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[[دوتنه:Asklepios.3.jpg|بټنوک|آسکليپيوس، د يونان د درملګر خدای پژۍ، چې د آسکليپيوس لکړې سره او پرې تاو شوي مار د درملګرۍ د سمبول په توګه انځور]]
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'''طب''' د [[عربي]] ژبي لغت دی چي په [[لاتيني]] ژبه ورته medicina او [[انګليسي]] ژبه ورته Medicine وايي. طب د [[ساينسپوهني]] هغه برخه ده چي د [[ناروغي|ناروغيو]] او [[زخمونو]] د [[درملني]] سره تړاو لري.
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'''درملګري''' (په انګرېزي: Medicine) (په عربي:طب) (په پارسي:پزشکي) د درملنې هنر او پوهې ته وييل کېږي. دغه پوهنه د روغتيا پالنې ټولې عملي کړنې چې د يوې ناروغۍ نه د ژغورنې او درملنې په خاطر او د روغتيا د ساتنې او بيا پر حال کولو په موخه رامېنځ ته شوي، په ځان کې رانغاړي.
په معاصرې يا نوې درملګرۍ کې د يوې ناروغۍ د پېژندنې، درملنې او د جراحي رغونې لپاره د روغتيا پوهنې، بايومېډيکل څېړنې او درملګريز تخنيک نه ګټه اخيستل کېږي. د درملګري نوم د ساينس هغه هنر ته وييل کېږي چې د همدې هنر په مرسته د ناروغانو درملنه پرې ترسره کېږي. درملګرۍ ته په انګرېزي ژبه Medicine وايي او دا نوم د لاتيني ژبې د وييکې ''ars medicina'' نه راوتلی او مانا يې ''د درملنې هنر'' دی.<ref>آرپوهه: ''medicina،'' له لاتيني ژبې ''ars medicina'' نه "د درملنې هنر" د ''medicus'' "physician." نه ([http://www.etymonline.com/index.php?term=medicine Etym.Online])
{{2otheruses||chemical substances|Medication}}
[[دوتنه:Asklepios.3.jpg|thumb|The [[ancient Greece|ancient Greek]] symbol today associated with medicine the world over: the [[rod of Asclepius]] with its ''single'' encoiled serpent. The [[World Health Organization]], the [[Royal Society of Medicine]], the [[American Medical Association|American Medical]] and [[American Osteopathic Association|Osteopathic Associations]], the [[British Medical Association|British]] and the [[Australian Medical Association]]s are some of the bodies that incorporate it in their [[logo|insignia]]]]
'''Medicine''' is the art and [[science]] of [[healing]]. It encompasses a range of [[health care]] practices evolved to maintain and restore [[health]] by the [[prevention (medical)|prevention]] and [[treatment]] of [[illness]].
Contemporary medicine applies [[health science]], [[biomedical research]], and [[medical technology]] to [[diagnosis (medical)|diagnose]] and treat [[injury]] and [[disease]], typically through [[medication]], [[surgery]], or some other form of [[therapy]]. The word ''medicine'' is derived from the [[Latin]] ''ars medicina'', meaning ''the art of healing''.<ref>Etymology: [[Latin language|Latin]]: ''medicina,'' from ''[[ars]] medicina'' "the medical art," from ''medicus'' "physician."([http://www.etymonline.com/index.php?term=medicine Etym.Online])
Cf. ''mederi'' "to heal," etym. "know the best course for," from [[Proto-Indo-European language|PIE]] base *med- "to measure, limit. Cf. [[Greek language|Greek]] ''medos'' "counsel, plan," [[Avestan language|Avestan]] ''vi-mad'' "physician")</ref><ref>[http://www.etymonline.com/index.php?term=medicine "Medicine"] ''Online Etymology Dictionary''</ref>
که څه هم چې درملګريز تخنيک او کلينيکي تجربه دواړه د ننۍ درملګرۍ کې يو محوري حيثيت لري، خو د ارني رنځ د مخامخې کاميابې درملنې او هوساينې لپاره د عادي انساني احساسمندۍ او زړه سوي اړتيا تل ليدل کېږي، چې په پښتو ژبه د ''خواخوږي'' په نامه يادېږي.
Though medical technology and clinical expertise are pivotal to contemporary medicine, successful face-to-face relief of actual [[suffering]] continues to require the application of ordinary human [[feeling]] and [[compassion]], known in English as ''[[bedside manner]]''.<ref>{{cite journal | journal=British Medical Journal | title=Spirituality and clinical care (Editorial) | author=Culliford Larry | volume=325 | issue=7378 | page=1434 | month=December | year=2002 | doi=10.1136/bmj.325.7378.1434 | pmid=12493652 | pages=1434–5}}</ref>
== History تاريخ==
{{main|History of medicine}}
[[دوتنه:Ningizzida.jpg|thumb|left|The ancient Sumerian god [[Ningishzida]], the patron of medicine, accompanied by two [[gryphons]].]]
