Understanding Medicine and Doctors
Understanding the Doctor's Perspective
Healing the sick—now called the practice of medicine—is one of the oldest professional callings. From ancient times persons with medical skills have tried to ease the distress of the ailing. Until the great scientific discoveries of the 19th and 20th centuries, medical practice involved little more than comfort for the patient until nature took its course. Medicine has changed greatly in the last 100 years. Unfortunately, due to economics, many are not receiving the care they desperately deserve. The general consensus of many people stricken by the rising epidemic of environmental illness, doctors are baffled but will never admit defeat. This is partly due to pharmadocs and their lack of knowledge of fundamental medicine.
Bubonic plague, smallpox, cholera, diphtheria, and other great killing and crippling diseases of the past are gone or can be controlled. Polio epidemics, once dreaded annual events, are now mentioned only in history books. The more recent viral epidemic called AIDS, or acquired immune deficiency syndrome, mycotoxicosis, SARS, West Nile Virus, etc., presents a new challenge for those in the medical profession. In the beginning of these outbreaks, many doctors skeptical, to say the least, until it reach epidemical proportions. Because there are still so many phamadocs in practice, this makes it exceedingly difficult for chronically ill patients who suffer from many of these new illnesses to get the new medical tests that are available on the market.
Now the threat of such complex vigils as an intangible that one contracts from a "sick building" where most people can hardly explain, especially when they are so ill, both mentally and physically, makes matters worse for most mainstream physicians. Especially when the Government, embarrassingly enough, refuses to knowledge such an atrocity.
Major advances in surgery, X-ray and laser technology, electronics, and blood transfusion permit rebuilding of key parts of the heart and blood vessels. These and other advances in medicine have extended the life spans of many. For example, a person born in the United States today can expect to live, on the average, more than ten years longer than someone born in 1930. Yet thousands each year die of "unexplained etiology." While many patients have so many unexplained illness, Cancer, allergies and asthma cases have never been higher, mystery autoimmune diseases such as Lupus, MS, Fibromyalgia, Rheumatoid Arthritis, and Chronic Fatigue are on the rise, and the doctors seem to find no explanation. Nowadays, when we open magazines or look at television advertisements, it is very common to notice ads for "stop gap" drugs to treat so many attributing symptoms. It's time for patients to take a vital role in their examination and treatment, by gaining more education and understanding the physician's point of view to form better communication and understanding. This will further enhance the treatment procedure.
The medical profession consists of men and women popularly called doctors or physicians. A licensed physician may be either a doctor of medicine (M.D.) or a doctor of osteopathy (D.O.). Osteopathy encompasses all phases of traditional medicine but also stresses the role of the body’s muscle and bone systems in health and diseases. Through intensive schooling and training, a physician becomes highly skilled. The physician prevents, detects, treats, and cures human diseases and also repairs injuries and corrects deformities. The act of serving a patient, or sick person, is called practicing medicine. The doctor is a key member of the health team composed also of nurses, medical therapists, and other professionals actively engaged in the promotion of health.
Many countries have educational, professional, and ethical standards for someone who wants to practice medicine. When these qualifications are met, the state, province, or country awards the physician a license to practice medicine there. Guidelines for medical education, licensing, and practice vary throughout the world. This article will focus on those within the United States.
The average physician in the United States in most practices has a very tight schedule, as most of us know. Most medical insurance companies, especially HMO's (Health Maintenance Organizations) allow for the doctor to see a patient for 12 minutes. This is hardly enough time to discuss a relatively new illness to most medical practitioners who have never known or have no new knowledge of this type of illness. If the patient spends that 12 minutes rambling on about symptoms alone, the chances are that the practitioner will most likely think that the patient may perhaps have some sort of mental instability. Most doctors will simply not understand what most mold exposure patients have endured (a host of symptoms, possibly other family member's illnesses, loss of home/career, chance of losing livelihood, loss of belongings) in other words, LOSS and illness combined. The medical practitioner in many cases, prescribes some type of benzodiazepine (tranquilizer), and orders a multiplicity of tests, if indeed, the provider believes the patient is a credible contender, due to the patient's stress level and other mitigating factors (loss of memory, crying, anger, confusion, etc.). During these precious 12 minutes with a typical family physician or specialist, it is important to stay on task and only discuss the pertinent facts and history so the physician may better determine the causes of the illness. if needed, print out Dr. Michael Gray's paper, Mold, Mycotoxins and Human Health. It prints out at 11 pages but it may be well worth it to illustrate a well documented paper the causes, effects and clinical importance of treatment of fungal exposure. It would also be important to read about medical tests to determine fungal exposure in order to enable a provider to help establish illness due to fungal exposure.
Many psychiatrists are now diagnosing post traumatic stress disorder due to this severe distress of the patient, comparing it to war veterans who are bereaving a very traumatic moment in their lives. This, of course, is compounded by the onset of extreme illness, and a skeptical audience of friends, physicians, and neighbors.
