Medicine

Medicine is a branch of health science concerned with maintaining human health and restoring it by treating disease and injury; it is both an area of knowledge, a science of body systems and diseases and their treatment, and the applied practice of that knowledge.

Practice of medicine

The practice of medicine combines both science and art. Science and technology are the evidence base for many clinical problems for the general population at large. The art of medicine is the application of this medical knowledge in combination with intuition and clinical judgment to determine the proper diagnoses and treatment plan for this unique patient and to treat the patient accordingly.

Related Topics:
Science - Art - Technology

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Central to medicne is the patient-doctor relationship established when a person with a health concern or problem seeks the help of a physician (i.e. the medical encounter). Other health professionals similarly establish a relationship with a patient and may perform interventions from their perspective, e.g. nurses, radiographers and therapists.

Related Topics:
Patient - Doctor

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As part of the medical encounter, the doctor needs to:

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• develop a relationship with the patient
• gather data (medical history and physical examination combined with laboratory or imaging studies)
• analyze and synthesize that data (assessment and/or differential diagnosis), 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.

The medical encounter is documented in a medical record, which is a legal document in many jurisdictions. One method that is used is called the problem-oriented medical record (POMR), which includes a problem list of diagnoses and a "SOAP" method of documentation for each visit:

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• S - Subjective, the medical history of the problem from the point-of-view of the patient.
• O - Objective, the physical examination and any laboratory or imaging studies.
• A - Assessment, is the medical decision-making process including the differential diagnoses and most probable diagnoses.
• P - Plan, the way resolve the problem and monitor progress

Medical systems

Medicine is practiced within the medical system of a particular culture or government. Leaving aside tribal cultures, the most significant divide in developed countries is that between universal health care and the market based health care (such as practiced in the U.S.).

Related Topics:
Medical system - Universal health care - Market based health care

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Patient-doctor relationship

The doctor-patient relationship and interaction is a central process in the practice of medicine. There are many perspectives from which to understand and describe it.

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An idealized physician's perspective, such as is taught in medical school, sees the core aspects of the process as the physician learning from the patient his symptoms, concerns and values; in response the physician examines the patient, interprets the symptoms, and formulates a diagnosis to explain the symptoms and their cause to the patient and to propose a treatment. In more detail, the patient presents a set of complaints or concerns about his health to the doctor, who then obtains further information about the patient's symptoms, previous state of health, living conditions, and so forth, and then formulates a diagnosis and enlists the patient's agreement to a treatment plan. Importantly, during this process the doctor educates the patient about the causes, progression, outcomes, and possible treatments of his ailments, as well as often providing advice for maintaining health. This teaching relationship is the basis of calling the physician doctor, which originally meant "teacher" in Latin. The patient-doctor relationship is additionally complicated by the patient's suffering (patient derives from the Latin patiens, "suffering") and limited ability to relieve it on his own. The doctor's expertise comes from his knowledge about, or experience with, other people who have suffered similar symptoms, and his presumed ability to relieve it with medicines or other therapies about which the patient may initially have little knowledge.

Related Topics:
Medical school - Doctor

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The doctor-patient relationship can be analyzed from the perspective of ethical concerns, in terms of how well the goals of non-maleficence, beneficence, autonomy, and justice are achieved. Many other values and ethical issues can be added to these. In different societies, periods, and cultures, different values may be assigned different priorities. For example, in the last 30 years medical care in the Western World has increasingly emphasized patient autonomy in decision making.

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The relationship and process can also be analyzed in terms of social power relationships (e.g., by Michel Foucault), or economic transactions. Physicians have been accorded gradually higher status and respect over the last century, and they have been entrusted with control of access to prescription medicines as a public health measure. This represents a concentration of power and carries both advantages and disadvantages to particular kinds of patients with particular kinds of conditions. A further twist has occurred in the last 25 years as costs of medical care have risen, and a third party (an insurance company or government agency) now often insists upon a share of decision-making power for a variety of reasons, reducing freedom of choice of both doctors and patients in many ways.

