View source for Medicine/ja

<languages/>
{{Infobox medical specialty
|title        = 医学 
|subdivisions =
|image        = [[File:Asklepios.3.jpg|alt=Marble statue of Asclephius on a pedestal, symbol of medicine in Western medicine|250px]]
|caption      = [[:en:Greek God|ギリシャ神話]]の医術の神[[:ja:アスクレーピオス|アスクレーピオス]]の像、蛇が巻きついた[[:en:Rod of Asclepius|アスクレピオスの杖]]を持つ
|system       =
|diseases     =
|tests        =
|specialist   = [[Specialty (medicine)/ja|医学分野]]
|glossary     = [[Glossary of medicine/ja|医学用語]]
}}

'''医学'''とは、患者をケアし、その[[injury/ja|けが]]、[[disease/ja|病気]]、[[Health promotion/ja|健康増進]]の[[diagnosis/ja|診断]]、[[prognosis/ja|予後]]、[[Preventive medicine/ja|予防]]、[[therapy/ja|治療]]、[[Palliative care/ja|緩和]]を管理する[[:ja:科学|科学]]と[[:ja:実践|実践]]である。医学は、[[illness/ja|病気]]の[[prevention (medical)/ja|予防]]と[[therapy/ja|治療]]によって[[health/ja|健康]]を維持・回復するために発展した様々な[[health care/ja|医療行為]]を包含している。現代医学は、[[biomedical sciences/ja|生物医学]]、[[biomedical research/ja|生物医学研究]]、[[medical genetics/ja|遺伝学]]、[[medical technology/ja|医療技術]]を応用して、傷病の[[diagnosis (medical)/ja|診断]]、治療、予防を行う。一般的には[[pharmaceutical/ja|医薬品の投与]]や[[surgery/ja|外科手術]]を行うが、[[psychotherapy/ja|心理療法]]、[[splint (medicine)/ja|外反、牽引]]、[[medical device/ja|医療機器]]、[[biologic medical product/ja|生物製剤]]、[[Radiation (medicine)/ja|電離放射線]]など様々な治療法がある。

医学は[[Prehistoric medicine/ja|先史時代]]から行われており、そのほとんどの期間、医学は[[:ja:芸樹|芸術]]（技術や知識の領域）であり、しばしばその土地の文化の[[:ja:宗教|宗教的]]・[[:ja:哲学|哲学的]]信念と結びついていた。例えば、[[medicine man/ja|呪術医]]が[[herbs/ja|薬草]]を塗って治癒の[[:ja:祈り|祈り]]を捧げたり、古代の[[:ja:哲学者|哲学者]]や[[:ja:医師|医師]]が[[:ja:四体液説|四体液説]]の理論に従って[[bloodletting/ja|瀉血]]を施したりする。[[:en:history of science|近代科学]]の出現以来、ここ数世紀、ほとんどの医学は[[:ja:芸術|芸術]]と[[:ja:科学|科学]]（'''医学(medical science)'''の[[:en:umbrella term|傘]]の下で、[[:ja:基礎科学|基礎]]と[[:ja:応用科学|応用]]の両方）の組み合わせになっている。例えば、縫合糸を縫う技術は練習によって習得される芸術であるが、縫合される組織の[[Cytology/ja|細胞]]レベルや[[molecular dmedicine/ja|分子]]レベルで何が起こっているかという知識は科学によって生まれる。

現在では[[traditional medicine/ja|伝統医学]]や''民間療法''として知られる、科学的根拠のない医学は、[[alternative medicine/ja|代替医療]]と呼ばれている。安全性や有効性に懸念がある科学的医学以外の代替療法は、[[:ja:藪医者|ヤブ医者]]と呼ばれる。
{{TOC limit|3}}

