practiced largely developed during the 19th and 20th centuries in Germany (Rudolf Virchow, Wilhelm Conrad Röntgen, Robert Koch), Austria (Karl Landsteiner, Otto Loewi), United Kingdom (Edward Jenner, Alexander Fleming, Joseph Lister, Francis Crick), New Zealand (Maurice Wilkins), Australia (Howard Floery, Frank Macfarlane Burnet), Russia (Nikolai Korotkov), United States (William Williams Keen, Harvey Cushing, William Coley, James D. Watson), Italy (Salvador Luria), Switzerland (Alexandre Yersin), Japan (Kitasato Shibasaburo), and France (Jean-Martin Charcot, Claude Bernard, Louis Pasteur, Paul Broca and others). The new "scientific" or "experimental" 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 Sumerian god Ningizzida was the patron of medicine. In the image he is accompanied by two gryphons. It is the oldest known image of snakes coiling around an axial rod, dating from before 2000 BCE. A similar image with two snakes coiling around a rod is called the Caduceus and, although historically inappropriate, appears in the logo/emblem of a significant number of private (rather than professional or academic) medical practices.
The focal points of development of clinical medicine shifted[citation needed] to the United Kingdom and the USA[citation needed] by the early 1900s (Canadian-born) Sir William Osler, Harvey Cushing). Possibly 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 Ibn al-Nafis and Vesalius led the way in improving upon or indeed rejecting the theories of great authorities from the past (such as Hippocrates, Galen and Avicenna), many of whose theories were in time discredited. Such new attitudes were made possible in Europe 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 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 minimize the side effects of prescribed drugs, to treat cancer, geriatric problems, long-term problems (such as high cholesterol), chronic diseases such as type 2 diabetes, lifestyle and degenerative diseases such as arthritis and Alzheimer's disease

Practice

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 inquiry, 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

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.
Most industrialized countries and many developing countries deliver health care though a system of universal health care which guarantees health care for all through a system of compulsory private or co-operative health insurance funds or via government backed social insurance. This insurance, (in effect, a form of taxation) ensures the entire population has access to medical care on the basis of need rather than ability to pay. The delivery systems may be provided by private medical practices or by state owned hospitals and clinics, or by charities.
Most tribal societies but also some communist countries (e.g. China) and at least one industrialized capitalist country (the United States) provide no guarantee of health care for the population as a whole. In such societies, health care is available to those that can afford to pay for it or have self insured it (either directly or as part of an employment contract) or who may be covered by care financed by the government or tribe directly.
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

Physical examination

Physical examination or clinical examination is the process by which a health care provider investigates the body of a patient for signs of disease. It generally follows the taking of the medical history — an account of the symptoms as experienced by the patient. Together with the medical history, the physical examination aids in determining the correct diagnosis and devising the treatment plan. This data then becomes part of the medical record.
Although providers have varying approaches as to the sequence of body parts, a systematic examination generally starts at the head and finishes at the extremities. After the main organ systems have been investigated by inspection, palpation, percussion and auscultation, specific tests may follow (such as a neurological investigation, orthopedic examination) or specific tests when a particular disease is suspected (e.g. eliciting Trousseau's sign in hypocalcemia).
With the clues obtained during the history and physical examination the healthcare provider can now formulate a differential diagnosis, a list of potential causes of the symptoms. Specific diagnostic tests (or occasionally empirical therapy) generally confirm the cause, or shed light on other, previously overlooked, causes.
Whilst the format of examination as listed below is largely as taught and expected of students, a specialist will focus on their particular field and the nature of the problem described by the patient. Hence a cardiologist will not in routine practice undertake neurological parts of the examination other than noting that the patient is able to use all four limbs on entering the consultation room and during the consultation become aware of their hearing, eyesight and speech. Likewise an Orthopaedic surgeon will examine the affected joint, but may only briefly check the heart sounds and chest to ensure that there is not likely to be any contraindication to surgery raised by the anaesthetist. Non-specialists generally examine the genitals only upon request of the patient.
A complete physical examination includes evaluation of general patient appearance and specific organ systems. It is recorded in the medical record in a standard layout which facilitates others later reading the notes. In practice the vital signs of temperature examination, pulse and blood pressure are usually measured first

Vital Signs

Temperature

Temperature recording gives an indication of core body temperature which is normally tightly controlled (thermoregulation) as it affects the rate of chemical reactions.
The main reason for checking body temperature is to solicit any signs of systemic infection or inflammation in the presence of a fever (temp > 38.5°C or sustained temp > 38°C). Other causes of elevated temperature include hyperthermia. Temperature depression (hypothermia) also needs to be evaluated. It is also noteworthy to review the trend of the patient's temperature. A patient with a fever of 38°C does not necessarily indicate an ominous sign if his previous temperature has been higher.


blood pressure#Measurement

The blood pressure is recorded as two readings, a high systolic pressure which is the maximal contraction of the heart and the lower diastolic or resting pressure. Usually the blood pressure is taken in the right arm unless there is some damage to the arm. The difference between the systolic and diastolic pressure is called the pulse pressure. The measurement of these pressures is now usually done with an aneroid or electronic sphygmomanometer. The classic measurement device is a mercury sphygmomanometer, using a column of mercury measured off in millimeters. In the United States and UK, the common form is millimeters of mercury, whilst elsewhere SI units of pressure are used. There is no natural 'normal' value for blood pressure, but rather a range of values that on increasing are associated with increased risks. The guideline acceptable reading also takes into account other co-factors for disease. Elevated blood pressure hypertension therefore is variously defined when the systolic number is persistently over 140-160 mmHg. Low blood pressure is hypotension. Blood pressures are also taken at other portions of the extremities. These pressures are called segmental blood pressures and are used to evaluate blockage or arterial occlusion in a limb .

Pulse

The pulse is the physical expansion of the artery Its rate is usually measured either at the wrist or the ankle and is recorded as beats per minute. The pulse commonly is taken is the radial artery at the wrist. Sometimes the pulse cannot be taken at the wrist and is taken at the elbow (brachial artery), at the neck against the carotid artery (carotid pulse), behind the knee (popliteal artery), or in the foot dorsalis pedis or posterior tibial arteries. The pulse rate can also be measured by listening directly to the heartbeat using a stethoscope. The pulse varies with age. A newborn or infant can have a heart rate of about 130-150 beats per minute. A toddler's heart will beat about 100-120 times per minute, an older child's heartbeat is around 90-110 beats per minute, adolescents around 80-100 beats per minute, and adults pulse rate is anywhere between 50 and 80 beats per minute

Basic biometrics

Height

Height is the anthropometric longitudinal growth of an individual. A statiometer is the device used to measure height although often a height stick is more frequently used for vertical measurement of adults or children older than 2. The patient is asked to stand barefoot. Height declines during the day because of compression of the intervertebral discs. Children under age 2 are measured lying horizontally.

Weight

Weight is the anthropometric mass of an individual. A scale is used to measure weight.
Body mass index, or BMI, is used to calculate the relationship between healthy height and weight and obesity or being overweight or underweight.
Medical professionals generally prefer to use the SI unit of kilograms, and many medical facilities have ready-reckoner conversion charts available for professionals to use, when patients describe their weight in non-SI units. (In the US, pounds and ounces are common, while in the UK stones and pounds are frequently used; in most other countries the metric system predominates.)

