The Doctor by Luke Fildes (detail)
|Names||Physician, medical practitioner, medical doctor or simply doctor|
|Medicine, health care|
|Competencies||The ethics, art and science of medicine, analytical skills, critical thinking|
|MBBS, MD, DO|
| General practitioner |
A physician, medical practitioner, medical doctor, or simply doctor, is a professional who practises medicine, which is concerned with promoting, maintaining, or restoring health through the study, diagnosis, prognosis and treatment of disease, injury, and other physical and mental impairments. Physicians may focus their practice on certain disease categories, types of patients, and methods of treatment—known as specialities—or they may assume responsibility for the provision of continuing and comprehensive medical care to individuals, families, and communities—known as general practice.Medical practice properly requires both a detailed knowledge of the academic disciplines, such as anatomy and physiology, underlying diseases and their treatment—the science of medicine—and also a decent competence in its applied practice—the art or craft of medicine.
A professional is a member of a profession or any person who earns their living from a specified professional activity. The term also describes the standards of education and training that prepare members of the profession with the particular knowledge and skills necessary to perform their specific role within that profession. In addition, most professionals are subject to strict codes of conduct, enshrining rigorous ethical and moral obligations. Professional standards of practice and ethics for a particular field are typically agreed upon and maintained through widely recognized professional associations, such as the IEEE. Some definitions of "professional" limit this term to those professions that serve some important aspect of public interest and the general good of society.
Medicine is the science and practice of establishing the diagnosis, prognosis, treatment, and prevention of disease. Medicine encompasses a variety of health care practices evolved to maintain and restore health by the prevention and treatment of illness. Contemporary medicine applies biomedical sciences, biomedical research, genetics, and medical technology to diagnose, treat, and prevent injury and disease, typically through pharmaceuticals or surgery, but also through therapies as diverse as psychotherapy, external splints and traction, medical devices, biologics, and ionizing radiation, amongst others.
Health, as defined by the World Health Organization (WHO), is "a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity." This definition has been subject to controversy, as it may have limited value for implementation. Health may be defined as the ability to adapt and manage physical, mental and social challenges throughout life.
Both the role of the physician and the meaning of the word itself vary around the world. Degrees and other qualifications vary widely, but there are some common elements, such as medical ethics requiring that physicians show consideration, compassion, and benevolence for their patients.
Medical ethics is a system of moral principles that apply values to the practice of clinical medicine and in scientific research. Medical ethics is based on a set of values that professionals can refer to in the case of any confusion or conflict. These values include the respect for autonomy, non-maleficence, beneficence, and justice. Such tenets may allow doctors, care providers, and families to create a treatment plan and work towards the same common goal. It is important to note that these four values are not ranked in order of importance or relevance and that they all encompass values pertaining to medical ethics. However, a conflict may arise leading to the need for hierarchy in an ethical system, such that some moral obligations overrule others with the purpose of applying the best moral judgement to a difficult medical situation.
A patient is any recipient of health care services. The patient is most often ill or injured and in need of treatment by a physician, nurse, psychologist, dentist, veterinarian, or other health care provider.
Around the world the term physician refers to a specialist in internal medicine or one of its many sub-specialties (especially as opposed to a specialist in surgery). This meaning of physician conveys a sense of expertise in treatment by drugs or medications, rather than by the procedures of surgeons.
Internal medicine or general medicine is the medical specialty dealing with the prevention, diagnosis, and treatment of adult diseases. Physicians specializing in internal medicine are called internists, or physicians in Commonwealth nations. Internists are skilled in the management of patients who have undifferentiated or multi-system disease processes. Internists care for hospitalized and ambulatory patients and may play a major role in teaching and research.
Surgery is a medical specialty that uses operative manual and instrumental techniques on a patient to investigate or treat a pathological condition such as a disease or injury, to help improve bodily function or appearance or to repair unwanted ruptured areas.
In modern medicine, a surgeon is a physician who performs surgical operations. There are also surgeons in podiatry, dentistry maxillofacial surgeon and the veterinary fields.
This term is at least nine hundred years old in English: physicians and surgeons were once members of separate professions, and traditionally were rivals. The Shorter Oxford English Dictionary , third edition, gives a Middle English quotation making this contrast, from as early as 1400: "O Lord, whi is it so greet difference betwixe a cirugian and a physician."
