Medicine is the science and art of healing. Medicine is a science because it is based on knowledge gained through careful study and experimentation.

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Medicine is the science and art of healing.  Medicine is a science because it is based on knowledge gained through careful study and experimentation.  It is an art because it depends on how skilfully doctors and other medical workers apply this knowledge when dealing with patients.  

The goals of medicine are to save lives, to relieve suffering, and to maintain the dignity of ill individuals.  For this reason, medicine has long been one of the most respected professions.  Many thousands of men and women who work in the medical profession spend their lives caring for the sick.  When disaster strikes, hospital workers rush emergency aid to the injured.  When epidemics threaten, doctors and nurses work to prevent the spread of disease.  Researchers continually search for better ways of fighting disease.  

Human beings have suffered from illnesses since they first appeared on the earth about 21/2 million years ago.  Throughout most of this time, they knew little about how the body works or what causes disease.  Treatment was based largely on superstition and guesswork.  

Medicine has made tremendous progress in the last several hundred years.  Today, it is possible to cure, control, or prevent hundreds of diseases.  People live longer than they did in the past as a result of new drugs, machines, and surgical operations.  Medical progress in the control of infectious diseases, improvements in health care for mothers and children, and better nutrition, sanitation, and living conditions have given people a longer life expectancy.  In 1900, most people did not live past the age of 50.  Today, people in the industrial world have an average life span of about 75 years.  

As medicine has become more scientific, it has also become more complicated.  In the past, doctors cared for patients almost single-handed.  Patients received treatment at home for most kinds of illnesses.  Today, doctors no longer work by themselves.  Instead, they head medical teams made up of nurses, laboratory workers, and many other skilled professionals.  The care provided by such teams cannot generally be started at home.  As a result health centres, clinics, and hospitals have become the chief centres for medical care.  

Medical care is often considered part of the larger field of health care.  In addition to medical care, health care includes the services provided by dentists, clinical psychologists, social workers, physiotherapists, occupational therapists, and other professionals in various fields of physical and mental health.  This article deals chiefly with the kind of service provided by doctors and other members of the medical team.  Information about other kinds of health care can be found in separate World Book articles, such as CLINICAL PSYCHOLOGY; DENTISTRY; OPTOMETRY; and CHIROPODY.  

                    Elements of medical care

Medical care consists of three main elements: (1) the diagnosis, or identification, of disease or injury; (2) the treatment of disease or injury; and (3) the promotion of health and prevention of disease.  

Diagnosis.  Doctors use three main types of "clues" in making a diagnosis: (1) the patient's case history; (2) the doctor's physical examination of the patient; and (3) the results of medical tests.  

Patients provide their own medical history by answering questions about their physical condition and past illnesses.  Doctors use certain basic tools and techniques to perform a physical examination.  For example, they use a stethoscope to listen to a patient's heart and lungs.  By pressing and probing various areas of the body, they check internal organs for unusual hardness, softness, or changes in size or shape.  A lighted instrument called an endoscope allows doctors to see the interior of hollow organs, such as the stomach or intestines.  Doctors also insert medical instruments through endoscopes to obtain pieces of tissue for study.  

Medical laboratories aid diagnosis by making chemical and microscopic tests on body fluids and tissues.  A doctor may also order tests that use radioactive trace elements, X rays, or sound or electric waves to detect disease by literally looking inside the body (see ULTRASOUND; X RAYS).  

To make a final diagnosis, the doctor fits together all the clues from the patient's case history, physical examination, and medical tests.  If the diagnosis is complicated, the doctor may ask the opinion of other experts.  

Treatment.  People usually recover from minor illnesses and injuries without special treatment.  In these cases, doctors may simply reassure their patients and allow the body to heal itself.  But serious ailments generally require special treatment.  In these cases, a doctor may prescribe drugs, surgery, or other treatment.  

For thousands of years, drugs and surgery have provided two of the chief methods of treating disease.  But modern science has helped make these methods much more effective than they used to be.  Penicillin and other "wonder drugs" help cure many infectious diseases that were once extremely difficult to treat.  With the help of machines, surgeons can repair or replace organs that have been seriously damaged, including the heart and kidneys.  Science has also helped develop entirely new methods of treatment.  Radiotherapy, for example, makes use of X rays and radioactive rays to treat cancer.  