A Physician's Training
To become a doctor in the United States, a person studies for at least seven years after graduating from high school. This usually involves the completion of three or four years of college and another three or four years of medical school. The medical school graduate then usually serves a year-long internship in a hospital to satisfy licensing requirements. After medical school and internship, most students go into residency training to become specialists.
Today there are about 125 schools of medicine and 15 schools of osteopathy in the United States. Canada has 16 medical schools. Almost all require at least three years of college education, and some require a bachelor's degree.
Medical-school opportunities for women and for black people and other minority-group members have improved in recent years. In 1984 women made up about one third of the medical students in the United States, and the percentage of minority students was in the range of 5 to 15 percent.
Many factors are considered before an applicant is admitted into medical school. Among them are the student ’s academic achievement, Medical College Admission Test (MCAT) scores, and extracurricular activities. To gain insight into the applicant’s personal qualities, admissions committees usually request an application with an essay, letters of recommendation, and personal interviews. Because openings are few, only a portion of those who apply get into medical school. In the mid-1980s approximately half of all the applicants were offered a place at one of the accredited medical schools in the United States.
Medical education is expensive. A student at a private medical school pays from 10,000 to 19,000 dollars per year for tuition, with living expenses adding 5,000 dollars or more to this figure. State-sponsored, tax-supported medical schools are less expensive, but these are usually limited to students from that state. The pharmaceutical industry has a large influence on the medical schools due to their deep pockets and special interests.
A medical school is usually part of a large university. Its function is to teach the wide variety of sciences and techniques a doctor must know. Very little mycology studies are required in this education.
The medical curriculum consists of two broad phases—basic medical sciences and clinical medicine. Studies in the medical sciences involve learning in detail the normal structure and function of the human body and how these are altered by disease. The student also studies the intricate anatomy of the body by dissecting a dead one—a cadaver. It is during the clinical phase that the medical student makes contact with real patients and learns how to diagnose and treat various diseases. It is unfortunate in American medicine that most doctors are not taught or encouraged to think beyond the box for diagnosing and treating patients. The average pharmadoc can write between 25 to 60 prescriptions per day.
These two phases were once rigidly separated, and students did not see patients until their third year in medical school. However, there is a growing tendency to combine the two phases. In some schools first-year students deal with patients. Other changes are occurring in medical education: the curriculum is being shortened; individualized training and self-instruction are being stressed; and the social aspects of health-care delivery are being emphasized. The osteopathic curriculum is the same as the allopathic, or traditional, one except for added training in muscle and joint manipulation for certain disorders.
Graduate Medical Education
A newly graduated doctor, with a medical or osteopathic degree, cannot practice in the United States until licensed. To receive a license to practice, a graduate of a medical school located in the United States is required to complete a year of residency. While learning more about medicine, the resident plays a more active part in caring for patients, is responsible for examining patients, and works with experienced physicians in diagnosing and treating illnesses. Most of the dealings with patients are supervised by physician members of the hospital staff, who also serve as teachers ( see Hospital).
The residency served by the new doctor is actually a fast-paced medical apprenticeship. An intern ordinarily works in a single medical service, such as surgery, medicine, radiology, or pediatrics. A service is a particular hospital department where only one branch of medicine is practiced.
Until a few decades ago, most medical graduates obtained a license after completing another year of study, or internship, and became general practitioners. Only those graduates who wanted to become specialists took additional training in a residency program. Because of the rise of medical specialties and the decline of general practice, however, the internship was merged into the residency. The first year of training at a teaching hospital after graduation is now considered the beginning of a residency. Residency periods last from three to seven years, depending on the specialty. Internal medicine and family medicine, for example, require three years of residency, general surgery requires five years, and neurological surgery requires six years. Within many of these specialties further post-residency fellowships are available for those who plan to specialize further.
A graduating medical student is assured of the best available residency through the National Resident Matching Program. This computer-coordinated program matches preferences of graduating doctors with those of hospitals offering residencies. The hours are extremely long and many question the accuracy and abilities of interns working extremely long shifts with little to no sleep n some cases.
Licensing of Physicians
Each state has laws regulating the licensing of physicians. Physician licensing is strictly a state task; there is no federal medical licensing law. As early as 1772, New Jersey enacted a law for the licensing of physicians in the soon-to-be state. There has been a trend toward standardizing the medical licensing requirements of the various states. Most states now permit reciprocal arrangements. This means that a doctor who is licensed in one state can practice medicine in any reciprocating state without taking another examination.
The National Board of Medical Examiners has been formed by the medical profession. It is not an official body, but its standards are so high that any doctor holding its diploma is reciprocally licensed by nearly every state. Another examination, called FLEX (Federation Licensure Examination), is used by nearly every state to test doctors.
A doctor is officially designated a physician and surgeon by the state granting licenses to practice. A doctor with a license is legally permitted to treat any patient. Unless the doctor is a member of a hospital surgical staff, however, there is little opportunity for performing major surgical operations. Before being admitted to such a staff, it must be proved beyond doubt that the doctor is able to perform surgery. Most surgery is done by certified physicians.
Some physicians continue their studies even after entering practice. States and medical societies are beginning to require medical and osteopathic physicians to keep up with advances by taking courses on current medical procedures.