The Shorter Oxford English Dictionary (SOED) is an English language dictionary published by the Oxford University Press. The SOED is a two-volume abridgement of the twenty-volume Oxford English Dictionary (OED).
Henry VIII granted a charter to the London Royal College of Physicians in 1518. It was not until 1540 that he granted the Company of Barber-Surgeons (ancestor of the Royal College of Surgeons) its separate charter. In the same year, the English monarch established the Regius Professorship of Physic at the University of Cambridge. Newer universities would probably describe such an academic as a professor of internal medicine. Hence, in the 16th century, physic meant roughly what internal medicine does now.
Henry VIII was King of England from 1509 until his death in 1547. Henry was the second Tudor monarch, succeeding his father, Henry VII. Henry is best known for his six marriages, in particular his efforts to have his first marriage, to Catherine of Aragon, annulled. His disagreement with the Pope on the question of such an annulment led Henry to initiate the English Reformation, separating the Church of England from papal authority. He appointed himself the Supreme Head of the Church of England and dissolved convents and monasteries, for which he was excommunicated. Henry is also known as "the father of the Royal Navy"; he invested heavily in the Navy, increasing its size greatly from a few to more than 50 ships.
The Royal College of Physicians is a British professional body dedicated to improving the practice of medicine, chiefly through the accreditation of physicians by examination. Founded in 1518, it set the first international standard in the classification of diseases, and its library contains medical texts of great historical interest.
The barber surgeon, one of the most common European medical practitioners of the Middle Ages, was generally charged with caring for soldiers during and after battle. In this era, surgery was seldom conducted by physicians, but instead by barbers, who, in having razors indispensable to their trade, were called upon for numerous tasks ranging from cutting hair to amputating limbs.
Currently, a specialist physician in the United States may be described as an internist. Another term, hospitalist , was introduced in 1996,to describe US specialists in internal medicine who work largely or exclusively in hospitals. Such 'hospitalists' now make up about 19% of all US general internists, who are often called general physicians in Commonwealth countries.
This original use, as distinct from surgeon, is common in most of the world including the United Kingdom and other Commonwealth countries (such as Australia, Bangladesh, India, New Zealand, Pakistan, South Africa, Sri Lanka, Zimbabwe), as well as in places as diverse as Brazil, Hong Kong, Indonesia, Japan, Ireland, and Taiwan. In such places, the more general English terms doctor or medical practitioner are prevalent, describing any practitioner of medicine (whom an American would likely call a physician, in the broad sense).In Commonwealth countries, specialist pediatricians and geriatricians are also described as specialist physicians who have sub-specialized by age of patient rather than by organ system.
Around the world, the combined term "physician and surgeon" is used to describe either a general practitioner or any medical practitioner irrespective of specialty.This usage still shows the original meaning of physician and preserves the old difference between a physician, as a practitioner of physic, and a surgeon. The term may be used by state medical boards in the United States of America, and by equivalent bodies in provinces of Canada, to describe any medical practitioner.
In modern English, the term physician is used in two main ways, with relatively broad and narrow meanings respectively. This is the result of history and is often confusing. These meanings and variations are explained below.
In the United States and Canada, the term physician describes all medical practitioners holding a professional medical degree. The American Medical Association, established in 1847, as well as the American Osteopathic Association, founded in 1897, both currently use the term physician to describe members. However, the American College of Physicians, established in 1915, does not: its title uses physician in its original sense.
The vast majority of physicians trained in the United States have a Doctor of Medicine degree, and use the initials M.D. A smaller number attend Osteopathic schools and have a Doctor of Osteopathic Medicine degree and use the initials D.O.After completion of medical school, physicians complete a residency in the specialty in which they will practice. Subspecialties require the completion of a fellowship after residency.
All boards of certification now require that physicians demonstrate, by examination, continuing mastery of the core knowledge and skills for a chosen specialty. Recertification varies by particular specialty between every seven and every ten years.
Also in the United States, the American Podiatric Medical Association (APMA) defines podiatrists as physicians and surgeons that fall under the department of surgery in hospitals.They undergo training with the Doctor of Podiatric Medicine (DPM) degree. This degree is also available at one Canadian university, namely the Université du Québec à Trois-Rivières. Students are typically required to complete an internship in New York prior to the obtention of their professional degree.