== 語源 ==

医学({{IPAc-en|UK|ˈ|m|ɛ|d|s|ᵻ|n|audio=En-uk-medicine.ogg}}, {{IPAc-en|US|ˈ|m|ɛ|d|ᵻ|s|ᵻ|n|audio=En-us-medicine.ogg}}) とは、[[disease/ja|病気]]の[[diagnosis/ja|診断]]、[[:ja:予後|予後]]、[[therapy/ja|治療]]、[[Preventive medicine/ja|予防]]に関する[[:ja:科学|科学]]と実践のことである。"医学"の語源は、 [[:ja:ラテン語|ラテン語]]の ''medicus''から来ており、''医師''を意味する。

== 臨床実習 ==
[[File:The Doctor Luke Fildes crop.jpg|thumb|upright=1.1|alt=植民地時代の医学を描いた油絵|[[:en:Sir Luke Fildes|ルーク・フィルデス卿]]作''ドクター''（1891年）]]
[[File:Elizabeth Blackwell.jpg|thumb|米国初の女性医師[[:ja:エリザベス・ブラックウェル|エリザベス・ブラックウェル]]は[[:en:State University of New York Upstate Medical University|SUNYアップステート]]を卒業した（1847年）]]

文化や技術の地域差により、医薬品が入手可能な地域や臨床現場は世界各地で異なる。近代科学医学は[[:en:Western world|西洋世界]]では高度に発達している一方、アフリカやアジアの一部のような[[:ja:発展途上国|発展途上国]]では、エビデンスや効能に乏しく、医療に正式な訓練を義務付けていない[[traditional medicine/ja|伝統医学]]に頼ることが多い。

[[:ja:先進国|先進国]]では、[[evidence-based medicine/ja|エビデンスに基づく医療]]は臨床で普遍的に用いられているわけではない、 
例えば、2007年に行われた文献レビューの調査では、治療の約49％が、有益性または有害性のいずれかを裏付ける十分な証拠を欠いていた。

現代の臨床現場では、[[physicians/ja|医師]]と[[physician assistants/ja|医師助手]]は、臨床的判断を用いて病気を[[medical diagnosis/ja|診断]]し、[[prognosis/ja|予後を予測]]し、治療し、予防するために、患者を個人的に評価する。[[doctor-patient relationship/ja|医師と患者の関係]]は通常、患者の[[medical history/ja|病歴]]と[[medical record/ja|カルテ]]の調査から始まり、問診と[[physical examination/ja|身体診察]]が続く。基本的な診断[[medical device/ja|医療機器]]（[[stethoscope/ja|聴診器]]、[[tongue depressor/ja|舌圧子]]など）が通常使用される。[[Medical sign/ja|徴候]]を調べ、[[symptoms/ja|症状]]を問診した後、医師は[[medical test/ja|医学的検査]]（[[blood test/ja|血液検査]]など）を指示したり、[[biopsy/ja|生検]]を行ったり、[[pharmaceutical drug/ja|医薬品]]やその他の治療法を処方したりする。[[Differential diagnosis/ja|鑑別診断法]]は、提供された情報に基づいて病態を除外するのに役立つ。診察の際、関連するすべての事実を患者に正しく伝えることは、患者との関係や信頼関係を築く上で重要なことである。この医療行為は、多くの法域で法的文書である医療記録に記録される。経過観察はより短時間で済むかもしれないが、一般的な手順は同じであり、専門医も同様のプロセスを踏む。診断と治療には、問題の複雑さに応じて、数分しかかからない場合もあれば、数週間かかる場合もある。