Related Topics:
Michel Foucault - Insurance

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The quality of the patient-doctor relationship is important to both parties. The better the relationship in terms of mutual respect, knowledge, trust, shared values and perspectives about disease and life, and time available, the better will be the amount and quality of information about the patient's disease transferred in both directions, enhancing accuracy of diagnosis and increasing the patient's knowledge about the disease.

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In some settings, e.g. the hospital ward, the patient-doctor relationship is much more complex, and many other people are involved when somebody is ill: relatives, neighbors, rescue specialists, nurses, technical personnel, social workers and others.

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Clinical skills

Main articles: Medical history, Physical examination.

Related Topics:
Medical history - Physical examination

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A complete medical evaluation includes a medical history, a physical examination, appropriate laboratory or imaging studies, analysis of data and medical decision making to obtain diagnoses, and treatment plan.

Related Topics:
Medical history - Physical examination

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The components of the medical history are:

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• Chief complaint (CC) - the reason for the current medical visit.
• History of present illness (HPI) - the chronological order of events of symptoms. A mnemonic PQRST is sometimes helpful in obtaining the history:
• Provocative-palliative factors - what makes a symptom worse or better.
• Quality - description of the symptom
• Region - which part of the body is affected
• Severity - what is the intensity of the symptom; using a scale of 0-10 (10 worst)
• Timing - what is the course of the symptom
• Current activity - occupation, hobbies, what the patient actually does.
• Medications - what drugs including OTCs, and home remedies, as well as herbal remedies such as St. John's Wort. Allergies are recorded.
• Past medical history (PMH/PMHx) - other medical diagnoses, past hospitalizations and operations, injuries, past infectious diseases and/or vaccinations, history of known allergies.
• Review of systems (ROS) - an outline of additional symptoms to ask which may be missed on HPI, generally following the body's main organ systems (heart, lungs, digestive tract, urinary tract, etc).
• Social history (SH) - birthplace, residences, marital history, social and economic status, habits (including diet, drugs, tobacco, alcohol).
• Family history (FH) - listing of diseases in the family that may impact the patient. A family tree is sometimes used.

The physical examination is the examination of the patient looking for signs of disease. The doctor uses his senses of sight, hearing, touch, and sometimes smell (taste has been made redundant by the availability of modern lab tests). Four chief methods are used: inspection, palpation, percussion, and auscultation; smelling may be useful (e.g. infection, uremia, diabetic ketoacidosis). The clinical examination involves study of:

Related Topics:
Physical examination - Uremia - Diabetic ketoacidosis

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• Vital signs include height, weight, body temperature, blood pressure, pulse, respiration rate, hemoglobin oxygen saturation
• General appearance of the patient
• Skin
• Head, eye, ear, nose, and throat (HEENT)
• Cardiovascular - heart and blood vessels
• Respiratory - lungs
• Abdomen and rectosigmoid
• Genitalia
• Spine and extremities - musculoskeletal
• Neurological and psychiatric

Laboratory and imaging studies results may be obtained, if necessary.

Related Topics:
Laboratory - Imaging studies

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The medical decision-making (MDM) process involves analysis and synthesis of all the above data to come up with a list of possible diagnoses (the differential diagnoses), along with an idea of what needs to be done to obtain a definitive diagnosis that would explain the patient's problem.

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The treatment plan may include ordering additional laboratory tests and studies, starting therapy, referral to a specialist, or watchful observation. Follow-up may be advised.

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This process is used by primary care providers as well as specialists. It may take only a few minutes if the problem is simple and straightforward. On the other hand, it may take weeks in a patient who has been hospitalized with multi-system problems, with involvement by several specialists.

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On subsequent visits, the process may be repeated in an abbreviated manner to obtain any new history, symptoms, physical findings, and lab or imaging results or specialist consultations.

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