Many countries in the developing world have the problem of too few physicians.In 2015, the Association of American Medical Colleges warned that the US will face a doctor shortage of as many as 90,000 by 2025.
Within Western culture and over recent centuries, medicine has become increasingly based on scientific reductionism and materialism. This style of medicine is now dominant throughout the industrialized world, and is often termed biomedicine by medical anthropologists.Biomedicine "formulates the human body and disease in a culturally distinctive pattern", and is a world view learnt by medical students. Within this tradition, the medical model is a term for the complete "set of procedures in which all doctors are trained" (R. D. Laing, 1972), including mental attitudes. A particularly clear expression of this world view, currently dominant among conventional physicians, is evidence-based medicine. Within conventional medicine, most physicians still pay heed to their ancient traditions:
The critical sense and sceptical attitude of the citation of medicine from the shackles of priestcraft and of caste; secondly, the conception of medicine as an art based on accurate observation, and as a science, an integral part of the science of man and of nature; thirdly, the high moral ideals, expressed in that most "memorable of human documents" (Gomperz), the Hippocratic oath; and fourthly, the conception and realization of medicine as the profession of a cultivated gentleman.
— Sir William Osler, Chauvanism in Medicine (1902)
In this Western tradition, physicians are considered to be members of a learned profession, and enjoy high social status, often combined with expectations of a high and stable income and job security. However, medical practitioners often work long and inflexible hours, with shifts at unsociable times. Their high status is partly from their extensive training requirements, and also because of their occupation's special ethical and legal duties. The term traditionally used by physicians to describe a person seeking their help is the word patient (although one who visits a physician for a routine check-up may also be so described). This word patient is an ancient reminder of medical duty, as it originally meant 'one who suffers'. The English noun comes from the Latin word patiens, the present participle of the deponent verb, patior, meaning 'I am suffering,' and akin to the Greek verb πάσχειν (= paskhein, to suffer) and its cognate noun πάθος (= pathos).
Physicians in the original, narrow sense (specialist physicians or internists, see above) are commonly members or fellows of professional organizations, such as the American College of Physicians or the Royal College of Physicians in the United Kingdom, and such hard-won membership is itself a mark of status. [ citation needed ]
While contemporary biomedicine has distanced itself from its ancient roots in religion and magic, many forms of traditional medicineand alternative medicine continue to espouse vitalism in various guises: 'As long as life had its own secret properties, it was possible to have sciences and medicines based on those properties' (Grossinger 1980). The US National Center for Complementary and Alternative Medicine (NCCAM) classifies CAM therapies into five categories or domains, including: alternative medical systems, or complete systems of therapy and practice; mind-body interventions, or techniques designed to facilitate the mind's effect on bodily functions and symptoms; biologically based systems including herbalism; and manipulative and body-based methods such as chiropractic and massage therapy.
In considering these alternate traditions that differ from biomedicine (see above), medical anthropologists emphasize that all ways of thinking about health and disease have a significant cultural content, including conventional western medicine.
Ayurveda, Unani medicine and homeopathy are popular types of alternative medicine. They are included in national system of medicines in countries such as India. In general, the practitioners of these medicine in these countries are referred to as Vaidya, Hakim and homeopathic doctor/homeopath/homeopathic physician, respectively.
Many disease have their root cause in mind related issues, and most physicians (and psychologists) following the Western system do not completely understand the functioning of the mind. Such physicians (who follow the Western system of science) also root out the role of ghosts and spirits as the cause of mind-oriented diseases.
Some commentators have argued that physicians have duties to serve as role models for the general public in matters of health, for example by not smoking cigarettes.Indeed, in most western nations relatively few physicians smoke, and their professional knowledge does appear to have a beneficial effect on their health and lifestyle. According to a study of male physicians, life expectancy is slightly higher for physicians (73.0 years for white and 68.7 for black) than lawyers or many other highly educated professionals. Causes of death less likely in physicians than the general population include respiratory disease (including pneumonia, pneumoconioses, COPD, but excluding emphysema and other chronic airway obstruction), alcohol-related deaths, rectosigmoidal and anal cancers, and bacterial diseases.