Certification of Specialists
Medical specialists are not certified by the state but by the profession itself. Leading members of various specialties have formed professional societies that set the standards for membership within their branch (see list of specialties recognized by the American Board of Medical Specialists).
Each major specialty has its own certification board. The board is composed of leading practitioners of that particular branch. To qualify as an expert, a doctor must pass a rigid examination given by the board.
WHAT DOCTORS DO
Physicians—general practitioners or specialists—do three things in the course of serving a patient. They first make a diagnosis, or identification, of the exact nature of the problem. They then determine the best method of therapy, or treatment, of the diagnosed ailment. Lastly, they predict the patient’s chances of recovery—the prognosis. It is very important as a patient to communicate to the doctor all of your history, signs, and symptoms in a calm, concise, discussion so the doctor may further assess your diagnosis and have a better knowledge of what further tests need to be taken to better come up with a comprehensive evaluation and treatment protocol.
Doctors use three general kinds of clues when making a diagnosis. These medical clues are called the case history, the symptoms, and the signs.
A patient’s case history includes all information needed for successful treatment. The case history tells, for example, how and when the patient became sick and whether the patient ever before had the same or a similar condition. It lists the patient ’s entire past history of disease and it provides information about personal habits, home life, family, and job. In the case history the physician also keeps a complete record of every step taken in treating the case. Sometimes, physicians ask questions that are not pertinent to your health and this is a patient's objective to decide where they ant their privacy line divided. Symptoms and family history are done very quickly and this is the first step.
A symptom is evidence of an abnormal body change that the patient himself can detect. Examples of common symptoms are pain, fever, loss of weight, loss of appetite, shortness of breath, bleeding, weakness, and fatigue. Symptoms are clues that help doctors decide what signs they should look for when examining patients.
A sign is evidence of an abnormal body change that the physician detects. They may observe a sign such as a rash by simple inspection. They may discover a tumor by palpation, or feeling body tissue. They may detect a heart murmur by auscultation, or listening, with a sound amplifier such as a stethoscope. They may determine infection in the body by a chemical analysis of body fluids.
When a doctor fits together all the clues, he or she can arrive at a diagnosis. A case of appendicitis, for instance, might be diagnosed on this basis:
1. The case history reveals symptoms such as pain in the abdomen, lack of appetite, and vomiting.
2. The physician finds such signs as fever, tenderness in the lower right portion of the abdomen, and a high number of white cells in the blood.
After amassing these clues and eliminating others, the doctor makes the diagnosis of probable appendicitis. The problem is that there are so many new tests available that leaves many ignorant doctors unwilling to try these great tools. Perhaps the next generation of physicians will not be so closed minded.
There are many ways of treating a fungal infection. A well trained doctor will select the best forms of therapy that will correct a particular illness in any given patient. Use of an antifungal such as Lamisil® may be the best treatment for a particular mycosis, for example; but it would not be the ideal therapy for someone in the earlier stages of aspergillosis.
Some of the common types of treatment are drug therapy, or Voraconazole® chemotherapy, the use of Lauricidin® and other natural treatments; holistic enzyme therapy, special diet, the use of acupuncture to treat fibromyalgia; and, the use of an electric current or, benzodiazepines (tranquilizers) and the SSRI class drugs (anti-depressants) may be prescribed to treat some anxiety and depression that is often accompanied with this disorder. This will all depend on the physician, their specialty, type of illness, length of exposure, and IgG levels, and any other additional illness that the patient may have acquired after fungal exposure has taken place. In some cases, only avoidance and diet may be the recommended routine.
The prognosis is the doctor’s prediction of the probable outcome of a case. It is based on knowledge of the course of a disease, experiences when treating it in other patients (and sometimes this may be frustrating if your practitioner is fairly inexperienced in fungal exposure cases but remember your research and professionalism will help also, and knowledge of the patient. Selection of a physician who is knowledgeable of fungal illness is also extremely important. Many physicians are still skeptical and ignorant about such afflictions as fungal exposure mycotoxicosis, but after trial and error, you should be able to find the right doctor. It is also important to remember that even some of the most experienced doctors are still rather unaware of neurological implications such as the destruction of the myelin sheath and other neurological damage that can take place upon such toxin production of fungi such as stachybotrys and chaetomium.
There is a physicians list on this site by geographic location, which may help you in your search. The more the patient knows about fungal exposure and mycotoxicosis, the better one can describe it in educated terms, thus the more likely a physician to understand and be considerate to the patient's needs able to offer adequate therapy and obtain optimum results.
HOW DOCTORS PRACTICE MEDICINE
Medicine can be practiced in a number of ways. Doctors might go into private practice in which they set up individual offices and cater to the medical needs of as many people as they can. Or, they might go into group practice with other physicians in which they share patients and certain medical responsibilities with the others. Physicians also choose to work for large companies and provide care solely for the employees. Or, they might devote their careers to serving as doctors in the armed forces.