Pain
Because of the importance of pain to the overall wellness of the patient, subjective measurement is considered to be a vital sign. Clinically pain is measured using a FACES scale which is a series of faces from '0' (no pain at all showing a normal happy face) to '5' (the worst pain ever experienced by the patient). There is also an analog scale from '0' to maximum '10'. It is important to allow patients to make their own choices on a pain scale. Physicians and health care workers frequently understate patient pain

Organ systems

Cardiovascular system

Blood pressure, pulse rate and rhythm.
Jugular venous pressure (JVP), peripheral oedema and evidence for pulmonary oedema.
Precordial exam (cardiac exam)
Lungs

4 parts: examination, auscultation, palpation, percussion

Examination involves observing the respiratory rate which should be in a ratio of 1:2 inspiration:expiration. An acidotic patient will have more rapid breathing to compensate known as Kussmaul breathing. Another type of breathing is Cheyne-Stokes respiration, which is alternating breathing in high frequency and low frequency from brain stem injury. Also observe for retractions seen in asthmatics. Observe for barrel-chest (increased AP diameter) seen in COPD. Observe for shifted trachea or one sided chest expansion, which can hint pneumothorax.
Lung auscultation is listening to the lungs bilaterally at the anterior chest and posterior chest. Wheezing is described as a musical sound on expiration or inspiration. It is the result of narrowed airways. Rhonchi are bubbly sounds similar to blowing bubbles through a straw into a sundae. They are heard on expiration and inspiration. It is the result of viscous fluid in the airays. Crackles or rales are similar to rhonchi except they are only heard during inspiration. It is the result of alveoli popping open from increased air pressure.
For palpation, place both palms or medial aspects of hands on the posterior lung field. Ask the patient to count 1-10. The point of this part is to feel for vibrations and compare between the right/left lung field. If the pt has a consolidation (maybe caused by pneumonia), the vibration will be louder at that part of the lung. This is because sound travels faster through denser material than air.
On percussion, you are testing mainly for pleural effusion or pneumothorax. The sound will be more tympanic if there is a pneumothorax because air will stretch the pleural membranes like a drum. If there is fluid between the pleural membranes, the percussion will be dampened and sound muffled.
There is always difficulty differentiating between pneumonia and pleural effusion based on just auscultation since both will have crackles or rhonchi. That is why such exams like palpation will help differentiate between the two. If there is pneumonia, palpation should reveal increased vibration and percussion should be decreased. If there is pleural effusion, palpation should reveal decreased vibration and percussion should also be decreased.

Breasts

Abdomen
Abdominal examination notes in particular any tenderness, bloating, organ enlargement, or aortic aneurysm.
No abdominal examination is complete without a Rectal examination
Genitalia
Musculoskeletal system
Nervous system, including mental status
Head and neck (HEENT)

Skin

Check of the hair to see if the hair growth is receding (baldness) or there is loss of hair (alopecia).
Check of the skin will tell if there are marks such as hemangioma or strawberry marks or changes to the skin. Dark spots on the skin, nevi are also places where cancerous changes can appear because the face, head and neck are most usually sun exposed. Specific skin conditions (e.g. pyoderma gangrenosum, erythema nodosum, acanthosis nigricans) may be associated with specific diseases (ulcerative colitis, sarcoidosis and polycystic ovary syndrome, respectively).

Medical history

The medical history or anamnesisof a patient is information gained by a physician or other healthcare professional by asking specific questions, either of the patient or of other people who know the person and can give suitable information (in this case, it is sometimes called heteroanamnesis), with the aim of obtaining information useful in formulating a diagnosis and providing medical care to the patient. The medically relevant complaints reported by the patient or others familiar with the patient are referred to as symptoms, in contrast with clinical signs, which are ascertained by direct examination on the part of medical personnel. Most health encounters will result in some form of history being taken. Medical histories vary in their depth and focus. For example an ambulance paramedic would typically limit their history to important details such as name, history of presenting complaint, allergies etc. In contrast, a psychiatric history is frequently lengthy and in depth as many details about the patients life are relevant to formulating a management plan for a psychiatric illness.
The information obtained in this way, together with clinical examination, enables the physician to form a diagnosis and treatment plan. If a diagnosis cannot be made then a provisional diagnosis may be formulated, and other possibilities (the differential diagnosis) may be added, by convention listed in order of likelihood. The treatment plan may then include further investigations to try and clarify the diagnosis.

Branches

Working together as an interdisciplinary team, many highly-trained health professionals besides medical practitioners are involved in the delivery of modern health care. Examples include: nurses, 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.
A patient admitted to hospital is usually under the care of a specific team based on their main presenting problem, e.g. the Cardiology team, who then may interact with other specialties, e.g. surgical, radiology, to help diagnose or treat the main problem or any subsequent complications / developments.
Physicians have many specializations and subspecializations into certain branches of medicine, which are listed below. There are variations from country to country regarding which specialties certain subspecialties are in.
The main branches of medicine used in Wikipedia are:
Basic sciences of medicine; this is what every physician is educated in, and some returns to in Biomedical research#Preclinical research.
Medical specialties
interdisciplinary fields, where different medical specialties are mixed to function in certain occasions

Basic 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.
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 immunohistochemistry.
Immunology is the study of the immune system, which includes the innate and adaptive immune system in humans, for example.
Microbiology is the study of microorganisms, including protozoa, bacteria, fungi, and viruses.
Neuroscience includes 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 and spinal cord.
Nutrition is the study of the relationship of food and drink to health and disease, especially in determining an optimal diet. Medical nutrition therapy is done by dietitians and is prescribed for diabetes, cardiovascular diseases, weight and eating disorders, allergies, malnutrition, and neoplastic diseases.
Pathology as a science is the study of disease—the causes, course, progression and resolution thereof.
Pharmacology is the study of drugs and their actions.
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

Timeline of antibiotics

Although potent antibiotic compounds for treatment of human diseases caused by bacteria (such as tuberculosis, bubonic plague, or leprosy) were not isolated and identified until the twentieth century, the first known use of antibiotics was by the ancient Chinese over 2,500 years ago.Many other ancient cultures, including the ancient Egyptians and ancient Greeks already used molds and plants to treat infections, owing to the production of antibiotic substances by these organisms, a phenomenon known as antibiosisAntibiosis was first described in 1877 in bacteria when Louis Pasteur and Robert Koch observed that an airborne bacillus could inhibit the growth of Bacillus anthracis.The antibiotic properties of Penicillium sp. were first described in France by Ernest Duchesne in 1897. However, his work went by without much notice from the scientific community until Alexander Fleming's discovery of Penicillin .
Modern research on antibiotic therapy began in Germany with the development of the narrow-spectrum antibiotic Salvarsan by Paul Ehrlich in 1909, for the first time allowing an efficient treatment of the then-widespread problem of Syphilis. The drug, which was also effective against other spirochaetal infections, is no longer in use in modern medicine.
Antibiotics were further developed in Britain following the discovery of Penicillin in 1928 by Alexander Fleming. More than ten years later, Ernst Chain and Howard Florey became interested in his work, and came up with the purified form of penicillin. The three shared the 1945 Nobel Prize in Medicine. In 1939, Rene Dubos isolated gramicidin, one of first antibiotics to be manufactured commercially used during World War II proving highly effective in the treatment of wounds and ulcers.. Florey credited Dubos for reviving his research on penicillin
"Antibiotic" was originally used to refer only to substances extracted from a fungus or other microorganism, but has come to also include the many synthetic and semi-synthetic drugs that have antibacterial effects. Antibiotics can help succeed in curing many illnesses

Antibiotic

An antibiotic (from Greek αντί - anti, "against" + βιοτικός - biotikos, "fit for life") is a chemotherapeutic agent that inhibits or abolishes the growth of micro-organisms, such as bacteria, fungi, or protozoa. The term originally referred to any agent with biological activity against living organisms; however, "antibiotic" now refers to substances with anti-bacterial, anti-fungal, or anti-parasitical activity. The first widely used antibiotic compounds used in modern medicine were produced and isolated from living organisms, such as the penicillin class produced by fungi in the genus Penicillium, or streptomycin from bacteria of the genus Streptomyces. With advances in organic chemistry many antibiotics are now also obtained by chemical synthesis, such as the sulfa drugs. Many antibiotics are relatively small molecules with a molecular weight less than 2000 Da.

Unlike previous treatments for infections, which often consisted of administering chemical compounds such as strychnine and arsenic, with high toxicity also against mammals, antibiotics from microbes had no or few side effects and high effective target activity. Most anti-bacterial antibiotics do not have activity against viruses, fungi, or other microbes. Anti-bacterial antibiotics can be categorized based on their target specificity: "narrow-spectrum" antibiotics target particular types of bacteria, such as Gram-negative or Gram-positive bacteria, while broad-spectrum antibiotics affect a wide range of bacteria.
The environment of individual antibiotics varies with the location of the infection, the ability of the antibiotic to reach the site of infection, and the ability of the microbe to inactivate or excrete the antibiotic. Some anti-bacterial antibiotics destroy bacteria (bactericidal), whereas others prevent bacteria from multiplying (bacteriostatic).
Oral antibiotics are simply ingested, while intravenous antibiotics are used in more serious cases, such as deep-seated systemic infections. Antibiotics may also sometimes be administered topically, as with eye drops or ointments.
In the last few years three new classes of antibiotics have been brought into clinical use. This follows a 40-year hiatus in discovering new classes of antibiotic compounds. These new antibiotics are of the following three classes: cyclic lipopeptides (daptomycin), glycylcyclines (tigecycline), and oxazolidinones (linezolid). Tigecycline is a broad-spectrum antibiotic, while the two others are used for gram-positive infections. These developments show promise as a means to counteract the growing bacterial resistance to existing antibiotics

Antibiotic misuse

Common forms of antibiotic misuse include failure to take the entire prescribed course of the antibiotic, or failure to rest for sufficient recovery allowing clearance from the infecting organism. These practices may cause the development of bacterial populations with antibiotic resistance. Inappropriate antibiotic treatment is another common form of antibiotic misuse. A common example is the use of antibacterial antibiotics to treat viral infections such as the common cold.