==سرچينې==
[[Prehistoric medicine]] incorporated plants ([[herbalism]]), animal parts and minerals. In many cases these materials were used ritually as magical substances by [[priest]]s, shamans, or [[medicine man|medicine men]]. Well-known spiritual systems include [[animism]] (the notion of inanimate objects having spirits), [[spiritualism]] (an appeal to gods or communion with ancestor spirits); [[shamanism]] (the vesting of an individual with mystic powers); and [[divination]] (magically obtaining the truth). The field of [[medical anthropology]] studies the various [[prehistory|prehistoric]] medical systems and their interaction with society.
Early records on medicine have been discovered from early [[Ayurveda|Ayurvedic]] medicine in the [[Indian subcontinent]], [[ancient Egyptian medicine]], [[traditional Chinese medicine]] and [[ancient Greek medicine]]. Earliest records of dedicated hospitals come from Mihintale in [[Sri Lanka]] where evidence of dedicated medicinal treatment facilities for patients are found.<ref>Prof. Arjuna Aluvihare, "Rohal Kramaya Lovata Dhayadha Kale Sri Lankikayo" ''Vidhusara Science Magazine'', Nov. 1993.</ref><ref>''[http://www.hsph.harvard.edu/ihsg/publications/pdf/No-42.PDF Resource Mobilization in Sri Lanka's Health Sector]'' - Rannan-Eliya, Ravi P. & De Mel, Nishan, [[Harvard School of Public Health]] & Health Policy Programme, [[Institute of Policy Studies]], February 1997, Page 19. Accessed 2008-02-22.</ref> Early Greek doctor [[Hippocrates]], who is called the ''Father of Medicine'',<ref>[http://www.ncbi.nlm.nih.gov/pubmed/18392218 Useful known and unknown views of the father of modern medicine, [[Hippocrates]] and his teacher [[Democritus]].], U.S. National Library of Medicine</ref><ref>[http://www.blackwellpublishing.com/eccmid16/abstract.asp?id=50854 The father of modern medicine: the first research of the physical factor of tetanus], European Society of Clinical Microbiology and Infectious Diseases</ref> and [[Galen]] laid a foundation for later developments in a rational approach to medicine. After the fall of the [[Western Roman Empire]] and the onset of the [[Dark Ages]], the Greek tradition of medicine went into decline in Western Europe, although it continued uninterrupted in the Easern Roman Empire (Byzantium). After 750, the Muslim Arab world had Hippocrates' and Galen's works translated into Arabic, and [[Islamic medicine|Islamic physicians]] engaged in some significant medical research. Notable Islamic medical pioneers include [[polymath]] [[Avicenna]], who, along with Hippocrates, has also been called the Father of Medicine,<ref>
{{cite journal
|journal=Cas Lek Cesk
|year=1980
|title=The father of medicine, Avicenna, in our science and culture: Abu Ali ibn Sina (980-1037) (Czech title: Otec lékarů Avicenna v nasí vĕdĕ a kulture)
|author=Becka J
|volume=119
|issue=1
|pages=17–23
|language=Czech
|pmid=6989499
}}</ref><ref>[https://eee.uci.edu/clients/bjbecker/PlaguesandPeople/lecture5.html Medical Practitioners]</ref> [[Abu al-Qasim al-Zahrawi|Abulcasis]], the father of surgery, [[Ibn Zuhr|Avenzoar]], the father of experimental surgery, [[Ibn al-Nafis]], the father of circulatory physiology, and [[Averroes]].<ref>
{{cite journal
|author=Martín-Araguz A, Bustamante-Martínez C, Fernández-Armayor Ajo V, Moreno-Martínez JM
|title=Neuroscience in al-Andalus and its influence on medieval scholastic medicine
|journal=Revista de neurología
|volume=34
|issue=9
|pages=877–892
|date=2002-05-01—15
|language=Spanish
|pmid=12134355
}}</ref> [[Muhammad ibn Zakarīya Rāzi|Rhazes]], who is called the father of [[pediatrics]], was one of first to question the Greek theory of [[humorism]], which nevertheless remained influential in both medieval Western and medieval [[Islamic medicine]] <ref> On the dominance of the Greek humoral theory, which was the basis for the practice of bloodletting, in medieval Islamic medicine see Peter E. Pormann and E. Savage Smith,''Medieval Islamic medicine,'' Georgetown University, Washington DC, 2007 p. 10, 43-45.</ref> During the Crusades, one Muslim observer famously expressed a dim view of contemporary Western medicine. <ref>{{cite web|url=http://www.fordham.edu/halsall/source/usamah2.html |title=Medieval Sourcebook: Usmah Ibn Munqidh (1095-1188): Autobiography, excerpts on the Franks |publisher=Fordham.edu |date= |accessdate=2009-05-04}}</ref> However, overall mortality and mordibity levels in the medieval [[Middle East]] and medieval Europe did not significantly differ one from the other, which indicates that there was no major medical "breakthrough" to modern medicine in either region in this period. The fourteenth and fifteenth century [[Black Death]] was just as devastating to the Middle East as to Europe, and it has even been argued that Western Europe was generally more effective in recovering from the pandemic than the Middle East. <ref> Michael Dols has shown that the Black Death was much more commonly believed by European authorities than by Middle Eastern authorities to be contagious; as a result, flight was more commonly counseled, and in urban Italy quarantines were organized on a much wider level than in urban Egypt or Syria (''The Black Death in the Middle East'' Princeton, 1977, p. 119; 285-290. </ref> In the early modern period, important early figures in medicine and anatomy emerged in Europe, including [[Gabriele Falloppio]] and [[William Harvey]].