Physicians do experience exposure to occupational hazards, and there is a well-known aphorism that "doctors make the worst patients".Causes of death that are shown to be higher in the physician population include suicide among doctors and self-inflicted injury, drug-related causes, traffic accidents, and cerebrovascular and ischaemic heart disease.
Medical education and career pathways for doctors vary considerably across the world.
In all developed countries, entry-level medical education programs are tertiary-level courses, undertaken at a medical school attached to a university. Depending on jurisdiction and university, entry may follow directly from secondary school or require pre-requisite undergraduate education. The former commonly takes five or six years to complete. Programs that require previous undergraduate education (typically a three- or four-year degree, often in Science) are usually four or five years in length. Hence, gaining a basic medical degree may typically take from five to eight years, depending on jurisdiction and university.
Following completion of entry-level training, newly graduated medical practitioners are often required to undertake a period of supervised practice before full registration is granted, typically one or two years. This may be referred to as an "internship", as the "foundation" years in the UK, or as "conditional registration". Some jurisdictions, including the United States, require residencies for practice.
Medical practitioners hold a medical degree specific to the university from which they graduated. This degree qualifies the medical practitioner to become licensed or registered under the laws of that particular country, and sometimes of several countries, subject to requirements for internship or conditional registration.
Specialty training is begun immediately following completion of entry-level training, or even before. In other jurisdictions, junior medical doctors must undertake generalist (un-streamed) training for one or more years before commencing specialization. Hence, depending on jurisdiction, a specialist physician (internist) often does not achieve recognition as a specialist until twelve or more years after commencing basic medical training—five to eight years at university to obtain a basic medical qualification, and up to another nine years to become a specialist.
In most jurisdictions, physicians (in either sense of the word) need government permission to practice. Such permission is intended to promote public safety, and often to protect the public purse, as medical care is commonly subsidized by national governments.
In some jurisdictions (e.g., Singapore), it is common for physicians to inflate their qualifications with the title "Dr" in correspondence or namecards, even if their qualifications are limited to a basic (e.g., bachelor level) degree. In other countries (e.g., Germany), only physicians holding an academic doctorate may call themselves doctor – on the other hand, the European Research Council has decided that the German medical doctorate does not meet the international standards of a PhD research degree.
Among the English-speaking countries, this process is known either as licensure as in the United States, or as registration in the United Kingdom, other Commonwealth countries, and Ireland. Synonyms in use elsewhere include colegiación in Spain, ishi menkyo in Japan, autorisasjon in Norway, Approbation in Germany, and "άδεια εργασίας" in Greece. In France, Italy and Portugal, civilian physicians must be members of the Order of Physicians to practice medicine.
In some countries, including the United Kingdom and Ireland, the profession largely regulates itself, with the government affirming the regulating body's authority. The best known example of this is probably the General Medical Council of Britain. In all countries, the regulating authorities will revoke permission to practice in cases of malpractice or serious misconduct.
In the large English-speaking federations (United States, Canada, Australia), the licensing or registration of medical practitioners is done at a state or provincial level or nationally as in New Zealand. Australian states usually have a "Medical Board," which has now been replaced by the Australian Health Practitioner Regulatory Authority (AHPRA) in most states, while Canadian provinces usually have a "College of Physicians and Surgeons." All American states have an agency that is usually called the "Medical Board", although there are alternate names such as "Board of Medicine," "Board of Medical Examiners", "Board of Medical Licensure", "Board of Healing Arts" or some other variation.After graduating from a first-professional school, physicians who wish to practice in the U.S. usually take standardized exams, such as the USMLE for MDs).
Most countries have some method of officially recognizing specialist qualifications in all branches of medicine, including internal medicine. Sometimes, this aims to promote public safety by restricting the use of hazardous treatments. Other reasons for regulating specialists may include standardization of recognition for hospital employment and restriction on which practitioners are entitled to receive higher insurance payments for specialist services.