A career in public medicine is also open to a doctor. He or she might become a public health physician, commonly called a health officer, and strive to improve the health of the community at large. Physicians working in the field of public health are mainly concerned with the environmental causes of ill health and their prevention. A doctor might also prefer to do research or to work solely for a hospital.
A good doctors will listen intently and earnestly. They will allow the patient to take an active role in their choices for testing. Unfortunately, there are very few doctors who are willing to cooperate, thus considered to be good.
Private Versus Group Practice
In private practice doctors can set up offices at home or in an office building. They may be on a hospital staff, but they do not ordinarily practice medicine with others on the staff. They may be general practitioners serving the medical needs of the family, or they may be specialists whose patients are referred by other doctors. The solo practitioner might also maintain his or her office in a medical center, a building designed especially for a number of physicians. A medical center usually contains a pharmacy and laboratories.
Private practitioners are usually paid on a fee-for-service basis; that is, they are paid only for services provided to a patient. The advantages of private practice are close rapport with patients and freedom of activity. Some disadvantages are long hours of work and low income in the early years of practice.
In group practice two or more physicians share patients. They usually practice in a clinic. The group ordinarily contains general practitioners and specialists. The clinic might be a large establishment, such as the Mayo Clinic in Minnesota, or it might be a smaller, looser association of several doctors. Although clinic-goers usually have their own doctors at these clinics they may be referred to other physicians in the group for specialized treatment or for further examination. All the clinic ’s facilities are usually located within a single building that contains offices and examining rooms for each doctor, clinical and X-ray laboratories, a pharmacy, and dental offices.
Doctors in the group may be paid through the traditional fee-for-service or through a prepaid program of medical care in which patients pay a set monthly fee for medical service whether they need it every month or not. An example of the prepaid type of health-care system is the Kaiser-Permanente plan, which operates mainly in the western United States. It entails the services of some 2,000 doctors at many clinics and hospitals. The advantages of group practice developed on a Kaiser-Permanente basis are regular hours of work, steady income, easy access to group consultation, availability of multiphasic diagnostic test equipment that would normally be beyond the means of a private practitioner, and computer handling of test results. A disadvantage is the lack of opportunity to run one’s own business and earn the high incomes that can be acquired in some private practices.
Medical Manpower Problems
A shortage of doctors has occurred in recent years because the graduation of physicians from medical schools has not kept pace with the growing national population. And in spite of the increasing ability of people to pay for medical care, the widening insurance coverage, and the expanding attitudes that health care is a civil right, medical services have not been as readily available as many might wish. In 1963 the United States government responded to the demand for more health personnel by launching a health professions educational assistance program. It supports schools training physicians, dentists, and other health professionals. In 1963, for example, medical schools graduated only 7,300 doctors, but in 1988 they graduated about 15,000 doctors. Federal support of medically related education is available. With the federal, state, and private loan funds available to students, the mean debt of graduating medical students was $20,000 in 1982.
In 1985 about 572,000 physicians—553,000 M.D.’s and 19,000 D.O.’s—were actively practicing in the United States. On the average, this represents about one doctor for every 420 persons. About 12 percent of active physicians were female. Although the number of women physicians is still low, this situation is changing. In 1984, for example, 30 percent of the medical school graduates were female, compared to 11 percent in 1974. Almost 80 percent of the doctors are involved in direct care of patients. The remainder are concerned with such activities as medical teaching, research, or administration. In Canada there are some 44,000 physicians.
Over the past 30 years medical schools have housed a more diverse student body. The number of minority students, for example, has increased. A more recent trend in medical education has been that of older applicants. Many doctors in the United States are graduates of foreign medical schools. About 22 percent of the active physicians in 1985, for instance, were graduates of foreign medical schools; about 2 percent graduated from Canadian schools.
General practice, which once was the bulk of the medical profession, declined by 44 percent from 1970 to 1980. During the same period the number of doctors specializing in internal medicine increased by more than 70 percent. A major reason for the growth in medical specialization in general was the inability of any one person to master all the new developments of scientific medicine. A possible reason for decrease in general practice practitioners, in particular, may have been the establishment in 1975 of the discipline of family practice by the American Board of Medical Specialties. The federal government had already begun to support the training of family practitioners in 1971. As a result, the number of institutions offering programs in family practice rose considerably in the 1970s.
Another area of medicine that recently grew was emergency medicine. Many younger doctors were attracted to emergency medicine at a time when hospital emergency rooms were treating more and more people.
Physical Distribution of Physicians
In the 1970s and 1980s a number of factors, including an increased demand for health services, caused concern in the medical community that physicians would not be available for future health needs. To provide a supply of physicians, several measures were taken. Immigration regulations and restrictions, for example, were changed to allow more physicians to practice in the United States. Federal and state governments and private foundations undertook measures to promote new health-care objectives.
Doctors are not equally distributed throughout the United States. Hardest hit by this unequal distribution are rural and inner-city residents. About 25 percent of the national population live in rural areas, but only about 10 to 15 percent of all physicians live there. One reason for this discrepancy is that doctors tend to practice in the state of their training—and medical centers, hospitals, and other teaching facilities are usually clustered in heavily populated states. In 1985 the number of physicians per 100,000 population ranged from a high of about 331 in Massachusetts to a low of about 126 in Mississippi. Even in states with a high doctor population, distribution was not equal throughout the state.