[[دوتنه:Medicine aryballos Louvre CA1989-2183.jpg|thumb|An ancient Greek patient gets medical treatment: this [[aryballos]] (''circa'' 480-470 BCE, now in [[Paris]]'s [[Louvre|Louvre Museum]], probably contained healing oil]]
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 [[Nicolaus Copernicus|Copernicus]]'s rejection of [[Ptolemy]]'s theories on astronomy). Physicians like [[Ibn al-Nafis]] and [[Vesalius]] improved upon or indeed rejected the theories of great authorities from the past (such as [[Hippocrates]], and [[Galen]]), many of whose theories were in time discredited.
Modern scientific [[biomedical research]] (where results are testable and [[reproducible]]) began to replace early Western traditions based on herbalism, the Greek "[[humorism|four humours]]" and other such pre-modern notions. The modern era really began with [[Robert Koch]]'s discoveries around 1880 of the transmission of disease by bacteria, and then the discovery of [[antibiotic]]s around 1900. The post-18th century [[modernity]] period brought more groundbreaking researchers from Europe. From [[Germany]] and [[Austrians|Austrian]] doctors such as [[Rudolf Virchow]], [[Wilhelm Conrad Röntgen]], [[Karl Landsteiner]], and [[Otto Loewi]]) made contributions. In the [[United Kingdom]] [[Alexander Fleming]], [[Joseph Lister]], [[Francis Crick]], and [[Florence Nightingale]] are considered important. From [[New Zealand]] and Australia came [[Maurice Wilkins]], [[Howard Florey, Baron Florey|Howard Florey]], and [[Frank Macfarlane Burnet]]). In the [[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]], [[Paul Broca]] and others did significant work. [[Russia]]n ([[Nikolai Korotkov]] also did significant work, as did [[William Osler|Sir William Osler]] and [[Harvey Cushing]].
As science and technology developed, medicine became more reliant upon [[medication]]s. [[Pharmacology]] developed from [[herbalism]] and many drugs are still derived from plants (atropine, ephedrine, warfarin, [[aspirin]], digoxin, vinca alkaloids, taxol, hyoscine, etc). 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. [[Vaccine]]s were discovered by [[Edward Jenner]] and [[Louis Pasteur]]. The first major class of [[antibiotic]]s was the [[Sulfonamide (medicine)|sulfa]] drugs, derived by French chemists originally from [[azo compound|azo]] dyes. This has become increasingly sophisticated; modern [[biotechnology]] allows drugs targeted towards specific physiological processes to be developed, sometimes designed for compatibility with the body to reduce [[Side effect|side-effects]]. [[Genomics]] and knowledge of [[human genetics]] is having some influence on medicine, as the causative [[gene]]s of most monogenic [[genetic disorder]]s have now been identified, and the development of techniques in [[molecular biology]] and genetics are influencing medical technology, practice and decision-making.
[[Evidence-based medicine]] is a contemporary movement to establish the most effective [[algorithms]] of practice (ways of doing things) through the use of [[systematic review]]s and [[meta-analysis]]. The movement is facilitated by the modern global [[information science]], which allows all evidence to be collected and analyzed according to 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. The [[Cochrane Collaboration]] leads this movement. A 2001 review of 160 Cochrane systematic reviews revealed that, according to two readers, 21.3% of the reviews concluded insufficient evidence, 20% concluded evidence of no effect, and 22.5% concluded positive effect.<ref name=Ezzo2001>
{{cite journal
| author = Ezzo J, Bausell B, Moerman DE, Berman B, Hadhazy V
| title= Reviewing the reviews. How strong is the evidence? How clear are the conclusions?