The issue of medical errors, drug abuse, and other issues in physician professional behavior received significant attention across the world,in particular following a critical 2000 report which "arguably launched" the patient-safety movement. In the U.S., as of 2006 there were few organizations that systematically monitored performance. In the U.S. only the Department of Veterans Affairs randomly drug tests, in contrast to drug testing practices for other professions that have a major impact on public welfare. Licensing boards at the U.S. state level depend upon continuing education to maintain competence. Through the utilization of the National Practitioner Data Bank, Federation of State Medical Boards Disciplinary Report, and American Medical Association Physician Profile Service, the 67 State Medical Boards (MD/DO) continually self-report any Adverse/Disciplinary Actions taken against a licensed Physician in order that the other Medical Boards in which the Physician holds or is applying for a medical license will be properly notified so that corrective, reciprocal action can be taken against the offending physician. In Europe, as of 2009 the health systems are governed according to various national laws, and can also vary according to regional differences similar to the United States.
Nurse practitioners (NPs) in the United States are advanced practice registered nurses holding a post-graduate degree such as a Doctor of Nursing Practice.In Canada, nurse practitioners typically have a Master of nursing degree as well as substantial experience they have accumulated throughout the years. Nurse practitioners are not physicians but may practice alongside physicians in a variety of fields. Nurse practitioners are educated in nursing theory and nursing practice. The scope of practice for a nurse practitioner in the United States is defined by regulatory boards of nursing, as opposed to boards of medicine that regulate physicians.
Emergency medicine, also known as accident and emergency medicine, is the medical specialty concerned with the care of illnesses or injuries requiring immediate medical attention. Emergency physicians care for unscheduled and undifferentiated patients of all ages. As first-line providers, their primary responsibility is to initiate resuscitation and stabilization and to start investigations and interventions to diagnose and treat illnesses in the acute phase. Emergency physicians generally practice in hospital emergency departments, pre-hospital settings via emergency medical services, and intensive care units, but may also work in primary care settings such as urgent care clinics. Sub-specializations of emergency medicine include disaster medicine, medical toxicology, ultrasonography, critical care medicine, hyperbaric medicine, sports medicine, palliative care, or aerospace medicine.
In the medical profession, a general practitioner (GP) is a medical doctor who treats acute and chronic illnesses and provides preventive care and health education to patients.
A podiatrist, also known as a podiatric physician or foot and ankle surgeon, is a medical professional devoted to the study and medical/surgical treatment of disorders of the foot, ankle and lower extremity. The term originated in North America, but has now become the accepted term in the English-speaking world for all practitioners of podiatric medicine.
Podiatry or podiatric medicine is a branch of medicine devoted to the study, diagnosis, and medical and surgical treatment of disorders of the foot, ankle and lower extremity. The term podiatry came into use in the early 20th century in the United States and is now used worldwide, including countries such as the United Kingdom, Australia and Canada.
Hospital medicine in the United States is the medical specialty concerned with the care of acutely ill hospitalized patients. Physicians whose primary professional focus is caring for hospitalized patients only while they are in the hospital are called hospitalists. This type of medical practice has extended beyond the United States into Australia and Canada. The vast majority of physicians who refer to themselves as hospitalists focus their practice upon hospitalized patients but do not necessarily have board certification in hospital medicine.
The American College of Physicians (ACP) is a national organization of internists, who specialize in the diagnosis, treatment, and care of adults. With 154,000 members, ACP is the largest medical-specialty organization and second-largest physician group in the United States, after the American Medical Association. Its flagship journal, the Annals of Internal Medicine, is considered one of the five top medical journals in the United States and Britain.
Family medicine (FM), formerly family practice (FP), is a medical specialty devoted to comprehensive health care for people of all ages; the specialist is named a family physician or family doctor. In Europe the discipline is often referred to as general practice and a practitioner as a general practice doctor or GP; this name emphasises the holistic nature of this speciality, as well as its roots in the family. Family practice is a division of primary care that provides continuing and comprehensive health care for the individual and family across all ages, genders, diseases, and parts of the body; family physicians are often primary care physicians. It is based on knowledge of the patient in the context of the family and the community, emphasizing disease prevention and health promotion. According to the World Organization of Family Doctors (WONCA), the aim of family medicine is to provide personal, comprehensive, and continuing care for the individual in the context of the family and the community. The issues of values underlying this practice are usually known as primary care ethics.
A primary care physician (PCP) is a physician who provides both the first contact for a person with an undiagnosed health concern as well as continuing care of varied medical conditions, not limited by cause, organ system, or diagnosis. The term is primarily used in the United States. In the past in the US and still in the United Kingdom, the equivalent term was/is general practitioner.
