Medicine

This article is about the science of healing. For other uses, see Medicine (disambiguation).

"Medical" redirects here. A "medical" is also an informal term in some places for a medical examination.

The Doctor by Sir Luke Fildes (1891)

Medicine is the science and practice of caring for patients, managing the diagnosis, prognosis, prevention, treatment and palliation of their injury or disease, while promoting their health. Medicine encompasses a variety of health care practices which evolved to maintain and restore health through the prevention and treatment of illness and infection. Contemporary medicine applies biomedical sciences, biomedical research, genetics, and medical technology to diagnose, treat, and prevent injury and disease, typically through various pharmaceuticals or surgery, but also through therapies such as psychotherapy, external splints and traction, medical devices, biologics, and ionizing radiation, amongst others.

Medicine has been practiced since prehistoric times, and for most of this time it was an art (an area of creativity and skill), frequently having connections to the religious and philosophical beliefs of local culture. For example, a medicine man would apply herbs and say prayers for healing, or an ancient philosopher and physician would apply bloodletting according to the theories of humorism, or the four humors. In recent centuries, since the advent of modern science, most medicine has become a combination of art and science (both basic and applied, under the umbrella of medical science). For example, while stitching technique for sutures is an art learned through practice, science provides knowledge of what happens at the cellular and molecular level in the tissues being stitched.

Prescientific forms of medicine, now known as traditional medicine or folk medicine, remain commonly used in the absence of scientific medicine and are thus called alternative medicine. Alternative treatments outside of scientific medicine with ethical, safety and efficacy concerns are termed quackery or being based on fringe science.

Etymology

Medicine (UK: /ˈmɛdsɪn/ ^ⓘ, US: /ˈmɛdɪsɪn/ ^ⓘ) is the science and practice of the diagnosis, prognosis, treatment, and prevention of disease. The word "medicine" is derived from Latin medicus, meaning "a physician". The word "physic" itself, from which "physician" derives, was the old word for what is now called a medicine, and also the field of medicine.

Clinical practice

Elizabeth Blackwell, the first female physician in the United States graduated from SUNY Upstate (1847)

Medical availability and clinical practice vary across the world due to regional differences in culture and technology. Modern scientific medicine is highly developed and widespread in the Western world, whereas in some low-resource regions—including parts of Africa, the Pacific Islands of Oceania, Southeast Asia, and Latin America—populations often rely more heavily on traditional medicine. These practices consist of decentralized training structures and vary widely in empirical support; consequently, they may lack formal regulatory oversight or robust evidence for clinical efficacy.

In the developed world, evidence-based medicine (EBM) is not universally applied in clinical practice; for example, a 2007 survey of literature reviews found that about 49% of medical interventions lacked sufficient evidence to support either benefit or harm. However, medical practitioners who apply an intervention with uncertain efficacy without adequate justification, transparency, or patient consent may violate the bioethical principle of non-maleficence, a core tenet of biomedical ethics historically associated with the Hippocratic Oath, which emphasizes a primary duty to "first, do no harm."

In modern clinical practice, physicians and mid-level practitioners such as physician assistants personally assess patients to diagnose, prognose, treat, and prevent disease using clinical judgment. An initial medical encounter with a patient typically begins with a review of the patient's medical history and medical record, followed by a medical interview and a physical examination. Basic diagnostic medical devices (e.g., stethoscope, tongue depressor) are typically used. After examining for signs and interviewing for symptoms, the doctor may order medical tests (e.g., blood tests), take a biopsy, or prescribe pharmaceutical drugs or other therapies. Differential diagnosis methods help to rule out conditions based on the information provided. During the encounter, properly informing the patient of all relevant facts is an important part of the relationship and the development of trust within the context of the doctor-patient relationship. The medical encounter is then documented in the medical record, which is a legal document in many jurisdictions. Follow-up encounters may be shorter but follow the same general procedure, and specialists follow a similar process. The diagnosis and treatment may take only a few minutes or a few weeks, depending on the complexity of the issue.