Animals

It is estimated that greater than 70% of the antibiotics used in U.S. are given to feed animals (e.g. chickens, pigs and cattle) in the absence of disease. Antibiotic use in food animal production has been associated with the emergence of antibiotic-resistant strains of bacteria including Salmonella spp., Campylobacter spp., Escherichia coli, and Enterococcus spp. Evidence from some US and European studies suggest that these resistant bacteria cause infections in humans that do not respond to commonly prescribed antibiotics. In response to these practices and attendant problems, several organizations (e.g. The American Society for Microbiology (ASM), American Public Health Association (APHA) and the American Medical Association (AMA)) have called for restrictions on antibiotic use in food animal production and an end to all non-therapeutic uses. However, delays in regulatory and legislative actions to limit the use of antibiotics are common, and may include resistance to these changes by industries using or selling antibiotics, as well as time spent on research to establish causal links between antibiotic use and emergence of untreatable bacterial diseases. Today, there are two federal bills (S.742 and H.R. 2562) aimed at phasing out non-therapeutic antibiotics in US food animal production. These bills are endorsed by public health and medical organizations including the American Nurses Association (ANA), the American Academy of Pediatrics (AAP), and the American Public Health Association (APHA).

Humans

One study on respiratory tract infections found "physicians were more likely to prescribe antibiotics to patients who they believed expected them, although they correctly identified only about 1 in 4 of those patients". Multifactorial interventions aimed at both physicians and patients can reduce inappropriate prescribing of antibiotics. Delaying antibiotics for 48 hours while observing for spontaneous resolution of respiratory tract infections may reduce antibiotic usage; however, this strategy may reduce patient satisfaction.
Excessive use of prophylactic antibiotics in travelers may also be classified as misuse

Medical specialty

A specialty in medicine is a branch of medical science, other than general practice. After completing medical school, physicians or surgeons usually further their medical education in a specific specialty of medicine by completing a multiple year residency. Doctors who engage in a medical specialty are known as medical specialists.

In the broadest meaning of "medicine", there are many different specialties. However, within medical circles, there are two broad categories: "Medicine" and "Surgery." "Medicine" refers to the practice of non-operative medicine, and most subspecialties in this area require preliminary training in "Internal Medicine". "Surgery" refers to the practice of operative medicine, and most subspecialties in this area require preliminary training in "General Surgery." There are some specialties of medicine that do not fit into either of these categories, such as radiology, pathology, or anesthesia, and those are also discussed further below.

Surgery

Surgical specialties employ operative treatment. In addition, surgeons must decide when an operation is necessary, and also treat many non-surgical issues, particularly in the surgical intensive care unit (SICU), where a variety of critical issues arise. Surgery has many subspecialties, e.g. general surgery, trauma surgery, cardiovascular surgery, neurosurgery, maxillofacial surgery, orthopedic surgery, otolaryngology, plastic surgery, oncologic surgery, vascular surgery, and pediatric surgery. In some centers, anesthesiology is part of the division of surgery (for logistical and planning purposes), although it is not a surgical discipline.
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. A surgical resident's average work week is approximately 75 hours. Some subspecialties of surgery, such as neurosurgery, require even longer hours, and utilize an extension to the 80 hour regulated work week, allowing up to 88 hours per week. Many surgical programs still exceed this work hour limit. Attempts to limit the amount of hours worked has been difficult because of the large volume of patients who require surgical care, the limited amount of resources (including a shortage of people willing to enter into surgery as a career), the need to perform long operations and still provide care to all pre- and post-operative patients, and the need to provide constant coverage in the OR, ICU, and ER

Other selected fields of medical specialties

Following are some selected fields of medical specialties that don't directly fit into any of the above mentioned groups.
Ophthalmology exclusively concerned with the eye and ocular adnexa. Combines conservative and surgical therapy, and has its own College.
Dermatology is concerned with the skin and its diseases. In the UK, dermatology is a subspecialty 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.
Obstetrics and gynecology (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 subspecialties for specific age ranges, organ systems, disease classes, and sites of care delivery.
Physical medicine and rehabilitation (or physiatry) is concerned with functional improvement after injury, illness, or congenital disorders.
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

Interdisciplinary fields

Interdisciplinary sub-specialties of medicine are:

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.
Many other health science fields, e.g. dietetics
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.
Gender-based medicine studies the biological and physiological differences between the human sexes and how that affects differences in disease.
Hospital medicine is the general medical care of hospitalized patients. Physicians whose primary professional focus is hospital medicine are called hospitalists in the USA.
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.
Preventive medicine is the branch of medicine concerned with preventing disease.
Community health or public health is an aspect of health services concerned with threats to the overall health of a community based on population health analysis.
Occupational medicine's principal role is the provision of health advice to organizations and individuals to ensure that the highest standards of health and safety at work can be achieved and maintained.
Aerospace medicine deals with medical problems related to flying and space travel.
Osteopathic medicine, a branch of the U.S. medical profession.
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 .
Travel medicine or emporiatrics deals with health problems of international travelers or travelers across highly different environments.
Professions complementing physicians
Nursing specialties; Medical specialties performed by Nurses.
Mid-level Practitioners: Performance of medical sciences by other certified people than physicians or nurses; Nurse practitioners, midwives and physician assistants, treat patients and prescribe medication in many legal jurisdictions.
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.
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, Rudolf Virchow, to proclaim the doctrine of "one medicine".

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 utilized in medical education, which is an active area of educational research.
Presently, in England, a typical medicine course at university is 5 years after secondary education (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 US and Canada, a potential medical student must first complete an undergraduate degree in any subject before applying to a graduate medical school to pursue a (M.D., N.D. or D.O.) program. Some students opt for the research-focused MD/PhD dual degree, which is usually completed in 7-8 years. There are certain courses which are pre-requisite for being accepted to medical school, such as general chemistry, organic chemistry, physics, mathematics, biology, English, labwork, etc. The specific requirements vary by school.
In Australia, there are two pathways to a medical degree. Students can choose to take a five or six year undergraduate medical degree Bachelor of Medicine/Bachelor of Surgery (MBBS or BMed) straight from high school, or complete a bachelors degree (generally three years, usually in the medical sciences) and then apply for a four year graduate entry Bachelor of Medicine/Bachelor of Surgery (MBBS) program

Homeopathy

Homeopathy (also homœopathy or homoeopathy; from the Greek ὅμοιος, hómoios, "similar" + πάθος, páthos, "suffering" or "disease") is a form of alternative medicine first defined by Samuel Hahnemann in the 18th century.Homeopathic practitioners contend that an ill person can be treated using a substance that can produce, in a healthy person, symptoms similar to those of the illness. According to homeopaths, serial dilution, with shaking between each dilution, removes the toxic effects of the remedy while the qualities of the substance are retained by the diluent (water, sugar, or alcohol). The end product is often so diluted that it is indistinguishable from pure water, sugar or alcohol. Practitioners select treatments according to a patient consultation that explores the physical and psychological state of the patient, both of which are considered important to selecting the remedy.
Claims for efficacy of homeopathic treatment beyond the placebo effect are unsupported by scientific and clinical studies. While advocates point to positive results reported in high-impact journals as evidence for its efficacy, the number of such high-quality studies is small, the conclusions are not definitive, and duplication of the results, a key test of scientific validity, has proven problematic at best. Homeopathy is scientifically implausible and claims for pharmacological effect at many common homeopathic dilutions violate fundamental principles of mainstream science: For instance, above about 12C or 24X potencies, the level of dilution is greater than the number of molecules present in the original tincture. Claims that these could still have a pharmacological effect greater than placebo violate, among other things, the Law of Mass Action, a fundamental principle of chemistry.The lack of convincing scientific evidence supporting its efficacy and its use of remedies without active ingredients have caused homeopathy to be regarded as pseudoscience; quackery; or, in the words of a 1998 medical review, "placebo therapy at best and quackery at worst."
Homeopathic remedies are generally considered safe, with rare exceptions,although homeopaths have been criticized for putting patients at risk by advising them to avoid conventional medicine, such as vaccinations, anti-malarial drugsand antibiotics. In many countries, the laws that govern the regulation and testing of conventional drugs do not apply to homeopathic remedies. Current usage around the world varies from two percent of people in the United Kingdom and the United States using homeopathy in any one yearto 15 percent in India, where it is considered part of Indian traditional medicine. In the UK, the National Health Service runs five homeopathic hospitals, and in the 1990s, between 5.9 and 7.5 percent of English family doctors are reported to have prescribed homeopathic remedies, a figure rising to at least 12 percent in Scotland.In 2005, around 100,000 physicians used homeopathy worldwide, making it one of the most popular and widely used complementary therapies.