| year = 2001
| journal = Int J Technol Assess Health Care
| volume = 17
| issue = 4
| pages = 457–466
| pmid=11758290
}}</ref>
== Clinical practice ==
[[دوتنه:Henriette Browne Mutter Kind.jpg|thumb|Girl having her head bandaged, as depicted by the portraitist [[Henriette Browne]] (1829-1901)]]
In clinical practice doctors personally assess patients in order to [[medical diagnosis|diagnose]], treat, and prevent disease using clinical judgment. The [[doctor-patient relationship]] typically begins an interaction with an examination of the patient's [[medical history]] and [[medical record]], followed a medical interview<ref name=Coulehan_2005>{{cite book | author = Coulehan JL, Block MR | title = The Medical Interview: Mastering Skills for Clinical Practice | edition = 5th | publisher = F. A. Davis | year = 2005 | isbn= 0-8036-1246-X | oclc = 232304023 }}</ref> and a [[physical examination]]. Basic diagnostic [[medical device]]s (e.g. [[stethoscope]], [[tongue depressor]]) are typically used. After examination for [[sign (medical)|signs]] and interviewing for [[symptoms]], the doctor may order [[medical test]]s (e.g. [[blood test]]s), take a [[biopsy]], or prescribe [[pharmaceutical drug]]s 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. The medical encounter is then documented in the medical record, which is a legal document in many jurisdictions.<ref name=AHIMA2005>
{{cite journal | author = Addison K, Braden JH, Cupp JE, Emmert D, et al. (AHIMA e-HIM Work Group on the Legal Health Record) | title = Update: Guidelines for Defining the Legal Health Record for Disclosure Purposes | journal = Journal of AHIMA | year = 2005 | month = September | volume = 78
| issue = 8 | pages = 64A–G | url= http://library.ahima.org/xpedio/groups/public/documents/ahima/bok1_027921.hcsp?dDocName=bok1_027921 | pmid=16245584 | last12 = Musa | first12 = D | last13 = Olenik | first13 = KL | last14 = Quinsey | first14 = CA | last15 = Reynolds | first15 = R | last16 = Servais | first16 = C | last17 = Watters | first17 = A | last18 = Wiedemann | first18 = LA | last19 = Wilkins | first19 = M | last20 = Wills | first20 = M | last21 = Vogt | first21 = NE}}</ref> Followups may be shorter but follow the same general procedure.
The components of the medical interview<ref name=Coulehan_2005/> 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 'presenting complaint.'
* History of present illness / complaint (HPI): the chronological order of events of symptoms and further clarification of each symptom.
* Current activity: occupation, hobbies, what the patient actually does.
* [[Medication]]s (Rx): what drugs the patient takes including prescribed, [[over-the-counter drug|over-the-counter]], and [[Home remedy|home remedies]], as well as alternative and [[Herbalism|herbal medicines/herbal remedies]]. [[Allergy|Allergies]] are also recorded.
* Past medical history (PMH/PMHx): concurrent medical problems, past hospitalizations and [[surgery|operations]], injuries, past [[infectious disease]]s and/or [[vaccination]]s, history of known allergies.
* Social history (SH): birthplace, residences, marital history, social and economic status, habits (including [[diet (nutrition)|diet]], [[medication]]s, [[tobacco smoking|tobacco]], [[alcohol]]).
* [[Family history (medicine)|Family history]] (FH): listing of diseases in the family that may impact the patient. A [[family tree]] is sometimes used.
* 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]], [[lung]]s, [[Gastrointestinal tract|digestive tract]], [[Urinary system|urinary tract]], etc).
The [[physical examination]] is the examination of the patient looking for signs of disease ('Symptoms' are what the patient volunteers, 'Signs' are what the healthcare provider detects by examination). The healthcare provider uses the 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 (medicine)|inspection]], [[palpation]] (feel), [[percussion (medicine)|percussion]] (tap to determine resonance characteristics), and [[auscultation]] (listen); smelling may be useful (e.g. infection, [[uremia]], [[diabetic ketoacidosis]]). The clinical examination involves study of:
* Vital signs including height, weight, body temperature, [[blood pressure]], [[pulse]], respiration rate, hemoglobin [[oxygen saturation]]
* General appearance of the patient and specific indicators of disease (nutritional status, presence of jaundice, pallor or [[clubbing]])
* [[Skin]]
* [[Head]], [[eye]], [[ear]], [[nose]], and [[throat]] (HEENT)
* [[Cardiovascular]] ([[heart]] and [[blood vessel]]s)
* [[Respiratory]] (large airways and [[lungs]])
* [[Abdomen]] and [[rectum]]
* Genitalia (and pregnancy if the patient is or could be pregnant)
* [[Musculoskeletal]] (including spine and extremities)
* [[Neurological]] (consciousness, awareness, brain, vision, [[cranial nerves]], spinal cord and [[Peripheral nervous system|peripheral nerves]])
* [[Psychiatric]] (orientation, [[mental state examination|mental state]], evidence of abnormal perception or thought)
[[Medical laboratory|Laboratory]] and [[Medical imaging|imaging studies]] results may be obtained, if necessary.