The components of the medical interview and encounter are:

• Chief complaint (CC): the reason for the current medical visit. These are the symptoms. They are in the patient's own words and are recorded along with the duration of each one. Also called chief concern or presenting complaint.
• Current activity: occupation, hobbies, what the patient actually does professionally and non-professionally.
• Family history (FH): listing of diseases in the family that may impact the patient. A family tree is sometimes used.
• History of present illness (HPI): the chronological order of events of symptoms and further clarification of each symptom. Distinguishable from history of previous illness, often called past medical history (PMH). Medical history comprises HPI and PMH.
• Medications (Rx): what drugs the patient takes including prescribed, over-the-counter, and home remedies, as well as alternative and herbal medicines or remedies. Allergies are also recorded.
• Past medical history (PMH/PMHx): concurrent medical problems, past hospitalizations and operations, injuries, past infectious diseases or vaccinations, history of known allergies.
• Review of systems (ROS) or systems inquiry: a set of additional questions to ask, which may be missed on HPI: a general enquiry (have you noticed any weight loss, change in sleep quality, fevers, lumps and bumps? etc.), followed by questions on 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, medications, tobacco, alcohol).

The physical examination is the examination of the patient for medical signs of disease that are objective and observable, in contrast to symptoms that are volunteered by the patient and are not necessarily objectively observable. The healthcare provider uses sight, hearing, touch, and sometimes smell (e.g., in infection, uremia, diabetic ketoacidosis). Four actions are the basis of physical examination: inspection, palpation (feel), percussion (tap to determine resonance characteristics), and auscultation (listen), generally in that order, although auscultation occurs prior to percussion and palpation for abdominal assessments.

The clinical examination involves the study of:

• Abdomen and rectum
• Cardiovascular (heart and blood vessels)
• General appearance of the patient and specific indicators of disease (nutritional status, presence of jaundice, pallor or clubbing)
• Genitalia (and pregnancy if the patient is or could be pregnant)
• Head, eye, ear, nose, and throat (HEENT)
• Musculoskeletal (including spine and extremities)
• Neurological (consciousness, awareness, brain, vision, cranial nerves, spinal cord and peripheral nerves)
• Psychiatric (orientation, mental state, mood, evidence of abnormal perception or thought).
• Respiratory (large airways and lungs)
• Skin
• Vital signs including height, weight, body temperature, blood pressure, pulse, respiration rate, and hemoglobin oxygen saturation

It is to likely focus on areas of interest highlighted in the medical history and may not include everything listed above.

The treatment plan may include ordering additional medical laboratory tests and medical imaging studies, starting therapy, referral to a specialist, or watchful observation. A follow-up may be advised. Depending upon the health insurance plan and the managed care system, various forms of "utilization review", such as prior authorization of tests, may place barriers on accessing expensive services.

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

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

Institutions

The Hospital of Santa Maria della Scala, fresco by Domenico di Bartolo, 1441–1442

Contemporary medicine is, in general, conducted within health care systems. Legal, credentialing, and financing frameworks are established by individual governments, augmented on occasion by international organizations, such as churches. The characteristics of any given health care system have a significant impact on the way medical care is provided.

From ancient times, Christian emphasis on practical charity gave rise to the development of systematic nursing and hospitals, and the Catholic Church today remains the largest non-government provider of medical services in the world. Advanced industrial countries (with the exception of the United States) and many developing countries provide medical services through a system of universal health care that aims to guarantee care for all through a single-payer health care system or compulsory private or cooperative health insurance. This is intended to ensure that the entire population has access to medical care on the basis of need rather than ability to pay. Delivery may be via private medical practices, state-owned hospitals and clinics, or charities, most commonly a combination of all three.

Most tribal societies provide no guarantee of healthcare for the population as a whole. In such societies, healthcare is available to those who can afford to pay for it, have self-insured it (either directly or as part of an employment contract), or may be covered by care financed directly by the government or tribe.