Alternative medicine

Alternative medicine includes practices that differ from conventional medicine. A typical definition is "every available approach to healing that does not fall within the realm of conventional medicine". Commonly cited examples are homeopathy, naturopathy, chiropractic, and herbal medicine.
Alternative medicine practices are based on unscientific belief systems or philosophies. They may incorporate spiritual, metaphysical, or religious underpinnings, untested practices, pre-modern medical traditions, or newly developed approaches to healing. If an alternative medical approach, previously unproven according to orthodox scientific or regulatory methodologies, is subsequently shown to be safe and effective, it may then be adopted by conventional practitioners and no longer considered "alternative."
"Alternative medicine" is often categorized together with complementary medicine using the umbrella term Complementary and alternative medicine or CAM

Medical education

Increasing numbers of medical colleges have started offering courses in alternative medicine. For example, in three separate research surveys that surveyed 729 schools in the United States (125 medical schools offering an MD degree, 25 medical schools offering a Doctor of Osteopathic medicine degree, and 585 schools offering a nursing degree), 60% of the standard medical schools, 95% of osteopathic medical schools and 84.8% of the nursing schools teach some form of CAM. The University of Arizona College of Medicine offers a program in Integrative Medicine under the leadership of Dr. Andrew Weil which trains physicians in various branches of alternative medicine which "...neither rejects conventional medicine, nor embraces alternative practices uncritically.Accredited Naturopathic colleges and universities are also increasing in number and popularity in the U.S.A. They offer the most complete medical training in complementary medicines that is available today.
In Britain, no conventional medical schools offer courses that teach the clinical practice of alternative medicine.However, alternative medicine is taught in several unconventional schools as part of their curriculum. Teaching is based mostly on theory and understanding of alternative medicine, with emphasis on being able to communicate with alternative medicine specialists.To obtain competence in practicing clinical alternative medicine, qualifications must be obtained from individual medical societies.The student must have graduated and be a qualified doctor.The British Medical Acupuncture Society, which offers medical acupuncture certificates to doctors, is one such example, as is the College of Naturopathic Medicine UK and Ireland.

Criticism of alternative medicine

Alternative medicine is commonly categorised together with complementary medicine under the umbrella term 'complementary and alternative medicine' (CAM for short). Some scientists reject this and the above classifications and to varying degrees reject the term "alternative medicine" itself.
The following four commentators argue for classifying treatments based on the objectively verifiable criteria of the scientific method, not based on the changing curricula of various medical schools or social sphere of usage. They advocate a classification based on evidence-based medicine, i.e., scientifically proven evidence of efficacy According to them it is possible for a method to change categories (proven vs. unproven) in either direction, based on increased knowledge of its effectiveness or lack thereof:
Marcia Angell, former editor-in-chief of the New England Journal of Medicine, states that "...since many alternative remedies have recently found their way into the medical mainstream [there] cannot be two kinds of medicine - conventional and alternative. There is only medicine that has been adequately tested and medicine that has not, medicine that works and medicine that may or may not work. Once a treatment has been tested rigorously, it no longer matters whether it was considered alternative at the outset. If it is found to be reasonably safe and effective, it will be accepted."
George D. Lundberg, former editor of the Journal of the American Medical Association (JAMA), and Phil B. Fontanarosa, Senior Editor of JAMA, state: "There is no alternative medicine. There is only scientifically proven, evidence-based medicine supported by solid data or unproven medicine, for which scientific evidence is lacking. Whether a therapeutic practice is 'Eastern' or 'Western,' is unconventional or mainstream, or involves mind-body techniques or molecular genetics is largely irrelevant except for historical purposes and cultural interest. As believers in science and evidence, we must focus on fundamental issues—namely, the patient, the target disease or condition, the proposed or practiced treatment, and the need for convincing data on safety and therapeutic efficacy."
Richard Dawkins, Professor of the Public Understanding of Science at Oxford, defines alternative medicine as a "...set of practices which cannot be tested, refuse to be tested, or consistently fail tests. If a healing technique is demonstrated to have curative properties in properly controlled double-blind trials, it ceases to be alternative. It simply...becomes medicine."He also states that "There is no alternative medicine. There is only medicine that works and medicine that doesn't work."
Stephen Barrett, an alternative medicine critic, argues that techniques currently labeled "alternative" should be reclassified as "genuine, experimental, or questionable. Genuine alternatives are comparable methods that have met science-based criteria for safety and effectiveness. Experimental alternatives are unproven but have a plausible rationale and are undergoing responsible investigation. ... Questionable alternatives are groundless and lack a scientifically plausible rationale. ... Blurring these distinctions enables promoters of quackery to argue that because some practices labeled "alternative" have merit, the rest deserve equal consideration and respect. Enough is known, however, to conclude that most questionable "alternatives" are worthless."
Other well-known proponents of evidence-based medicine, such as the Cochrane Collaboration and Edzard Ernst, Professor of Complementary Medicine at the University of Exeter, use the term "alternative medicine" but agree with the above commentators that all treatments, whether "mainstream" or "alternative", ought to be held to standards of the scientific method.

Efficacy

Lack of proper testing

Although proponents of alternative medicine often cite the large number of studies which have been performed, critics point out that there are no statistics on exactly how many of those studies were controlled, double blind, peer-reviewed experiments, or how many produced results supporting alternative medicine or parts thereof. They contend that many forms of alternative medicine are rejected by conventional medicine because the efficacy of the treatments has not been demonstrated through double-blind randomized controlled trials; in contrast, conventional drugs reach the market only after such trials have proved their efficacy.
Some argue that less research is carried out on alternative medicine because many alternative medicine techniques cannot be patented, and hence there is little financial incentive to study them. Drug research, by contrast, can be very lucrative, which has resulted in funding of trials by pharmaceutical companies. Many people, including conventional and alternative medical practitioners, contend that this funding has led to corruption of the scientific process for approval of drug usage, and that ghostwritten work has appeared in major peer-reviewed medical journals. Increasing the funding for research of alternative medicine techniques was the purpose of the U.S. National Center for Complementary and Alternative Medicine. NCCAM and its predecessor, the Office of Alternative Medicine, have spent more than $1 billion on such research since 1992.The German Federal Institute for Drugs and Medical Devices Commission E has studied many herbal remedies for efficacy.
Some skeptics of alternative practices point out that a person may attribute symptomatic relief to an otherwise ineffective therapy due to the placebo effect, the natural recovery from or the cyclical nature of an illness (the regression fallacy), or the possibility that the person never originally had a true illness. CAM proponents point out this may also apply in cases where conventional treatments have been used. To this, CAM critics point out that this does not account for conventional medical success in double blind clinical trials. CAM proponents, however, do not typically question conventional medical successes revealed in double blind clinical trials.