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 diagnosis|differential diagnoses]]), along with an idea of what needs to be done to obtain a definitive diagnosis that would explain the patient's problem.
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.
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 bizarre symptoms or multi-system problems, with involvement by several specialists.
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.
== Institutions ==
Contemporary medicine is in general conducted within [[health care system]]s. Legal, [[credential]]ing and financing frameworks are established by individual governments, augmented on occasion by international organizations. The characteristics of any given health care system have significant impact on the way medical care is provided.
Advanced industrial countries (with the exception of the United States) <ref name="IOM">[http://www.iom.edu/?id=17848 Insuring America's Health: Principles and Recommendations], Institute of Medicine at the National Academies of Science, 2004-01-14</ref><ref name="ccuhc">{{cite web|url=http://cthealth.server101.com/the_case_for_universal_health_care_in_the_united_states.htm |title=The Case For Single Payer, Universal Health Care For The United States |publisher=Cthealth.server101.com |date= |accessdate=2009-05-04}}</ref> and many [[Developing country|developing countries]] provide medical services though a system of [[universal health care]] which aims to guarantee care for all through a [[single-payer health care]] system, or compulsory private or co-operative [[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 or by state-owned hospitals and clinics, or by charities; most commonly by a combination of all three.
Most [[tribe|tribal]] societies, but also some communist countries (e.g. China) and the United States,<ref name="IOM">[http://www.iom.edu/?id=17848 Insuring America's Health: Principles and Recommendations], Institute of Medicine at the National Academies of Science, 2004-01-14</ref><ref name="ccuhc">{{cite web|url=http://cthealth.server101.com/the_case_for_universal_health_care_in_the_united_states.htm |title=The Case For Single Payer, Universal Health Care For The United States |publisher=Cthealth.server101.com |date= |accessdate=2009-05-04}}</ref> 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.
[[دوتنه:Drug ampoule JPN.jpg|thumb|Modern drug [[ampoule]]s]]
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 the US health care system has come under fire for lack of openness,<ref>
{{cite journal
|author=Martin Sipkoff
|title=Transparency called key to uniting cost control, quality improvement
|journal=Managed Care
|month=January
|year=2004
|url=http://www.managedcaremag.com/archives/0401/0401.forum.html
}}</ref> 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.
=== Delivery ===
{{see also|clinic|hospital|hospice}}
Provision of medical care is classified into primary, secondary and tertiary care categories.
[[Primary care]] medical services are provided by [[physicians]], [[physician assistants]],Nurse Practioners, or other health professionals who have first contact with a patient seeking medical treatment or care. These occur in physician offices, [[clinic]]s, [[nursing home]]s, [[school]]s, [[home]] visits and other places close to patients. About 90% of medical visits can be treated by the primary care provider. These include treatment of acute and chronic illnesses, [[preventive care]] and [[health education]] for all ages and both sexes.
[[Secondary care]] medical services are provided by [[medical specialist]]s in their offices or clinics or at local community hospitals for a patient referred by a primary care provider who first diagnosed or treated the patient. Referrals are made for those patients who required the expertise or procedures performed by specialists. These include both [[ambulatory care]] and [[patient#Outpatient vs Inpatient|inpatient]] services, [[Emergency department|emergency rooms]], [[intensive care medicine]], [[surgery]] services, [[physical therapy]], [[childbirth|labor and delivery]], [[endoscopy]] units, diagnostic [[Medical laboratory|laboratory]] and [[medical imaging]] services, [[Hospice care|hospice]] centers, etc. 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 hospitals or regional centers equipped with diagnostic and treatment facilities not generally available at local hospitals. These include [[trauma center]]s, [[burn (injury)|burn]] treatment centers, advanced [[neonatology]] unit services, [[organ transplant]]s, high-risk [[pregnancy]], [[radiation therapy|radiation]] [[oncology]], etc.
Modern medical care also depends on information - still delivered in many health care settings on paper records, but increasingly nowadays by electronic means.
== Branches ==
Working together as an [[interdisciplinary team]], many highly-trained [[health profession]]als besides medical practitioners are involved in the delivery of modern health care. Examples include: [[nurse]]s, [[emergency medical technician]]s and paramedics, laboratory scientists, (pharmacy, pharmacists), (physiotherapy,physiotherapists), [[respiratory therapists]], [[speech therapy|speech therapists]], [[occupational therapy|occupational therapists]], radiographers, [[dietitian]]s and [[bioengineering|bioengineers]].
The scope and sciences underpinning human medicine overlap many other fields. [[Dentistry]], while a separate discipline from medicine, is considered a medical field.
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 return to in [[Biomedical research#Preclinical research|biomedical research]].
