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, and critical thinking|
|MBBS, MD, MDCM, or DO|
| General practitioner |
A physician (American English), medical practitioner (Commonwealth English), 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.
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.
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.
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."
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.
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, and 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, 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.
Primary care physicians guide patients in preventing disease and detecting health problems early while they’re still treatable.They are divided into two types: family medicine doctors and internal medicine doctors. Family doctors, or family physicians, are trained to care for patients of any age, while internists are trained to care for adults. Family doctors receive training in a variety of care and are therefore also referred to as general practitioners. Family medicine grew out of the general practitioner movement of the 1960s in response to the growing specialization in medicine that was seen as threatening to the doctor-patient relationship and continuity of care.
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", 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 ( romanized:paschein, lit. to suffer) and its cognate noun πάθος (pathos, suffering).
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". The US National Center for Complementary and Alternative Medicine (NCCAM) classifies complementary and alternative medicine 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. [ citation needed ]
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 years for white and 69 years for black) than lawyers or many other highly educated professionals. Causes of death which are less likely to occur in physicians than the general population include respiratory disease (including pneumonia, pneumoconioses, COPD, but excluding emphysema and other chronic airway obstruction), alcohol-related deaths, rectosigmoid 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 government spending, as medical care is commonly subsidized by national governments.
In some jurisdictions such as in 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 such as 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.[ dubious ]
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 US usually take standardized exams, such as the USMLE for a Doctor in Medicine.
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 US, as of 2006 there were few organizations that systematically monitored performance. In the US, only the Department of Veterans Affairs randomly drug tests physicians, in contrast to drug testing practices for other professions that have a major impact on public welfare. Licensing boards at the US 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 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.
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.
Neurology is a branch of medicine dealing with disorders of the nervous system. Neurology deals with the diagnosis and treatment of all categories of conditions and disease involving the central and peripheral nervous systems, including their coverings, blood vessels, and all effector tissue, such as muscle. Neurological practice relies heavily on the field of neuroscience, the scientific study of the nervous system.
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 practise 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.
Internal medicine or general internal 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. Of note is that internal medicine and family medicine are often confused as equal in the Commonwealth nations.
A podiatrist, also known as a podiatric physician or foot and ankle surgeon, is a medical professional devoted to the 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 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 in countries such as the United Kingdom, Australia, and Canada.
Hospital medicine is a medical specialty that exists in some countries as a branch of internal or family medicine, dealing 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. Originating in the United States, this type of medical practice has extended into Australia and Canada. The vast majority of physicians who refer to themselves as hospitalists focus their practice upon hospitalized patients. Hospitalists are not necessarily required to have separate board certification in hospital medicine.
Residency or postgraduate training is a stage of graduate medical education. It refers to a qualified physician, podiatrist, dentist, optometrist, veterinarian, or pharmacist who practices medicine, usually in a hospital or clinic, under the direct or indirect supervision of a senior clinician registered in that specialty such as an attending physician or consultant. In many jurisdictions, successful completion of such training is a requirement in order to obtain an unrestricted license to practice medicine, and in particular a license to practice a chosen specialty. An individual engaged in such training may be referred to as a resident, house officer, registrar or trainee depending on the jurisdiction. Residency training may be followed by fellowship or sub-specialty training.
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, the equivalent term was general practitioner in the US; that is still the term in the United Kingdom.
A medical speciality is a branch of medical practice that is focused on a defined group of patients, diseases, skills, or philosophy. Examples include children (pediatrics), 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.
Internal medicine-pediatrics, or med-peds, is a medical specialty in which doctors train to be board certified in both internal medicine and pediatrics. A residency program in med-peds is four years in length, contrasted with three years for internal medicine or pediatrics alone. Upon completion of a med-peds residency, a doctor can practice in the areas of internal medicine, pediatrics or can complete a fellowship program to further specialize in an internal medicine or pediatrics sub-field.
The American Board of Internal Medicine (ABIM) is a 501(c)(3) nonprofit, self-appointed physician-evaluation organization that certifies physicians practicing internal medicine and its subspecialties. The American Board of Internal Medicine is not a membership society, educational institution, or licensing body.
The Society of Hospital Medicine 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 who 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.
Post-Hospitalist Medicine is the discipline concerned with the medical care of patients residing in Post-Acute, Long-Term Care, Rehabilitation and Assisted Living Facilities. The Physicians whose primary professional focus is the post-hospital medical care of these patients are called Post-Hospitalists.
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.
See also editorial by Hamel M. B. et al. on pp1141–1143 of same issue
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