The National Health Service Corps, now part of the Health Services Administration, was created in 1970 to provide a number of health workers for some 200 medically underserved areas. Also, the federal government has funded clinics in rural and inner-city areas that provide health care to persons who are not sick enough for hospitalization.
Health-care workers who provide clinical services to patients under the supervision of a physician are called paramedical personnel, or paramedics. They include persons who share with the physicians the direct responsibility for patient care, such as nurses, therapists, and technicians (see Nursing). Nurse practitioners, physician’s assistants, and emergency medical technicians are paramedical workers who perform routine diagnostic procedures, such as the taking of blood samples, and therapeutic procedures, such as administering injections or suturing wounds. They also relieve physicians of making routine health assessments and taking medical histories.
Paramedical training generally prepares individuals to fill specific health-care roles. It is considerably less comprehensive than the lengthy education required of physicians.
Early medicine did not have the professional status it now does. It was closely identified with pagan religions and superstitions. Illness was attributed to angry gods and evil spirits. Prayers, charms, incantations, and other mystic rituals were used to appease the gods or to ward off demons. It was thought such ceremonies would drive off disease.
The ancients did manage, however, to gain some valid medical knowledge from observation and experience. Quarantine regulations and sanitary practices, which are still useful, are set forth in the book of Leviticus in the Old Testament.
Early practitioners often did the right thing without knowing why. For example, the practice of trepanning, or trephining (making a circular opening in the skull), was not uncommon. Trepanning was performed by many primitive peoples, including the American Indians. Although it was evidently done to let out evil spirits, it probably also relieved many headaches caused by brain tumors. No doubt this procedure also killed many persons. Those who were cured by such crude medical practices would probably have recovered more comfortably if they had not been treated at all.
Egyptian and Babylonian Medicine
The ancient Egyptians were among the first to use certain herbs and drugs. They also set and splinted fractured bones. Their techniques were remarkably similar to those of today. Some surgery was also practiced in Egypt. As anesthesia was unknown the patient was rendered unconscious by means of a blow on the head with a mallet.
Records indicate that surgery was far more advanced in Babylonia than in any other country. The Code of Hammurabi was established there about 1800 BC. It was a collection of laws set up to unify legal practices in Babylonia. The code also listed the penalties that had to be paid by unsuccessful surgeons. For example, if the patient lost an eye because of faulty surgery, the surgeon’s eye was put out.
Greek and Roman Medicine
The Greeks added their contributions to Egyptian and Babylonian medical knowledge. One new Greek concept was the doctrine of the four humors. The humors were blood, black bile, yellow bile, and phlegm, which were believed to be balanced in a healthy person. Any disturbance of these fluids in the body supposedly led to disease. This erroneous doctrine confused medical thinking for centuries.
Hippocrates, known as the “father of medicine,” was the outstanding physician of ancient Greece. He separated medicine from superstition. He also set forth a code of ethical behavior for physicians. The Hippocratic oath is still respected by modern physicians.
The Greeks developed a great center of medical education and practice in Alexandria, Egypt, during the 3rd century BC. Here human bodies were dissected for teaching purposes. Such dissections helped physicians recognize some of the functions of the brain, the heart, and the lungs.
The teachings of Hippocrates were carried to other lands. One of the men trained in Hippocratic medicine was Claudius Galen, who became the most renowned physician in ancient Rome. Galen added to the four-humor confusion by contributing erroneous ideas of his own. He attributed life, for example, to three spirits—natural spirits, formed in the liver; vital spirits, produced in the heart; and animal spirits, which came from the brain.
Although Galen was an industrious worker and writer, his wrong ideas blocked medical progress for a long time. He did, however, correct the mistaken Greek theory that arteries contained air. Galen found that they contain blood ( see Blood). Unfortunately, he became so great an authority on medicine that for centuries his ideas were accepted without question and his errors were perpetuated.
After the breakup of the Roman Empire the tradition of Greek medicine continued in the universities of the Arab world. Many of the original Greek manuscripts were preserved at these centers and were used in formal medical studies. Since the Near East abounded with plants from which drugs could be extracted, Arab physicians used them extensively. The study of anatomy, however, was hampered by Islamic doctrine, which forbade dissection of the human body. Thus Arab surgeons were forced to rely on the Greek texts for anatomical descriptions.
Rhazes, an Arab physician born in Persia, is credited with being the first to distinguish between smallpox and measles. He was also among the first to recognize the need for sanitation in hospitals.
Probably the most important physician at the beginning of the 2nd century was Avicenna. His monumental ‘Canon of Medicine’, an extensive five-volume work of case histories and therapeutic instructions, was long held as an absolute medical authority by instructors in the Near East and in Europe.
It was not until the Renaissance that Europeans began to seek a scientific basis for medical knowledge instead of relying on Galen’s teachings. Leonardo da Vinci and Andreas Vesalius were among those who sought new scientific facts. They discovered many new principles of anatomy through their systematic dissection of human bodies.