問診とカウンセリングは以下の通り:
* 主訴(CC): 現在の受診の理由。これは''[[symptom/ja|症状]]''である。患者自身の言葉で書かれ、それぞれの期間とともに記録される。'主訴(chief concern)'または1'主訴提示(presenting complaint)'とも呼ばれる。
* 現[[illness/ja|病]]歴（History of present illness：HPI）：症状の時系列的な順序と、各症状の詳細な説明である。過去病歴（PMH）と呼ばれることもある。[[Medical history/ja|病歴]]はHPIとPMHからなる。
* 現在の活動：職業、趣味、患者が実際に行っていること。
* [[Medication/ja|医薬品]](Rx)：[[Medical prescription/ja|処方薬]]、[[over-the-counter drug/ja|市販薬]]、[[Home remedy/ja|家庭薬]]、代替薬や[[Herbalism/ja|漢方薬]]など、患者が服用している薬物。[[Allergy/ja|アレルギー]]も記録する。
* 過去の病歴（PMH/PMHx）：同時発生した医学的問題、過去の入院や手術、怪我、過去の[[infectious disease/ja|感染症]]や[[vaccination/ja|予防接種]]、既知のアレルギー歴など。
* 生活履歴（SH）：出生地、居住地、婚姻歴、社会的・経済的地位、習慣（[[diet (nutrition)/ja|食事]]、医薬品、[[:en:tobacco smoking|タバコ]]、アルコールを含む）。
* [[Family history (medicine)/ja|家族歴]]（FH）：患者に影響を及ぼす可能性のある家族の疾患のリスト。[[:ja:家系図|家系図]]が用いられることもある。
* システム・レビュー（ROS）または''システム探求''：質問すべき一連の追加質問、 一般的な問診（[[:en:weight loss|体重減少]]、睡眠の質の変化、発熱、しこりやこぶに気づいたか、など）に続いて、身体の主な臓器系（[[human heart/ja|心臓]]、[[human lung/ja|肺]]、[[digestive/ja|消化管]]、[[Urinary system/ja|尿路]]など）に関する問診を行う。

[[physical examination/ja|身体診察]]とは、客観的で観察可能な疾患の[[medical sign/ja|医学的徴候]]があるかどうかを調べることであり、患者が自発的に訴え、必ずしも客観的に観察できない症状とは対照的である。医療従事者は、視覚、聴覚、触覚、時には嗅覚（感染症、[[uremia/ja|尿毒症]]、[[diabetic ketoacidosis/ja|糖尿病性ケトアシドーシス]]など）を用いる。身体診察の基本は、[[inspection (medicine)/ja|検査]]、[[palpation/ja|触診]]（触る）、[[percussion (medicine)/ja|打診]]（叩いて共鳴特性を調べる）、[[auscultation/ja|聴診]]（聞く）の4つの行為であり、一般的にはこの順番であるが、腹部の評価では打診と触診の前に聴診が行われる。

臨床検査では以下のことを調べる：
* 身長、体重、体温、[[blood pressure/ja|血圧]]、[[pulse/ja|脈拍]]、呼吸数、ヘモグロビン[[oxygen saturation/ja|酸素飽和度]]などのバイタルサイン
* 患者の一般的な外見および疾患の特異的指標（栄養状態、黄疸の存在、蒼白あるいは[[Nail clubbing/ja|ばち状]]）
* [[human skin/ja|皮膚]]
* 頭部、[[eye/ja|眼]]、[[ear/ja|耳]]、鼻、喉（[[HEENT examination/ja|HEENT]]）
* [[Cardiovascular/ja|循環器]]（[[heart/ja|心臓]]および[[blood vessel/ja|血管]]）
* [[Respiratory/ja|呼吸器]]（大きな気道と[[Human lug/ja|肺]]）
* [[Abdomen/ja|腹部]]及び [[rectum/ja|直腸]]
* 生殖器（患者が妊娠中または妊娠の可能性がある場合は妊娠も含む）
* [[Musculoskeletal/ja|筋骨格系]] (脊髄と四肢を含む)
* [[Neurological/ja|神経学]] (意識(consciousness), 意識(awareness), 脳, 視覚, [[cranial nerves/ja|脳神経]], 脊髄、[[Peripheral nervous system/ja|末梢神経]])
* [[Psychiatry/ja|精神医学]] (オリエンテーション, [[mental state examination/ja|精神状態]], 気分、異常な知覚や思考の証拠)