* [[Medical specialties]]
* [[Interdisciplinary sub-specialties of medicine|interdisciplinary fields]], where different medical specialties are mixed to function in certain occasions.
=== Basic sciences ===
* ''[[Anatomy]]'' is the study of the physical structure of [[organism]]s. 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 [[cell (biology)|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 tissue]]s by light [[microscopy]], [[Electron microscope|electron microscopy]] and [[immunohistochemistry]].
* ''[[Immunology]]'' is the study of the [[immune system]], which includes the innate and adaptive immune system in humans, for example.
* ''[[Medical physics]]'' is the study of the applications of physics principles in medicine.
* ''[[Microbiology]]'' is the study of [[microorganism]]s, including [[protozoa]], [[bacterium|bacteria]], [[fungus|fungi]], and [[virus]]es.
* ''[[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 science]]'' (theoretical focus) and ''[[dietetics]]'' (practical focus) 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 disease]]s, weight and eating [[mental illness|disorders]], allergies, [[malnutrition]], and [[neoplasia|neoplastic]] diseases.
* ''[[Pathology as a science]]'' is the study of disease—the causes, course, progression and resolution thereof.
* ''[[Pharmacology]]'' is the study of [[Medication|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 [[poison]]s.
=== Specialties ===
{{Main|Medical specialty}}
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 ====
{{main|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]],Transplant 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.
==== 'Medicine' as a specialty ====
{{main|Internal Medicine}}
'''Internal medicine''' is the medical [[specialty (medicine)|specialty]] concerned with the diagnosis, management and nonsurgical treatment of unusual or serious diseases, either of one particular organ system or of the body as a whole. According to some sources, an emphasis on internal structures is implied.<ref>{{DorlandsDict|five/000063883|internal medicine}}</ref> In [[North America]], specialists in internal medicine are commonly called "internists". Elsewhere, especially in [[Commonwealth of Nations|Commonwealth]] nations, such specialists are often called [[Physician|physicians]].<ref name="Fowler">{{cite book |author= H.W. Fowler.|title=A Dictionary of Modern English Usage (Wordsworth Collection) (Wordsworth Collection) |publisher=NTC/Contemporary Publishing Company |location= |year= 1994|pages= |isbn=1853263184 |oclc= |doi=}}</ref> These terms, ''internist'' or ''physician'' (in the narrow sense, common outside North America), generally exclude practitioners of gynecology and obstetrics, pathology, psychiatry, and especially surgery and its subspecialities.
Because their patients are often seriously ill or require complex investigations, internists do much of their work in hospitals. Formerly, many internists were not subspecialized; such ''general physicians'' would see any complex nonsurgical problem; this style of practice has become much less common. In modern urban practice, most internists are subspecialists: that is, they generally limit their medical practice to problems of one organ system or to one particular area of medical knowledge. For example, [[gastroenterology|gastroenterologists]] and [[nephrology|nephrologists]] specialize respectively in diseases of the gut and the kidneys.<ref>{{cite web | url = http://www.racp.edu.au/index.cfm?objectid=49EF1EB5-2A57-5487-D74DBAFBAE9143A3 | title = The Royal Australasian College of Physicians: What are Physicians? | accessdate = 2008-02-05 | publisher = [[Royal Australasian College of Physicians]] }}</ref>
In [[Commonwealth of Nations|Commonwealth]] and some other countries, specialist [[Pediatrics|pediatricians]] and [[Geriatrics|geriatricians]] are also described as ''specialist physicians'' (or internists) who have subspecialized by age of patient rather than by organ system. Elsewhere, especially in North America, general pediatrics is often a form of [[Primary care physician|Primary care]].
There are many subspecialities (or subdisciplines) of [[internal medicine]]:
<div class="references-small" style="-moz-column-count:3; column-count:3;">
:* ''[[Cardiology]]''
:* ''[[Critical care medicine]]''
:* ''[[Dermatology]]''
:* ''[[Endocrinology]]''
:* ''[[Gastroenterology]]''
:* ''[[Geriatrics]]''
:* ''[[Haematology]]''
:* ''[[Hepatology]]''
:* ''[[Infectious disease]]s''
:* ''[[Nephrology]]''
:* ''[[Neurology]]''
:* ''[[Oncology]]''
:* ''[[Pediatrics]]''
:* ''[[Pulmonology]]''
:* ''[[Rheumatology]]''
:* ''[[Sleep medicine]]''
</div>
Training in internal medicine (as opposed to surgical training), varies considerably across the world: see the articles on [[Medical education]] and [[Physician]] for more details. In North America, it requires at least three years of residency training after medical school, which can then be followed by a one to three year fellowship in the subspecialties listed above. In general, resident work hours in medicine are less than those in surgery, averaging about 60 hours per week in the USA.