Safety

Critics contend that people have been hurt or killed directly from the various alternative practices or indirectly by failed diagnoses or avoidance of conventional medicine. Proponents counter that harm from conventional medical practice, known as iatrogenesis, is a major cause of death and injury.Deaths have been reported due to the use of alternative medicines such as colloidal silver. Colloidal silver was used before 1938 as an antibiotic, resulting in an "alarming increase" in cases of Argyria. Since 1995 it has been promoted as an alternative medicine, sparking heavy critique from a victim from the 1940s: "Colloidal silver (CSP) is not a new alternative remedy. It is an old, discarded traditional one that homeopaths and other people calling themselves "alternative health-care practitioners" have pulled out of the garbage pail of useless and dangerous drugs and therapies, things mainstream medicine threw away decades ago."
Alternative medicine critics agree with its proponents that people should be free to choose whatever method of healthcare they want, but stipulate that people must be informed as to the safety and efficacy of whatever method they choose. People who choose alternative medicine may think they are choosing a safe, effective medicine, while they may only be getting quack remedies. The use of Grapefruit seed extract is an example of quackery, since multiple studies demonstrate its universal antimicrobial effect is due to synthetic antimicrobial contamination

Medical error

In the United States medical error is estimated to result in 44,000 to 98,000 unnecessary deaths and 1,000,000 excess injuries each year. One older extrapolation suggests '180,000 people die each year partly as a result of iatrogenic injury, the equivalent of three jumbo-jet crashes every 2 days'. It is estimated that in a typical 100 to 300 bed hospital in the United States, excess costs of $1,000,000 to $3,000,000 attributable to prolonged stays and complications just due to medication errors occur yearly.
However, medical error definitions are subject to debate, as there are many types of medical error from minor to major,and causality is often poorly determined.The Health Grades study statistics, based on AHRQ MedPAR data, were based on administrative records, not clinical records, and largely overlooked multi-causality of outcomes.
Medical care is frequently compared adversely to aviation, in that, while many of the factors which lead to error are similar, aviation's error management protocols are much more effective.
An objection to this comparison is that an airplane does not take an active role in its own maintenance, while a human does (for better or worse). Furthermore, an airplane does not have input into its maintenance schedule, while a human and his/her family do. Humans are notorious for ignoring maintenance schedules and for non-compliance, while airplanes are not. Also, an airplane is a mechanical device that functions in very predictable ways; whereas the human body is a biological mechanism that is sometimes difficult to diagnosis or predict

Iatrogenesis

The terms Iatrogenesis and Iatrogenic artifact refer to adverse effects or complications caused by or resulting from medical treatment or advice. In addition to harmful consequences of actions by physicians, iatrogenesis can also refer to actions by other healthcare professionals, such as psychologists, therapists, pharmacists, nurses, dentists, and others. Iatrogenisis is not restricted to conventional medicine and can also result from complementary and alternative medicine treatments.
Some iatrogenic artifacts are clearly defined and easily recognized, such as a complication following a surgical procedure. Some are less obvious and can require significant investigation to identify, such as complex drug interactions. And, some conditions have been described for which it is unknown, unproven or even controversial whether they iatrogenic or not; this has been encountered particularly with regard to various psychological and chronic pain conditions.

History

Etymologically, the term means "brought forth by a healer" (iatros means healer in Greek); as such, in its earlier forms, it could refer to good or bad effects.
Since Hippocrates's time, the potential damaging effect of a healer's actions has been recognized. The old mandate "first do no harm" (primum non nocere) is an important clause of medical ethics, and iatrogenic illness or death caused purposefully, or by avoidable error or negligence on the healer's part became a punishable offence in many civilizations.
With the development of scientific medicine in the 20th century, it could be expected that iatrogenic illness or death would be more easily avoided. With the discovery of antiseptics, anesthesia, antibiotics, and new and better surgical techniques, iatrogenic mortality decreased enormously.

Complication (medicine)

Complication, in medicine, is an unfavorable evolution of a disease, a health condition or a medical treatment. The disease can become worse in its severity or show a higher number of signs, symptoms or new pathological changes, become widespread throughout the body or affect other organ systems. A medical treatment, such as drugs or surgery may produce adverse effects and/or produce new health problem(s) by itself. A new disease may also appear as a complication to a previous existing disease. Therefore, a complication may be iatrogenic, i.e., literally brought forth by the physician.
Medical knowledge about a disease, procedure or treatment usually entails a list of the most common complications, so that they can be foreseen, prevented or recognized more easily and speedily.
Depending on the degree of vulnerability, susceptibility, age, health status, immune system condition, etc. complications may arise more easily. Complications affect adversely the prognosis of a disease. Non-invasive and minimally invasive medical procedures usually favor less complications in comparison to invasive ones.

Chemotherapy

Chemotherapy, in its most general sense, refers to treatment of disease by chemicals that kill cells, specifically those of micro-organisms or cancer. In popular usage, it usually refers to antineoplastic drugs used to treat cancer or the combination of these drugs into a standardized treatment regimen.
In its non-oncological use, the term may also refer to antibiotics (antibacterial chemotherapy). In that sense, the first modern chemotherapeutic agent was Paul Ehrlich's arsphenamine, an arsenic compound discovered in 1909 and used to treat syphilis. This was later followed by sulfonamides discovered by Domagk and penicillin discovered by Alexander Fleming.
Other uses of cytostatic chemotherapy agents are the treatment of autoimmune diseases such as multiple sclerosis and rheumatoid arthritis and the suppression of transplant rejections .

Adverse effect (medicine)

In medicine, an adverse effect is a harmful and undesired effect resulting from a medication or other intervention such as chemotherapy or surgery. An adverse effect may be termed a "side-effect" (when judged to be secondary to a main or therapeutic effect) and may result from an unsuitable or incorrect dosage or procedure (which could be due to medical error). Adverse effects are sometimes referred to as "iatrogenic" because they are generated by a physician/treatment. Some adverse effects only occur only when starting, increasing or discontinuing a treatment. Using a drug or other medical intervention which is contraindicated may increase the risk of adverse effects. Adverse effects may cause medical complications of a disease or procedure and negatively affect its prognosis. They may also lead to non-compliance with a treatment regimen.
The harmful outcome is usually indicated by some result such as morbidity, mortality, alteration in body weight, levels of enzymes, loss of function, or as a pathological change detected at the microscopic, macroscopic or physiological level. It may also be indicated by symptoms reported by a patient. Adverse effects may cause a reversible or irreversible change, including an increase or decrease in the susceptibility of the individual to other chemicals, foods, or procedures (e.g. drug interaction).
In clinical trials, a distinction is made between Adverse Events (AEs) and Serious Adverse Events (SAEs). Generally, any event which causes death, permanent damage, birth defects, or requires hospitalization is considered an SAE. The results of these trials are often included in the labeling of the medication to provide information both for patients and the prescribing physicians

Reporting systems

In many countries, adverse effects are required by law to be reported, researched in clinical trials and included into the patient information accompanying medical devices and drugs for sale to the public.

UK

The Yellow Card Scheme is a UK initiative run by the Medicines and Healthcare products Regulatory Agency (MHRA) and the Commission on Human Medicines (CHM) to gather information on adverse effects to medicines. This includes all licensed medicines from medicines issued on prescription to medicines bought over the counter from a supermarket. The Scheme also includes all herbal preparations and unlicensed medicines found in cosmetic treatments. ADRs can be reported by a number of healthcare professionals including doctors, pharmacists and nurses, as well as patients.
For further information see the Yellow Card Scheme website, or find copies of the Yellow Card in the appedices of a BNF.
To read reports from the UK Yellow Card Scheme you can download here.

USA

In the USA several reporting systems have been built, such as the Vaccine Adverse Event Reporting System (VAERS), the Manufacturer and User Facility Device Experience Database (MAUDE) and the Special Nutritionals Adverse Event Monitoring System. MedWatch is the main reporting center, operated by the Food and Drug Administration.