病歴の中で強調された関心分野に焦点を当てることになると思われ、上記のすべてが含まれるとは限らない。

治療計画には、[[medical laboratory/ja|臨床]]検査や[[medical imaging/ja|画像]]検査の追加、治療の開始、専門医への紹介、経過観察などが含まれる。経過観察が勧められることもある。[[health insurance/ja|健康保険]]制度や[[managed care/ja|マネージドケア]]制度によっては、検査の事前承認など様々な形態の "[[utilization review/ja|利用審査]]"が、高額なサービスへのアクセスを阻むこともある。

医療上の意思決定（MDM）プロセスでは、上記のすべてのデータを分析・統合して、可能性のある診断（[[differential diagnosis/ja|鑑別診断]]）のリストを作成し、患者の問題を説明する確定診断を得るために何をすべきかを考える。

その後の診察では、新たな病歴、症状、身体所見、検査や画像診断の結果、専門医の診察などを得るために、このプロセスを省略した形で繰り返すこともある。

== 施設 ==
[[File:Pellegrinaio Santa Maria della Scala n5.jpg|thumb|alt=古代の病院を描いたフレスコ画|[[:en:Santa Maria della Scala (Siena)|サンタ・マリア・デッラ・スカラ]]病院、[[Wikipedia:Domenico di Bartolo|ドメニコ・ディ・バルトロ]]によるフレスコ画、1441-1442年]]
現代の医療は、一般的に[[health care system/ja|医療制度]]の中で行われている。法律、[[:en:credential|資格認定]]、資金調達の枠組みは各国政府によって確立され、時には教会などの国際組織によって補強されることもある。どのような医療制度であっても、その医薬品が医療のあり方に大きな影響を与える。

古来、キリスト教が実践的な慈善を重視した結果、組織的な看護や病院が発展し、今日でも[[:ja:カトリック教会|カトリック教会]]が世界最大の非政府医療サービス提供者である。先進工業国（[[:ja:米国|米国]]を除く）と多くの[[:ja:発展途上国|発展途上国]]は、[[universal health care/ja|国民皆保険制度]]を通じて医療サービスを提供している。この制度は、[[single-payer health care/ja|一人払いの医療]]制度、あるいは強制加入の民間[[health insurance/ja|医療保険]]や協同組合医療保険を通じて、すべての人に医療を保証することを目的としている。これは、支払い能力よりも必要性に基づいて、全国民が医療を受けられるようにすることを目的としている。医薬品は、民間の診療所、国営の病院や診療所、慈善団体によって提供されるが、最も一般的なのは、これら3つの組み合わせである。

ほとんどの[[:ja:部族|部族]]社会では、国民全体に対する医療の保証はない。そのような社会では、医療費を支払う余裕のある人や、（直接または雇用契約の一部として）自己保険に加入している人、あるいは政府や部族が直接資金援助する医療でカバーされている人が、医療を受けることができる。

[[File:Drug ampoule JPN.jpg|thumb|upright|alt=さまざまなサイズのガラス瓶のコレクション|最新の薬物[[ampoule/ja|アンプル]]]]

情報の透明性は、医療提供システムを定義するもうひとつの要素である。病態、医薬品、品質、価格に関する情報へのアクセスは、患者・消費者の選択、ひいては医療従事者のインセンティブに大きく影響する。米国の医療制度は、開放性が欠如しているとして非難を浴びているが、新しい法律が開放性の拡大を促すかもしれない。一方では透明性の必要性、他方では患者の守秘義務や商業的利益のための情報搾取の可能性といった問題との間に緊張関係があると認識されている。

医療でケアを提供する[[health professional/ja|医療専門家]]は、[[Doctor of Medicine/ja|医者]]、[[Nursing/ja|看護師]]、[[Physical therapy/ja|理学療法士]]、[[psychologist/ja|心理学者]]など複数の職種から構成されている。これらの専門職は、それぞれ独自の[[:ja:職業倫理|倫理基準]]、専門教育、組織を持っている。医療専門職は[[Medical sociology#The Medical Profession/ja|社会学的観点]]から概念化されてきた。