==== Diagnostic specialties ====
* ''[[Clinical laboratory]] sciences'' are the clinical diagnostic services which apply laboratory techniques to diagnosis and management of patients. In the United States these services are supervised by a pathologist. The personnel that work in these [[medical laboratory]] departments are technically trained staff who do not hold medical degrees, but who usually hold an undergraduate [[medical technology]] degree, who actually perform the [[medical test|tests]], [[assay]]s, and procedures needed for providing the specific services. Subspecialties include [[Transfusion medicine]], [[Cellular pathology]], [[Clinical chemistry]], [[Hematology]], [[Clinical microbiology]] and [[Clinical immunology]].
* ''[[Pathology as a medical specialty]]'' is the branch of medicine that deals with the study of diseases and the morphologic, physiologic changes produced by them. As a diagnostic specialty, pathology can be considered the basis of modern scientific medical knowledge and plays a large role in [[evidence-based medicine]]. Many modern molecular tests such as [[flow cytometry]], [[polymerase chain reaction]] (PCR), [[immunohistochemistry]], [[cytogenetics]], gene rearrangements studies and [[fluorescent in situ hybridization]] (FISH) fall within the territory of pathology.
* ''[[Radiology]]'' is concerned with imaging of the human body, e.g. by [[x-ray]]s, x-ray [[computed tomography]], [[ultrasonography]], and [[nuclear magnetic resonance]] [[tomography]].
* ''[[Nuclear medicine]]'' is concerned with studying human organ systems by administering radiolabelled substances (radiopharmaceuticals) to the body, which can then be imaged outside the body by a [[gamma camera]] or a PET scanner. Each radiopharmaceutical consists of two parts: a tracer which is specific for the function under study (e.g., neurotransmitter pathway, metabolic pathway, blood flow, or other), and a radionuclide (usually either a gamma-emitter, or a positron emitter). There is a degree of overlap between nuclear medicine and radiology, as evidenced by the emergence of combined devices such as the PET/CT scanner.
* ''[[Clinical neurophysiology]]'' is concerned with testing the physiology or function of the central and peripheral aspects of the nervous system. These kinds of tests can be divided into recordings of: (1) spontaneous or continuously running electrical activity, or (2) stimulus evoked responses. Subspecialties include [[Electroencephalography]], [[Electromyography]], [[Evoked potential]], [[Nerve conduction study]] and [[Polysomnography]]. Sometimes these tests are performed by techs without a medical degree, but the interpretation of these tests is done by a medical professional.
==== Other ====
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, combining conservative and surgical therapy.
* ''[[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 [[physical trauma|trauma]], surgical, medical, pediatric, and psychiatric emergencies.
* ''[[Obstetrics]] and [[gynecology]]'' (often abbreviated as ''[[OB/GYN]]'' (American English) or ''Obs & Gynae'' (British English)) 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 illness]]es 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 disorder]]s.
* ''[[Psychiatry]]'' is the branch of medicine concerned with the [[biopsychosocial|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 redirects here-->
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 [[Evolution|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 [[hospitalist]]s in the USA.
* ''[[Laser medicine]]'' involves the use of lasers in the diagnostics and/or treatment of various conditions.
* ''[[Medical humanities]]'' includes the [[humanities]] ([[literature]], [[philosophy]], [[ethics]], [[history]] and [[religion]]), [[social science]] ([[anthropology]], [[cultural studies]], [[psychology]], [[sociology]]), and the [[art]]s ([[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 [[computer]]s and [[information technology]] to medicine.
* ''[[Nosology]]'' is the classification of diseases for various purposes.
* ''[[Nosokinetics]]'' is the science/subject of measuring and modelling the process of care in health and social care systems.
* ''[[Pain management]]'' (also called [[pain medicine]]) is the medical discipline concerned with the relief of pain.
* ''[[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 [[Human spaceflight|space travel]].
* ''[[Osteopathic medicine in the United States|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 [[sportsperson|athletes]], [[amateur]] and [[professional]]. The team includes specialty physicians and surgeons, athletic trainers, physical therapists, [[Coach (sport)|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 [http://www.britannica.com/eb/article-9106176?query=Therapeutics&ct=].
* ''[[Travel medicine]]'' or ''emporiatrics'' deals with health problems of international travelers or travelers across highly different environments.
* ''[[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. In some jurisdictions this function is combined with the emergency room.
* [[Veterinary medicine]]; [[veterinarians]] apply similar techniques as physicians to the care of animals.
* [[Wilderness medicine]]; its about practice of medicine in the wild ,where conventional medical facilities may not be available.
== Education ==
{{main|Medical education|Medical school}}
[[دوتنه:Get lautrec 1901 examination at faculty of medicine.jpg|thumb|Painted by [[Henri de Toulouse-Lautrec|Toulouse-Lautrec]] in the year of his own death: an examination in the [[Paris]] faculty of medicine, [[1901]]]]
Medical education and training varies around the world. It typically involves entry level education at a university [[medical school]], followed by a period of supervised practice or [[medical intern|internship]], and/or [[residency (medicine)|residency]]. This can be followed by postgraduate vocational training. A variety of teaching methods have been employed in medical education, still itself a focus of active research.