This resurgence of scientific investigation did not, however, eliminate all the antiquated medical practices of ancient and medieval times. Barbers, for example, were also surgeons. They combined haircutting with minor surgery, bleeding, and attention to small wounds. Barbers were not considered to be as respectable as physicians.
The practice of bloodletting, popular for many centuries, had been developed by doctors. It was thought that bleeding had some curative effect on disease, but it probably hastened the deaths of many persons who might otherwise have recovered. Bleeding was not abandoned as a general practice until the 18th century and is rarely done today.
Ambroise Paré was among the first to win recognition as a skilled surgeon. He studied, learned, and taught new ideas about wounds and wound healing. He proved that tying blood vessels was a better method of stopping hemorrhages than cauterizing with hot oil or a hot iron. Paré also recognized the necessity of keeping wounds clean. He devised appliances such as artificial limbs and trusses. Paré made this modest statement about his success with his patients: “I treated them, God cured them.”
Paracelsus was one of the most controversial figures in the history of medicine. A vain man, he gave the impression that he knew the answers to all medical questions. Although he was wrong in many instances, he was correct in many others. Paracelsus advanced medical practice more than anyone had up to his time.
17th- and 18th-Century Medicine
William Harvey discovered how blood circulates through the body. His treatise on the circulation of blood was published in 1628 and received wide acceptance. The work was based on Harvey’s observation of his own veins and on his study of the veins and arteries of sheep.
Harvey reasoned that blood pumped away from the heart could return to the heart only by way of the veins. He could not explain, however, the manner in which blood passes from the arteries to the veins. Soon after Harvey’s death, this question was answered by Marcello Malpighi. Using a microscope built by Anthony van Leeuwenhoek, Malpighi discovered, identified, and described the capillaries.
Leeuwenhoek’s discovery of tiny living organisms in drops of ordinary water was made possible by his microscope. He did not, however, recognize what he saw as possible disease-causing microbes.
The art of surgery developed in 17th-century England at a time when elsewhere in Europe surgical operations were being performed mainly by barbers and bleeders. William Cheselden, a surgeon and anatomist, greatly reduced the death rate in surgery.
In 1711 Stephen Hales gave the first demonstration of blood pressure. William Withering, in 1785, prescribed the use of the drug digitalis to treat edema (dropsy) caused by heart disease. James Lind found that citrus juice (now known to contain vitamin C) could be used to prevent scurvy. Another medical milestone of the era was the classical description of diseases made by John Hunter, who founded the science of experimental pathology. Giovanni Morgagni pioneered the science of pathological anatomy. He believed that disease struck the organs of the body. The breakthrough experiment in immunization was vaccination against smallpox, announced in 1798 by Edward Jenner (see Jenner).
The beginning of American medicine came in 1765, when John Morgan established the first medical school, in Philadelphia Pa. He was joined by William Shippen, who had unsuccessfully tried to start a medical school in the same city three years earlier. Another Philadelphian, Benjamin Rush, joined the staff. Rush, who was a signer of the Declaration of Independence, taught some 3,000 medical students during his lifetime. He also, however, persisted in teaching the harmful practice of bleeding.
The golden age of medicine began in the 19th century. René T. Laënnec invented the stethoscope. He described how the sounds made by the heart and the lungs could be used to help in the diagnosis of disease. The physiology of digestion became better understood as a result of William Beaumont’s direct observations of the digestive process. Ivan P. Pavlov contributed to the study of digestion also. His famous experiments concerning conditioned reflexes in the nervous system shed new light on brain function. Rudolf Virchow contributed his cellular theory of disease, and Louis Pasteur presented his germ theory of disease. Robert Koch isolated the tubercle bacillus. Emil von Behring discovered diphtheria antitoxin, the first antitoxin. Jules Bordet uncovered the whooping cough bacillus and developed a serum for use against the disease.
Joseph Lister applied the new knowledge of bacteriology to the operating room. He became the pioneer of antiseptic surgery. Crawford W. Long, a surgeon, and William T. G. Morton, a dentist, almost simultaneously introduced ether anesthesia. Nitrous oxide, or laughing gas, was first used as an anesthetic in dentistry by Horace Wells.
High nursing standards were established through the persistent efforts of Florence Nightingale. Ignaz P. Semmelweis recognized that unsanitary conditions in hospital maternity wards gave rise to puerperal (childbed) fever.
The first serious studies of mental disease were conducted during the 19th century. Jean M. Charcot used hypnosis as a tool to search into the troubled minds of mental patients. His student Sigmund Freud developed the psychoanalytic technique for treating mental illness.
Charles L.A. Laveran described the roles played by protozoans as disease-causing organisms. He is particularly noted for identifying the mosquito parasite that causes malaria. At the turn of the century Walter Reed headed a team of physicians who proved that yellow fever is also transmitted by mosquitoes. A significant achievement late in the 19th century was the discovery of X rays by Wilhelm K. Roentgen.