Modern drug ampoules

Transparency of information is another factor defining a delivery system. Access to information on conditions, treatments, quality, and pricing greatly affects the choice of patients/consumers and, therefore, the incentives of medical professionals. While the US healthcare system has come under fire for its lack of openness, new legislation may encourage greater openness. There is a perceived tension between the demand for transparency and concerns over patient confidentiality and the commercial misuse of medical data. Advocates argue that openness helps patients make informed decisions, while critics warn it can expose sensitive records and invite exploitation by insurers, employers, or marketers. Balancing accountability with privacy remains a central challenge.

The health professionals who provide care in medicine comprise multiple professions, such as medics, nurses, physiotherapists, and psychologists. These professions will have their own ethical standards, professional education, and bodies. The medical profession has been conceptualized from a sociological perspective.

Delivery

See also: Health care, clinic, hospital, and hospice

Provision of medical care is classified into primary, secondary, and tertiary care categories.

Nurses in Kokopo, East New Britain, Papua New Guinea

Primary care medical services are provided by physicians, physician assistants, nurse practitioners, or other health professionals who have first contact with a patient seeking medical treatment or care. These occur in physician offices, medical practices, clinics, nursing homes, schools, patients' homes, and in other places that are typically geographically close to where patients live, work or study. About 90% of medical visits can be satisfactorily and effectively dealt with by primary care provider(s). Primary care visits might include treatment of minor, acute or chronic illnesses, preventive care, and health education. Primary care is directed to the health of entire populations and thus providers care for patients of all ages and sexes.

Secondary care medical services are provided by medical specialists in their offices, practices or clinics, or at local community hospitals, to patients referred by the primary care provider who first diagnosed or treated the patient. 'Referrals' are made of those patients who required the particular expertise of, or specific procedures performed by, specialists. Secondary care services include both ambulatory care and inpatient services, emergency departments, some intensive care medicine, some surgeries and related services, physical therapy, labor and delivery, endoscopy units, diagnostic laboratory and medical imaging services, hospice centers, and others depending on the health services systems within which the care is being delivered. Some primary care providers may also take care of hospitalized patients and deliver babies in a secondary care setting.

Tertiary care medical services are provided by specialist teams of providers in larger, more specialised hospitals or regional medical centers, which are equipped with diagnostic and treatment facilities not typically available at local (often smaller) hospitals. This allows for the treatment and care of patients with more complex or urgent or serious medical conditions, which in turn may require more expertise (including multi-disciplinary teams) and resources (facilities, staff, bed days) to effectively treat. Tertiary care may include that provided at burn treatment or trauma centers, advanced neonatology unit services, organ transplants, high-risk pregnancy and child delivery, radiation oncology, and very many other forms of specialist and intensive care.

Modern medical care also depends on the keeping and use of information, including about a particular patient—still kept in many health care settings on paper 'medical records', but increasingly nowadays by electronic means.

In low-income countries, modern healthcare is often too expensive for the average person. International healthcare policy researchers have advocated that "user fees" be removed in these areas to ensure access; however, even with removal of patient fee obligations, significant costs and barriers remain for the poor and the sick in accessing sufficient care.

Separation of prescribing and dispensing is a practice in medicine and pharmacy in which the physician who provides a medical prescription is different from the pharmacist who provides the prescription drug to the patient. In the Western world there are centuries of tradition and practice differentiating pharmacists from physicians, and two quite separate professions developed. In many Asian countries, on the other hand, it is traditional for physicians to also deliver drugs directly to patients, at least in some cases. This model is also being used increasingly in the west: especially for simply-treated conditions (eg, those needing general antibiotics), in remote locations, with vulnerable communities of patients, and in small or integrated medical facilities.

Branches

Drawing by Marguerite Martyn (1918) of a visiting nurse in St. Louis, Missouri, with medicine and babies

Working together as an interdisciplinary team, many health professionals besides medical practitioners are involved in the delivery of modern health care. Examples include: nurses, emergency medical technicians and paramedics, laboratory scientists, pharmacists, podiatrists,