Many regulatory authorities require [[continuing medical education]], since knowledge, techniques and medical technology continue to evolve at a rapid rate.
== Legal controls ==
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 [[charlatan]]s 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.
Doctors who are negligent or intentionally harmful in their care of patients can face charges of [[medical malpractice]] and be subject to civil, criminal, or professional sanctions.
== Controversy ==
The Catholic social theorist [[Ivan Illich]] subjected contemporary western medicine to detailed attack in his ''Medical Nemesis'', first published in 1975. He argued that the [[medicalization]] in recent decades of so many of life's vicissitudes — [[birth]] and [[death]], for example — frequently caused more harm than good and rendered many people in effect lifelong patients. He marshalled a body of statistics to show what he considered the shocking extent of post-operative side-effects and drug-induced illness in advanced [[industrial society]]. He was the first to introduce to a wider public the notion of [[iatrogenesis]].<ref>
{{cite book | title=Medical Nemesis |author=Illich Ivan |authorlink=Ivan Illich |year=1974 |isbn=0714510963 |oclc=224760852 | publisher=Calder & Boyars | location=London
}}</ref> Others have since voiced similar views, but none so trenchantly, perhaps, as Illich. <ref>{{cite book |author=Postman Neil |authorlink=[[Neil Postman]] |title=Technopoly: The Surrender of Culture to Technology |publisher=Knopf |location=New York |oclc=24694343 |year=1992}}</ref>
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 criticisms that medicine was neglecting a [[holistic]] model.{{Fact|date=February 2007}} 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, notably acupuncture for some conditions and certain herbs, are backed by evidence.<ref name=goodbadugly>[http://www.healthwatch-uk.org/awardwinners/edzardernst.html The HealthWatch Award 2005:] Prof. Edzard Ernst, ''Complementary medicine: the good the bad and the ugly.'' Retrieved 5 August 2006.</ref>
[[Medical error]]s and [[overmedication]] are also the focus of 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 is recognized that it is dangerous to place too much responsibility on one "superhuman" individual and expect him or her not to make [[error]]s. Reporting systems and checking mechanisms are becoming more common in identifying sources of error and improving practice. Clinical versus statistical, [[algorithmic]] diagnostic methods were famously examined in psychiatric practice in a 1954 book by [[Paul E. Meehl]], which controversially found statistical methods superior.<ref name=Grove2000/> A 2000 [[meta-analysis]] comparing these methods in both psychology and medicine found that statistical or "mechanical" diagnostic methods were generally, although not always, superior.<ref name=Grove2000>{{cite journal | year = 2000 | title = Clinical versus mechanical prediction: A meta-analysis | journal = Psychological Assessment | volume = 12 | issue = 1 | pages = 19–30 | doi = 10.1037/1040-3590.12.1.19 | url = http://www.psych.umn.edu/faculty/grove/096clinicalversusmechanicalprediction.pdf | format = w | author = Grove WH, Zald DH, Lebow BS, Snitz BE, Nelson C.}}</ref>
Disparities in quality of care given are often an additional cause of controversy.<ref>{{cite web|url=http://www.ama-assn.org/ama/pub/physician-resources/public-health/eliminating-health-disparities.shtml|title=Eliminating Health Disparities|publisher=American Medical Association}}</ref> For example, elderly mentally ill patients received poorer care during hospitalization in a 2008 study.<ref>{{cite web|url=[http://archpsyc.ama-assn.org/cgi/content/abstract/65/12/1402]|title=Mental Disorders, Quality of Care, and Outcomes Among Older Patients Hospitalized With Heart Failure}}</ref> Rural poor African-American men were used in a [[Tuskegee Study of Untreated Syphilis in the Negro Male|study of syphilis]] that denied them basic medical care.
== See also ==
{{main|Outline of medicine}}
{{portal|Medicine}}
<div class="references-medium" style="-moz-column-count:3; column-count:3;">
* [[List of causes of death by rate]]
* [[List of diseases]]
* [[List of disorders]]
* [[List of important publications in medicine]]
* [[Medical Encyclopedia]]
* [[Medical equipment]]
* [[Medical literature]]
* [[Outline of health]]
* [[Pharmacognosy]]
* [[Timeline of medicine and medical technology]]
</div>
== References ==
{{Reflist|2}}
==باندنۍ تړنې==
== External links ==
{{Sister project links
{{sisterlinks
|n = Health
|s = Category:Medicine
|wikt = Category:Medicine}}
{{medicine}}
{{Use dmy dates|date=October 2010}}
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