The 20th century saw the development, in rapid succession, of serums, vaccines, antitoxins, and toxoids to combat many deadly infectious diseases. Typhoid fever, diphtheria, tetanus, spotted fever, whooping cough, polio, cholera, typhus, bubonic plague, and measles were among the diseases brought under control. John F. Enders cultivated live polio viruses which resulted in the polio vaccines of Jonas E. Salk and Albert B. Sabin.
Diagnostic devices and practices became more reliable. Willem Einthoven invented the mechanism for the electrocardiograph, which detects and records heart irregularities. Karl Landsteiner discovered the ABO system and the Rh factor in human blood. August von Wassermann developed a test for syphilis.
Élie Metchnikoff performed valuable research in the field of immunity. He discovered the principle of phagocytosis, the process by which white blood cells engulf and destroy bacteria. William M. Bayliss and Ernest H. Starling found that chemicals they called hormones are vital to the control of many body functions.
Frederick Grant Banting, Charles H. Best, and J.J.R. Macleod isolated the hormone insulin, necessary for the treatment of diabetes mellitus. In the 1950s cortisone and other anti-inflammatory agents were found to temper the painful results of many diseases.
Paul Ehrlich’s discovery of Salvarsan, or “606,” inaugurated the era of modern drug therapy. Alexander Fleming discovered the first antibiotic, penicillin, in 1928. The sulfa drugs were introduced in the 1930s. Antihistamines, antispasmodics, and tranquilizers appeared in the 1940s and 1950s. Selman A. Waksman discovered streptomycin, a powerful antibiotic, in 1948. Further research in antibiotics led to the control of tuberculosis. Since Ehrlich suggested that antibodies might be used as carriers of drugs, many are now produced in the laboratory. In the 1980s much private and public funding was directed toward the research of genetically engineered drugs.
Research in nutrition produced new knowledge about dietary needs. The roles of proteins, fats, carbohydrates, vitamins, and minerals were described.
There have been many advances in surgery since the discovery and refinement of anesthesia. Means were found to maintain lung inflation and breathing rhythm when the vacuum inside the chest is disturbed by surgery. This made possible heart operations and the removal of diseased portions of lungs. Surgical transplantations of the kidneys, liver, and heart have been performed. Major improvements have also been made in the mechanical heart.
Since the early 1970s major technological advances have improved physicians’ ability to see inside the human body for the purpose of disease detection and diagnosis. Invasive and sometimes painful or even dangerous techniques have been replaced by safer, noninvasive methods. These methods include new uses for conventional X rays, such as computed tomography (CT) detection of radioactive materials within the body using techniques such as positron emission tomography (PET), and other types of probes, such as ultrasound and magnetic resonance imaging (MRI).
PREPARING TO BE A PHYSICIAN
A future doctor should have a genuine desire to help people. He or she must develop good study habits to complete the years of arduous schooling ahead.
In high school, the future doctor should start learning how the body works by taking two to three years of the laboratory sciences—biology, chemistry, and physics. Other courses needed for a well-rounded education include four years of English, three years of mathematics, two to three years of the social sciences—history, sociology, economics, and political science—and two to three years of a foreign language. While in high school, the medical aspirant can join clubs that feature talks by practicing physicians, trips to hospitals and clinics, and practice in such medical procedures as blood pressure measurement and splint application. Future Physicians Clubs and Ars Medica Clubs are examples.
A premedical program in college is not mandatory for admission into medical school, but most medical schools require applicants to have college courses in biology, physics, inorganic chemistry, and organic chemistry and to have maintained an overall “B” average in their college work. The prospective medical student must also take the Medical College Admission Test (MCAT). It is composed of six parts: reading analysis, which tests analytical and reading skills through reading passages quantitative analysis, which tests mathematical facility; science, which tests scientific knowledge; chemistry; physics; and biology. Admission committees then consider MCAT scores, college grades, and personality traits—such as initiative, self-reliance, and strength of purpose—when selecting medical students.
PREPARING TO BE A MEDICAL AIDE
Not everyone who wants to help the sick wants to become a physician. There are careers open in therapy to rehabilitate the disabled or in social work to help physically or mentally ill patients cope with their problems. Career opportunities also exist for medical technologists, technicians, and laboratory assistants who perform many of the clinical tests for doctors. In addition, someone interested in health care can become a physician’s assistant and serve as a paramedical worker.
While in college a therapist learns a skill in either physical therapy, occupational therapy, recreational therapy, or speech or hearing therapy. A prospective therapist must also take college preparatory courses in high school and study the health, physical, and social sciences in college.
A physical therapist must understand the biological and physical properties of the body to help disabled people regain some use of their limbs. An occupational therapist uses the insights of the social sciences to help patients recover by showing them how to channel energy into work projects.
A recreational therapist majors in music, drama, or athletics in college to be able to organize the games and activities that help people in hospitals gain some enjoyment from life. A speech therapist (or speech pathologist) and a hearing therapist (or audiologist) pursue a liberal arts education in college and then earn a graduate degree in either field of therapy. Persons with disabilities that affect talking or hearing, such as cleft palates or stroke damage, are helped by the efforts of such therapists to improve their speech or hearing.