Australia

In Australia, adverse effect reporting is administered by the Adverse Drug Reactions Advisory Committee (ADRAC), a subcommittee of the Australian Drug Evaluation Committee (ADEC). Reporting is voluntary, and ADRAC requests health professionals to report all adverse reactions to its current drugs of interest, and serious adverse reactions to any drug. ADRAC publishes the Australian Adverse Drug Reactions Bulletin every 2 months

Laparoscopic surgery

Laparoscopic surgery, also called minimally invasive surgery (MIS), bandaid surgery, keyhole surgery, or pinhole surgery is a modern surgical technique in which operations in the abdomen are performed through small incisions (usually 0.5-1.5cm) as compared to larger incisions needed in traditional surgical procedures. Laparoscopic surgery includes operations within the abdominal or pelvic cavities, whereas keyhole surgery performed on the thoracic or chest cavity is called thoracoscopic surgery. Laparoscopic and thoracoscopic surgery belong to the broader field of endoscopy.
The key element in laparoscopic surgery is the use of a laparoscope: a telescopic rod lens system, that is usually connected to a video camera (single chip or three chip). Also attached is a fiber optic cable system connected to a 'cold' light source (halogen or xenon), to illuminate the operative field, inserted through a 5 mm or 10 mm cannula or Trocar to view the operative field. The abdomen is usually insufflated with carbon dioxide gas to create a working and viewing space. The abdomen is essentially blown up like a balloon (insufflated), elevating the abdominal wall above the internal organs like a dome. The gas used is CO2, which is common to the human body and can be absorbed by tissue and removed by the respiratory system. It is also non-flammable, which is important because electrosurgical devices are commonly used in laparoscopic pro

Infection

An infection is the detrimental colonization of a host organism by a foreign species. In an infection, the infecting organism seeks to utilize the host's resources to multiply (usually at the expense of the host). The infecting organism, or pathogen, interferes with the normal functioning of the host and can lead to chronic wounds, gangrene, loss of an infected limb, and even death. The host's response to infection is inflammation. Colloquially, a pathogen is usually considered a microscopic organism though the definition is broader, including feces, parasites, fungi, viruses, prions, and viroids. A symbiosis between parasite and host, whereby the relationship is beneficial for the former but detrimental to the latter, is characterised as parasitism. The branch of medicine that focuses on infections and pathogens is infectious disease.
A secondary infection is an infection that occurs during or following treatment of another already existing primary infecti

Colonization

Wound colonization refers to nonreplicating microorganisms within the wound, while in infected wounds replicating organisms exist and tissue is injured. All multicellular organisms are colonized to some degree by extrinsic organisms, and the vast majority of these exist in either a mutualistic or commensal relationship with the host. An example of the former would be the anaerobic bacteria species which colonize the mammalian colon, and an example of the latter would be the various species of staphylococcus which exist on human skin. Neither of these colonizations would be considered infections. The difference between an infection and a colonization is often only a matter of circumstance. Organisms which are non-pathogenic can become pathogenic under the right conditions, and even the most virulent organism requires certain circumstances to cause a compromising infection. Some colonizing bacteria, such as Corynebacteria sp. and viridans streptococci, prevent the adhesion and colonization of pathogenic bacteria and thus have a symbiotic relationship with the host, preventing infection and speeding wound healing.
The variables involved in the outcome of a host becoming inoculated by a pathogen and the ultimate outcome include:
the route of entry of the pathogen and the access to host regions that it gains
the intrinsic virulence of the particular organism
the quantity or load of the initial inoculant
the immune status of the host being colonized
As an example, the staphylococcus species present on skin remain harmless on the skin, but, when present in a normally sterile space, such as in the capsule of a joint or the peritoneum, will multiply without resistance and create a huge burden on the host.

Bacterial or viral

Bacterial and viral infections can both cause similar symptoms such as malaise, fever, and chills. It can be difficult, even for a doctor to distinguish which is the cause of a specific infection. It's important to distinguish, because viral infections cannot be cured by antibiotics


Comparison of viral and bacterial infection

Characteristic :
Typical symptoms


Viral

In general, viral infections are systemic. This means they involve many different parts of the body or more than one body system at the same time; i.e. a runny nose, sinus congestion, cough, fever, body aches etc.They can be local at times as in viral conjunctivitis or "pink eye" and herpes. Only a few viral infections are painful, like herpes. The pain of viral infections is often described as itchy or burning.,

Bacterial

The classic symptoms of a bacterial infection are localized Redness, Heat, Swelling and Pain. In ancient Rome the terms were; Rubor, Calor, Turgor, and Dolor. One of the hallmarks of a bacterial infection is local pain, pain that is in a specific part of the body. For example,if you get cut and the cut gets infected with a bacterium, it will be painful right where the infection is. If you have a sore throat and the infection is bacterial, one side of the throat is often more sore than the other. An ear infection is usually bacterial if one ear hurts and the other doesn't. An infection that produces pus is always bacterial.

Cause

Pathogenic viruses
Pathogenic bacteria

Wound

In medicine, a wound is a type of injury in which in the skin is torn, cut or punctured (an open wound), or where blunt force trauma causes a contusion (a closed wound). In pathology, it specifically refers to a sharp injury which damages the dermis of the skin

Open

Open wounds can be classified according to the object that caused the wound. The types of open wound are:
Incisions or incised wounds, caused by a clean, sharp-edged object such as a knife, a razor or a glass splinter. Incisions which involve only the epidermis are legally classified as cuts, rather than wounds.
Lacerations, irregular wounds caused by a blunt impact to soft tissue that lies over hard tissue (e.g. laceration of the skin covering the skull) or tearing of skin and other tissues such as caused by childbirth. Lacerations may show bridging, as connective tissue or blood vessels are flattened against the underlying hard surface. The term laceration is commonly misused in reference to injury with sharp objects, which would not display bridging (connective tissue and blood vessels are severed).
Abrasions (grazes), superficial wounds in which the topmost layer of the skin (the epidermis) is scraped off. Abrasions are often caused by a sliding fall onto a rough surface.
Puncture wounds, caused by an object puncturing the skin, such as a nail or needle.
Penetration wounds, caused by an object such as a knife entering the body.
Gunshot wounds, caused by a bullet or similar projectile driving into or through the body. There may be two wounds, one at the site of entry and one at the site of exit, such is generally known as a through-and-through.
In a medical context, stab wounds and gunshot wounds are considered major wounds.

Closed

Closed wounds have fewer categories, but are just as dangerous as open wounds. The types of closed wounds are:
Contusions, more commonly known as bruises, caused by blunt force trauma that damages tissue under the skin.
Hematomas, also called blood tumors, caused by damage to a blood vessel that in turn causes blood to collect under the skin.
Crushing injuries, caused by a great or extreme amount of force applied over a long period of time.

Healing

To heal a wound, the body undertakes a series of actions collectively known as the wound healing process.

Bacteria

Bacteria (singular: bacterium) are unicellular microorganisms. Typically a few micrometres in length, bacteria have a wide range of shapes, ranging from spheres to rods to spirals. Bacteria are ubiquitous in every habitat on Earth, growing in soil, acidic hot springs, radioactive waste, seawater, and deep in the Earth's crust. There are typically 40 million bacterial cells in a gram of soil and a million bacterial cells in a millilitre of fresh water; in all, there are approximately five nonillion (5×1030) bacteria on Earth,forming much of the world's biomass. Bacteria are vital in recycling nutrients, and many important steps in nutrient cycles depend on bacteria, such as the fixation of nitrogen from the atmosphere. However, most of these bacteria have not been characterized, and only about half of the phyla of bacteria have species that can be cultured in the laboratory.The study of bacteria is known as bacteriology, a branch of microbiology.
There are approximately ten times as many bacterial cells as human cells in the human body, with large numbers of bacteria on the skin and in the digestive tract. Although the vast majority of these bacteria are rendered harmless by the protective effects of the immune system, and a few are beneficial, some are pathogenic bacteria and cause infectious diseases, including cholera, syphilis, anthrax, leprosy and bubonic plague. The most common fatal bacterial diseases are respiratory infections, with tuberculosis alone killing about 2 million people a year, mostly in sub-Saharan Africa. In developed countries, antibiotics are used to treat bacterial infections and in various agricultural processes, so antibiotic resistance is becoming common. In industry, bacteria are important in processes such as sewage treatment, the production of cheese and yoghurt, and the manufacture of antibiotics and other chemicals.
Bacteria are prokaryotes. Unlike cells of animals and other eukaryotes, bacterial cells do not contain a nucleus and rarely harbour membrane-bound organelles. Although the term bacteria traditionally included all prokaryotes, the scientific classification changed after the discovery in the 1990s that prokaryotic life consists of two very different groups of organisms that evolved independently from an ancient common ancestor. These evolutionary domains are called Bacteria and Archaea.

Adverse effects of medical procedures

Surgery may have a number of undesirable or harmful after effects, such as infection, hemorrhage, inflammation, scarring, loss of function, changes in local blood flow, and so on. They can be reversible or irreversible, and a compromise must be found by the physician and the patient between the beneficial or life-saving consequences of surgery versus its adverse effects. For example, a limb may be lost to amputation in case of untreatable gangrene, but life is saved. Presently, one of the greatest advantages of minimally invasive surgery, such as laparoscopic surgery is the reduction of adverse effects.
Other non-surgical physical procedures such as high intensity radiotherapy may cause burns and alterations in the skin. In general, these therapies try to avoid damage to healthy tissues while maximizing the therapeutic effect.
Vaccination may have adverse effects, due to the nature of its biological preparation (sometimes using attenuated pathogens and toxins). Common adverse effects may be fever, malaise and local reactions in the vaccination site, such as eczema vaccinatum, a severe, sometimes fatal complication which may result in persons who have eczema or atopic dermatitis.
Diagnostic procedures may also have adverse effects, depending much on whether they are invasive, non-invasive or minimally invasive. For example, allergic reactions to x-ray contrasting material often occur, a colonoscopy may cause the perforation of the intestine wall, etc.