Prevention.  Doctors help prevent disease in various ways.  For example, they give vaccinations to guard against such diseases as polio, hepatitis, and measles.  They may also order a special diet or drug to strengthen a patient's natural defences against illness.  People can also help themselves remain healthy by exercising, by not smoking, and by avoiding use of alcohol or illegal drugs.  Doctors can prevent many diseases from becoming serious by diagnosing and treating them in their early stages.  For this reason, most doctors recommend regular physical examinations.  

Screening programmes can diagnose commonly occurring diseases such as tuberculosis.  Screening programmes are used for diseases that carry a high risk of death.  They are used with groups that are especially at risk of contracting the diseases.  For example, target groups for breast cancer are women aged between 50 and 65 years of age, and younger women who have a high incidence of breast cancer in the family.  See DISEASE (Preventing disease).  

Local governments help prevent disease by enforcing public health measures.  For example, they make sure the community has pure drinking water and a system of rubbish and sewage disposal.

                    Providing medical care

In industrial countries, high-quality medical care is available to most people when they need it.  These countries include Australia, New Zealand, Canada, Japan, the United States, and most European nations.  Certain developing countries of Africa, Asia, and Latin America lack adequate facilities for high-quality medical care.  Some of these countries have only 1 doctor for every 20,000 to 60,000 people.  Some industrial countries, on the other hand, have 1 doctor for every 450 people.  

In case of illness or injury, people first of all need someone to diagnose their condition and prescribe or give the necessary treatment.  This kind of basic health care is called primary medical care.  It is provided by such doctors as general practitioners to whom people can go directly, without having to be referred by another doctor or medical worker.  If a case is complicated or severe, the person who provides primary medical care refers the patient to a doctor or a hospital or other institution that provides specialized care.  

The role of the doctor.  Doctors have detailed knowledge of the human body and how it works, and they are specially trained in the diagnosis, treatment, and prevention of disease.  For this reason, they take responsibility for making all major decisions regarding the care of patients.  Doctors who provide medical care can be divided into two groups: (1) general practitioners and (2) specialists.  

General practitioners provide primary medical care only.  But they treat a wide variety of ailments.  They provide care for every member of the family, regardless of the ages of those family members.  

Specialists.  In the past, almost all doctors were general practitioners.  But medical knowledge has increased so rapidly during the 1900's that no doctor can possibly keep up with all the important advances.  As a result, many doctors today specialize in a particular field of medicine.  Neurologists, for example, specialize in diseases of the nervous system.  Paediatricians specialize in children's diseases.  The section Improving the quality of medical care (The specialities) describes the major medical specialities.  

Advances in medicine and technology have led to the growth of the medical specialities.  Seriously ill patients, especially, receive much more effective treatment than ever before.  But as more and more doctors become specialists, fewer doctors may be available for primary medical care.  

The role of medical workers.  Doctors could not do their job without the help of many other skilled professionals.  Registered nurses, for example, work closely with doctors in clinics, hospitals, and medical centres.  Nurses also provide many services to patients independent of doctors.  Pharmacists dispense prescriptions and give advice on the drugs prescribed.  Various kinds of therapists give special treatment as ordered by the doctor.  Other skilled workers serve in clinics, medical laboratories, X-ray departments, and operating theatres.  The jobs of various kinds of medical workers are described later in this article.

                    Where medical care is provided

In the doctor's surgery.  Most doctors who provide primary medical care have a surgery-based practice.  In their surgeries, they examine patients and, based on the findings, provide treatment.  

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Primary-care doctors practise alone or in a group practice, where two or more doctors share the same clinic, equipment, and personnel.  Group practice reduces each doctor's expenses.  It also enables doctors to offer more services under the same roof.  

In hospitals.  Hospitals offer services not available anywhere else.  Patients receive round-the-clock care from a full-time staff of doctors, nurses, and other skilled workers.  Teaching hospitals, where a great deal of medical research and education are carried out, are usually well equipped and offer advanced standards of care.  The most advanced hospitals may have heart-lung machines, which can ...

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