Anyone with a heartfelt interest in human welfare may seek a career in medical or psychiatric social work. A medical social worker helps a patient get over such anxieties as worrying about getting back on the job. A psychiatric social worker gathers information about the factors contributing to mental illness and interprets the nature of the illness. The usual prerequisites for these careers are a liberal arts education in college with a major in psychology and a master ’s degree in social work.
Medical Technologist, Technician, and Laboratory Assistant
Certain clinical tasks necessary for disease diagnosis are done by skilled workers who learn them in school or on the job. A medical technologist may specialize in identifying diseased body cells, collecting and typing blood, or dealing with X rays and radioactive materials. After completing college and hospital laboratory programs, a medical technologist must pass a certifying examination. Certain types of laboratory work, such as routine blood and urine tests, can be done by medical technicians and laboratory assistants under the guidance of a physician specialist called a pathologist. Medical technicians frequently attain an associate degree from a community college. Laboratory assistants need a high school diploma.
A person without a college degree who is interested in a paramedical profession may become a physician’s assistant. A paramedic often has had medical training in the armed forces. After an intensive period of training at certain medical schools, colleges (where a bachelor’s degree in medical science can be earned), or hospitals, a physician’s assistant can perform some of the basic tasks of medicine—such as taking case histories, sewing wounds, and doing some types of physical examinations. Physician’s assistants are particularly needed in rural areas and inner-city neighborhoods where health-care demands are high but medical aid is not readily available.
Medical Specialties and Responsibilities:
allergy and immunology. Evaluation, diagnosis, and management of allergic diseases and disorders of the immune system.
anesthesiology. Provision of pain relief and maintenance of a stable condition during surgery.
colon and rectal surgery. Diagnosis and treatment of diseases of the intestinal tract, rectum, and anus. dermatology. Prevention, diagnosis, and treatment of skin diseases.
embryology. The study of the embryo and its development.
emergency medicine. Immediate diagnosis and action in response to acute illness and injury.
environmental medicine-This is an exciting and emerging field with great demand. The diagnosis, treatment of environmentally ill patients utilizing the newest technology available including geno-typing, minor mycological studies, and chemistry using both pharmaceuticals and alternative treatment.
epidemiology. The study of the occurrence and distribution of diseases and the factors controlling the presence or absence of a particular disease in a particular location.
family practice. Care and prevention of common family diseases.
gastroenterology. The study of the stomach, the intestines, and their diseases.
internal medicine. Nonsurgical correction of diseases of the body’s inner organs and tissues. Subspecialties include cardiovascular medicine, endocrinology, gastroenterology, medical oncology, and allergy and immunology.
neurological surgery. Diagnosis, evaluation, and treatment of diseases of the brain, spinal cord, and nerves. neurology. Diagnosis and treatment of all categories of disease involving the nervous system.
nuclear medicine. Use of radioactive and non-radioactive materials in the diagnosis and treatment of diseases.
obstetrics and gynecology. Medical and surgical care for pregnant women and their developing babies and treatment of female disorders.
ophthalmology. Diagnosis and treatment of eye disorders.
orthopedic surgery. Preservation and restoration of the musculoskeletal system and associated tissues by medical, surgical, and physical means.
otolaryngology. Diagnosis and treatment of diseases of the ears, nose, and throat.
pathology. Diagnosis of disease by analysis of cells and chemical tests of blood and other tissue.
pediatrics. Care for the physical, emotional, and social health of children from birth to young adulthood and diagnosis and treatment of childhood diseases.
physical medicine and rehabilitation. Treatment of muscle and limb disorders, stroke after effects, and other crippling conditions.
plastic surgery. Repair, replacement, and reconstruction of body tissue.
preventive medicine. Focus on health of individuals and the community in order to protect, promote, and maintain health, prevent disease, disability, and premature death.
psychiatry. Diagnosis, treatment, and prevention of mental, emotional, and behavioral disorders.
radiology. Use of X rays and other types of radiation in the diagnosis and treatment of disease.
general surgery. Provision of patient care before, during, and after surgical operations to correct disorders or injuries.
thoracic surgery. Provision of patient care before, during, and after surgical operations to correct chest disorders.
toxicology. The study of the nature of poisons and their effects, detection, and treatment of their effects.
urology. Diagnosis and treatment of diseases of the kidneys, bladder, and adrenal gland.
virology. The study of viruses and viral diseases.
BIBLIOGRAPHY FOR MEDICINE
Aaseng, Nathan. The Disease Fighters: The Nobel Prize in Medicine (Lerner, 1987).
Ablow, K.R. Medical School (Williams and Wilkins, 1986).
Gilbert, Susan. Medical Fakes and Frauds (Chelsea, 1989).
Goliszek, Andrew. The Complete Medical School Preparation and Admissions Guide (Carolina Press, 1986).
Lambert, Mark. Medicine in the Future (Watts, 1986).
(See also bibliographies for Biochemistry; Bioengineering; Bioethics; Brain and Spinal Cord; Disease, Human; Health; Psychology.)
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