A nurse practitioner (NP) is an advanced practice registered nurse (APRN) classified as a mid-level practitioner. A nurse practitioner is trained to assess patient needs, order and interpret diagnostic and laboratory tests, diagnose illness and disease, prescribe medication and formulate treatment plans. NP training covers basic disease prevention, coordination of care, and health promotion, but does not provide the depth of expertise needed to recognize more complex cases in which multiple symptoms suggest more serious conditions. According to the American Association of Nurse Practitioners, a nurse practitioner is educated at the masters or doctoral level to provide "primary, acute, chronic, and specialty care to patients of all ages and all walks of life". The scope of practice for a nurse practitioner is defined by jurisdiction. Depending on jurisdiction, nurse practitioners may or may not be required to practice under the supervision of a physician. In United States, nurse practitioners have been lobbying for independent practice.. The opponents of independent practice have argued that nurse practitioner education is "flimsy," because it can consist of online coursework with few hours of actual patient contact. The number of patient contact hours in nurse practitioner training is less than or equal to 3% of physician training. Increased utilization of nurse practitioners is leading to increased cost of care through increased use of resources and unnecessary referrals.
A medical speciality is a branch of medical practice that is focused on a defined group of patients, diseases, skills or philosophy, e.g. children (paediatrics), cancer (oncology), laboratory medicine (pathology) or primary care. After completing medical school, physicians or surgeons usually further their medical education in a specific specialty of medicine by completing a multiple year residency to become a medical specialist.
Medical education in Australia includes the educational activities involved in the initial and ongoing training of Medical Practitioners. In Australia, medical education begins in Medical School; upon graduation it is followed by a period of pre-vocational training including Internship and Residency; thereafter, enrolment into a specialist-vocational training program as a Registrar eventually leads to fellowship qualification and recognition as a fully qualified Specialist Medical Practitioner. Medical education in Australia is facilitated by Medical Schools and the Medical Specialty Colleges, and is regulated by the Australian Medical Council (AMC) and Australian Health Practitioners Regulatory Agency (AHPRA) of which includes the Medical Board of Australia where medical practitioners are registered nationally.
The American Board of Hospital Medicine (ABHM) is a Member Board of the American Board of Physician Specialties (ABPS), the nation's third largest physician multispecialty certifying organization and was founded in 2009. The ABHM is North America's first and only board of certification devoted exclusively to hospital medicine founded by hospitalists and governed by hospitalists.
The Society of Hospital Medicine (SHM) is an American membership society for hospitalists, that is, physicians and other caregivers who practice the specialty of hospital medicine.
Physicians in the United States are doctors that practice medicine for the human body. They are an important part of health care in the United States. The vast majority of physicians in the US have a Doctor of Medicine (MD) degree, though some have a DO or MBBS.
Infectious disease, also known as infectiology, is a medical specialty dealing with the diagnosis, control and treatment of infections. An infectious disease (ID) specialist's practice may consist largely of managing nosocomial (hospital-acquired) infections, or it may be out-patient based.
Post-Hospitalist Medicine is the discipline concerned with the medical care of post-acute patients. Physicians whose primary professional focus is post-hospital care are post-hospitalists. Typical community PCPs and most other NP/PA/extender models do not have the time or ability to effectively monitor patient care when the patient is in a post-acute facility. As a result, increased hospitalizations, readmissions and unnecessary ER utilization occur frequently, increasing overall health care costs. When patients become ill with an urgent or non-emergency problem, most traditional care models typically direct the patient to the ER, utilizing the ER as an outpatient clinic rather than going to the post-acute facility, examining and treating the patient on-site.
An obstetric hospitalist is an obstetrician and gynaecologist physician who is either employed by a hospital or a physician practice and whose duties include providing care for laboring patients and managing obstetric emergencies. Some obstetrics hospitalists also have responsibilities including resident and medical student teaching; providing backup support for family practitioners and nurse midwives, assisting private physicians with surgery, assuming care for ob-gyn patients unassigned to a physician and providing vacation coverage for the private practicing physician.
Medical malpractice is a legal cause of action that occurs when a medical or health care professional deviates from standards in his or her profession, thereby causing injury to a patient.
See also editorial by Hamel M. B. et al. on pp1141–1143 of same issue
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