Adverse effects of drugs

Adverse effects can occur as a collateral or side effect of many interventions, but they are particularly important in pharmacology, due to its wider, and sometimes uncontrollable, use by way of self-medication. Thus, responsible drug use becomes an important issue here.
Adverse effects, like intended effects of drugs, are a function of dosage or drug levels at the target organs, so they may be avoided or decreased by means of careful and precise pharmacokinetics (the change of drug levels in the organism in function of time after administration).
Adverse effects may also be caused by drug interaction, i.e., when physicians fail to check for all medicaments a patient is taking and prescribe new ones which interact agonistically or antagonistically (potentiate or decrease the intended therapeutic effect). Significant morbidity and mortality is caused around the world because of this. Drug-drug and food-drug interactions may occur, and even so-called "natural drugs" used in alternative medicine may have dangerous adverse effects. For example, extracts of St. John's wort (Hypericum perforatum), a phytotherapic used for treating mild depression are known to cause an increase in the cytochrome P450 enzymes responsible for the metabolism and elimination of many drugs, so that patients taking it are likely to experience a reduction in blood levels of drugs that they are taking for other purposes, such as cancer chemotherapeutic drugs, protease inhibitors for HIV and hormonal contraceptives.
The scientific field of activity associated with drug safety is increasingly government-regulated and is of major concern for the public as well as to drug manufacturers. The distinction between adverse and non-adverse effects is a major undertaking when a new drug is developed and tested before marketing it. This is done in toxicity studies to determine the non-adverse effect level (NOAEL). These studies are used to define the dosage to be used in human testing (phase I) as well as to calculate the maximum admissible daily intake. Imperfections in clinical trials, such as insufficient number of patients or short duration, sometimes lead to public health disasters such as those of fenfluramine (the so-called fen-phen episode), thalidomide and, more recently, of cerivastatin (Baycol, Lipobay) and rofecoxib (Vioxx), where drastic adverse effects were observed, like teratogenesis, pulmonary hypertension, stroke, heart disease, neuropathy, etc., and a significant number of deaths, causing the forced or voluntary withdrawal of the drug from the market.
Most drugs have a large list of non-severe or mild adverse effects which do not rule out the interruption of usage. These effects have widely variable incidence, according to individual sensitivity. They comprise nausea, dizziness, diarrhea, malaise, vomit, headache, dermatitis, dry mouth, etc.

Controversies

Sometimes, putative medical adverse effects are regarded as controversial and generate heated discussions in society and lawsuits against drug manufacturers. One example is the recent controversy as to whether autism was linked to the MMR vaccine (or by thimerosal, a mercury-based preservative used in some vaccines). No link has been found in several large studies and no change in the rate of autism has occurred when thimerisal was removed from vaccines a decade ago in C Controversiesanada and Europe.
Another instance is the potential adverse effects of silicone breast implants, which lead to hundreds of thousands of litigations against manufacturers of gel-based implants, due to allegations of damage to the immune system which have not yet been conclusively proven.
Due to the exceedingly high impact on public health of widely used medications, such as hormonal contraception and hormone replacement therapy, which may affect millions of users, even marginal probabilities of adverse effects of a severe nature, such as breast cancer, have led to public outcry and changes in medical therapy, although its benefits largely surpassed the statistical risks.

Limitations of adverse effects reporting

In principle, medical professionals are required to report all adverse effects related to a specific form of therapy. In practice, it is at the discretion of the professional to determine whether a medical event is at all related to the therapy. For example, a leg fracture in a skiing accident in a patient who years before took antibiotics for pneumonia is not likely to get reported.
As a result, routine adverse effects reporting may often not include long-term and subtle effects that may ultimately be attributed to a therapy.
Part of the difficulty is identifying the source of a complaint. A headache in a patient taking medication for influenza may be the underlying disease and may be an adverse effect. In patients with end-stage cancer, death is a very likely outcome and whether the drug is the cause or a bystander is often difficult to discern

Examples of adverse effects associated with specific medications

Abortion, miscarriage or uterine hemorrhage associated with misoprostol (Cytotec), a labor-inducing drug (this is a case where the adverse effect has been used legally and illegally for performing abortions)

Addiction to many sedatives and analgesics such as diazepam, morphine, etc.

Birth defects associated with Thalidomide and Accutane.

Bleeding of the intestine associated with aspirin therapy

Cardiovascular disease associated with COX-2 inhibitors (i.e. Vioxx)

Deafness and kidney failure associated with gentamicin (an antibiotic)

Death, following sedation in children using propofol (Diprivan)

Dementia associated with heart bypass surgery

Depression or hepatic injury caused by interferon

Diabetes caused by atypical antipsychotic medications (neuroleptic psychiatric drugs)

Diarrhea caused by the use of orlistat (Xenical)

Erectile dysfunction associated with many drugs, such as antidepressants

Fever associated with vaccination (in the past, imperfectly manufactured vaccines, such as BCG and poliomyelitis, have caused the very disease they intended to fight).

Glaucoma associated with corticosteroid-based eye drops

Hair loss and anemia may be caused by chemotherapy against cancer, leukemia, etc.

Headache following spinal anesthesia

Hypertension in ephedrine users, which prompted FDA to remove the status of dietary supplement of ephedra extracts

Insomnia caused by stimulants, Ritalin, Adderall, etc.

Lactic acidosis associated with the use of stavudine (Zerit, for anti-HIV therapy) or metformin (for diabetes)

Liver damage from paracetamol

Melasma and thrombosis associated with use of estrogen-containing hormonal contraception such as the combined oral contraceptive pill

Rhabdomyolysis associated with statins (anti-cholesterol drugs)

Seizures caused by withdrawal from benzodiazepine

Drowsiness or increase in appetite due to antihistamine use. Some antihistamines are used in sleep aids explicitly because they cause drowsiness.

Stroke or heart attack associated with sildenafil (Viagra) when used with nitroglycerine

Suicide, increased tendency associated to the use of fluoxetine and other SSRI antidepressants

Tardive dyskinesia associated with long-term use of metoclopramide and many antipsychotic medications

Danger from undesired side-effects

Conventional treatments are subjected to testing for undesired side-effects, whereas alternative treatments generally are not subjected to such testing at all. However, any treatment — whether conventional or alternative — that has a biological or psychological impact on a patient may also have potentially dangerous biological or psychological side-effects. Nevertheless, attempts to refute this fact with regard to alternative treatments sometimes use the appeal to nature fallacy, i.e. "that which is natural cannot be harmful".
Homeopathy, however, is insulated from direct side effects by the known laws of chemistry and physics. Homeopathic preparations, termed "remedies," are extremely dilute, often far beyond the point where a single molecule of the original active ingredient is likely to remain

Danger related to self-medication

Similar problems as those related to self-medication also apply to parts of alternative medicine. For example, an alternative medicine may instantly make symptoms better, but actually worsen problems in the long run. The result may be addiction and deteriorating health.

Self-medication is the use of drugs, sometimes illicit, to treat a perceived or real malady, often of a psychological nature.
Over-the-counter drugs are a form of self medication. The buyer diagnoses his/her own illness and buys a specific drug to treat it. The World Self-Medication Industry (WSMI) define self-medication as the treatment of common health problems with medicines especially designed and labeled for use without medical supervision and approved as safe and effective for such use.
A person may also self-medicate by taking more or less than the recommended dose of a drug.
Some mental illness sufferers attempt to correct their illnesses by use of certain drugs. Depression, for example, is notorious for being a trigger of alcohol, tobacco, cannabis, or other mind-altering drug use. While this may provide immediate relief of some symptoms such as anxiety, it may evoke and/or exacerbate some symptoms of several kinds of mental illnesses that are already latently present, and may lead to addiction/dependence, among other side effects of long-term use of the drug. The theory that drug dependence or addiction results from self-medication for the distress caused by a pre-existing condition was introduced in 1974 by David F. Duncan and Edward J. Khantzian in independent publications. This theory has come to be known as the self-medication hypothesis. For example, sufferers of post-traumatic stress disorder are prone to self-medication, as well as many individual without this diagnosis which have suffered from (mental) trauma.
Occasionally an individual will attempt self-medication for physical illnesses. For example, it is believed that Kurt Cobain's use of heroin partially stemmed from a painful stomach condition.
The current phenomenon in many Western societies of the widespread usage of vitamins, herbs, and other over-the-counter "supplements"--usually without the advice, supervision, or even knowledge of any licensed health professional--is another possible example of self-medication. Some observers of health behavior and medical affairs have speculated that this trend may arise from the desire of laymen to feel more in control of their own health--rather than relying on the traditional medical establishment, whose motives are sometimes seen as suspect. The extraordinary increases in the cost of traditional health care in recent decades--doctors, hospitals, prescriptions, etc.-- causes some individuals to desperately try to find more affordable alternatives to treat or prevent their own afflictions.

Issues of regulation

The production of modern pharmaceuticals is strictly regulated to ensure that every pill in every batch contains a standard quantity of active ingredients and is free from contamination. Alternative medicine products are not subject to such quality control regulation, and homogeneity at encapsulation and batch-to-batch consistency are sometimes compromised. This leads to uncertainty in the chemical content and biological activity of each pill. Additionally, alternative health products are sometimes adulterated or contaminated with prescription medications or toxic ingredients, such as lead.
Critics contend[who?] that some branches of alternative medicine are often not properly regulated in some countries, making it difficult to impossible for consumers to evaluate practitioner training and expertise. Critics contend that governmental regulation of any particular alternative therapy does necessarily indicate that the therapy is safe and effective. The most sensible course in such a case could be to simply ensure that the sold treatment is not dangerous, but the problem would then remain to know if it does what its proponents say it does

Socio-cultural reasons cited include

the low level of scientific literacy among the public at large
an increase in anti-intellectualism and antiscientific attitudes riding on the coattails of new age mysticism
vigorous marketing of extravagant claims by the "alternative" medical community
inadequate media scrutiny and attacks on critics
increasing social malaise and mistrust of traditional authority figures - the antidoctor backlash.
dislike of the delivery methods of scientific biomedicine

Psychological reasons cited include

the placebo effect
the will to believe
self-serving biases that help maintain self-esteem and promote harmonious social functioning
demand characteristics - the obligation to respond in kind when someone does them a good turn[
post hoc, ergo propter hoc fallacy ("after this, therefore because of this"; the basis of most superstitious beliefs)
psychological distortion, such as confirmation bias and cognitive dissonance (inability to respond to criticism of alternative medicine in order to reduce one's cognitive dissonance)
patients' unpleasant personal experiences with hospitals, doctors, and nurses and perceptions of rude, cold interpersonal interactions.
emotionally positive and psychologically affirming experiences with alternative practitioners.
painful, unpleasant, and sometimes dangerous side effects of biomedical treatments. Treatments for severe diseases such as cancer and HIV infection have well-known, significant side effects. Even low-risk medications such as antibiotics can potentially cause life-threatening anaphylactic reactions in a very few individuals. More commonly, many medications may cause minor but bothersome symptoms such as cough or upset stomach

Economic reasons include

Lack of access to scientific biomedicine, due to lack of private health insurance, societal resources or government funding.

Health insurance

The term health insurance is generally used to describe a form of insurance that pays for medical expenses. It is sometimes used more broadly to include insurance covering disability or long-term nursing or custodial care needs. It may be provided through a government-sponsored social insurance program, or from private insurance companies. It may be purchased on a group basis (e.g., by a firm to cover its employees) or purchased by individual consumers. In each case, the covered groups or individuals pay premiums or taxes to help protect themselves from high or unexpected healthcare expenses. Similar benefits paying for medical expenses may also be provided through social welfare programs funded by the government.
Health insurance works by estimating the overall risk of healthcare expenses and developing a routine finance structure (such as a monthly premium or annual tax) that will ensure that money is available to pay for the healthcare benefits specified in the insurance agreement. The benefit is administered by a central organization, most often either a government agency or a private or not-for-profit entity operating a health plan

Integrative medicine

According to the NCCAM, integrative medicine, or integrated medicine, "combines treatments from conventional medicine and CAM for which there is some high-quality evidence of safety and effectiveness.
According to Andrew T. Weil M.D., a leading proponent of integrative medicine, the principles of integrative medicine include: appropriate use of conventional and CAM methods; patient participation; promotion of health as well as treatment of disease; and a preference for natural, minimally-invasive methods

Integrative medicine, as defined by NCCAM, combines conventional medical treatments and CAM alternative treatments for which there is some high-quality scientific evidence of their safety and effectiveness.
The term Integrative Medicine has been attributed to Dr Andrew Weil, but this phrase was actually coined by the Californian physician and author, Dr Elson Haas.
"Integrative medicine is the term being used for a new movement that is being driven by the desires of consumers but that is now getting the attention of many academic health centers. Importantly, integrative medicine is not synonymous with complementary and alternative medicine (CAM). It has a far larger meaning and mission in that it calls for restoration of the focus of medicine on health and healing and emphasizes the centrality of the patient-physician relationship. In addition to providing the best conventional care, integrative medicine focuses on preventive maintenance of health by paying attention to all relative components of lifestyle, including diet, exercise, stress management, and emotional well-being. It insists on patients being active participants in their health care as well as on physicians viewing patients as whole persons—minds, community members, and spiritual beings, as well as physical bodies. Finally, it asks physicians to serve as guides, role models, and mentors, as well as dispensers of therapeutic aids

Hippocratic theory

Hippocrates is credited with being the first physician to reject superstitions and beliefs that credited supernatural or divine forces with causing illness. Hippocrates was credited by the disciples of Pythagoras of allying philosophy and medicine. He separated the discipline of medicine from religion, believing and arguing that disease was not a punishment inflicted by the gods but rather the product of environmental factors, diet and living habits. Indeed there is not a single mention of a mystical illness in the entirety of the Hippocratic Corpus. However, Hippocrates did work with many convictions that were based on what is now known to be incorrect anatomy and physiology, such as Humorism.
Ancient Greek schools of medicine were split (into the Knidian and Koan) on how to deal with disease. The Knidian school of medicine focused on diagnosis, but was dependent on many faulty assumptions about the human body: Greek medicine at the time of Hippocrates knew almost nothing of human anatomy and physiology because of the Greek taboo forbidding the dissection of humans. The Knidian school consequently failed to distinguish when one disease caused many possible series of symptoms. The Hippocratic school or Koan school achieved greater success by applying general diagnoses and passive treatments. Its focus was on patient care and prognosis, not diagnosis. It could effectively treat diseases and allowed for a great development in clinical practice.
Hippocratic medicine and its philosophy are far removed from that of modern medicine. Now, the physician focuses on specific diagnosis and specialized treatment, both of which were espoused by the Knidian school. This shift in medical thought since Hippocrates' day has caused serious criticism over the past two millennia, with the passivity of Hippocratic treatment being the subject of particularly strong denunciations; for example, the French doctor M. S. Houdart called the Hippocratic treatment a "meditation upon death".

Hippocrates

Hippocrates of Cos II or Hippokrates of Kos (ca. 460 BC – ca. 370 BC) - Greek: Ἱπποκράτης; Hippokrátēs was an ancient Greek physician of the Age of Pericles, and was considered one of the most outstanding figures in the history of medicine. He is referred to as the "father of medicine" in recognition of his lasting contributions to the field as the founder of the Hippocratic school of medicine. This intellectual school revolutionized medicine in ancient Greece, establishing it as a discipline distinct from other fields that it had traditionally been associated with (notably theurgy and philosophy), thus making medicine a profession.
However, the achievements of the writers of the Corpus, the practitioners of Hippocratic medicine, and the actions of Hippocrates himself are often commingled; thus very little is known about what Hippocrates actually thought, wrote and did. Nevertheless, Hippocrates is commonly portrayed as the paragon of the ancient physician. In particular, he is credited with greatly advancing the systematic study of clinical medicine, summing up the medical knowledge of previous schools, and prescribing practices for physicians through the Hippocratic Oath and other works

Legal restrictions

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 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 specialty 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 "medicalizes" disease and causes loss of health and wellness, while generally failing to restore health by eliminating disease. This medicalization of disease forces the human to become 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 criticizes overreliance on technological means in medicine.
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