=== 引渡し ===
{{See also/ja|Health care/ja|clinic/ja|hospital/ja|hospice/ja}}

医療の提供は、一次医療、二次医療、三次医療に分類される。

[[File:Nurses at Butawin Urban Clinic, PNG (10711159465).jpg|thumb|alt=看護師3人の写真|[[:ja:パプアニューギニア|パプアニューギニア]][[:ja:東部ニューブリテン州|東部ニューブリテン州]][[:ja:ココポ|ココポ]]の看護師たち]]
[[Primary care/ja|一次医療]]サービスは、[[physician/ja|医師]]、[[physician assistant/ja|医師助手]]、[[nurse practitioner/ja|看護師]]、または医療やケアを求める患者と最初に接触するその他の医療専門家によって提供される。これらは、医院、[[clinic/ja|診療所]]、[[nursing home/ja|ナーシングホーム]]、学校、訪問診療など、患者の身近な場所で行われる。医療機関の受診の約90％は、一次医療提供者によって治療される。これには、急性および慢性疾患の治療、[[preventive care/ja|予防ケア]]、すべての年齢および男女を対象とした[[health education/ja|健康教育]]が含まれる。

[[Secondary care/ja|二次医療]]サービスは、最初に診断や治療を行った一次医療提供者から紹介された患者に対して、[[medical specialist/ja|専門医]]がオフィスや診療所、または地域のコミュニティ病院で提供するものである。紹介は、専門医の専門知識や処置が必要な患者に対して行われる。これには、[[ambulatory care/ja|外来診療]]と[[inpatient/ja|入院]]診療の両方、[[Emergency department/ja|救急部]]、[[intensive care medicine/ja|集中治療部]]、手術部、[[physical therapy/ja|理学療法部]]、[[childbirth/ja|分娩部]]、[[endoscopy/ja|内視鏡検査部]]、診断[[Medical laboratory/ja|検査部]]、[[medical imaging/ja|画像診断部]]、[[Hospice care|ホスピス]]センターなどが含まれる。一次医療の提供者の中には、入院患者の世話や分娩を二次医療の場で行う場合もある。

[[Tertiary care/ja|三次医療]]サービスは、地域の病院では一般的に利用できない診断・治療設備を備えた専門病院や地域センターによって提供される。これには、[[:ja:外傷センター/ja|外傷センター]]、[[burn (injury)/ja|火傷]]治療センター、高度[[neonatology/ja|新生児]]科、[[organ transplant/ja|臓器移植]]、ハイリスク妊娠、[[radiation therapy/ja|放射線]][[oncology/ja|腫瘍学]]などが含まれる。

現代の医療は情報にも依存しており、多くの医療現場ではいまだに紙の記録で提供されているが、最近では[[Electronic health record/ja|電子的手段]]によるものも増えている。

低所得国では、近代的な医療は一般人には高すぎることが多い。国際的な医療政策研究者たちは、このような地域では、アクセスを確保するために''利用料''を撤廃するよう提唱しているが、撤廃された後でも、かなりのコストと障壁が残っている。

[[:en:Separation of prescribing and dispensing|処方と調剤の分離]]とは、[[medical prescription/ja|処方箋]]を出す[[physician/ja|医師]]が、[[prescription durg/ja|処方薬]]を提供する[[pharmacist/ja|薬剤師]]から独立している医療・薬局における慣行である。欧米諸国では、薬剤師を医師から切り離す伝統が何世紀も続いている。アジア諸国では、医師も薬物を提供するのが伝統的である。

== 分科 ==
[[File:Drawing by Marguerite Martyn of a visiting nurse with medicine and four babies, 1918.jpg|thumb|left|ミズーリ州セントルイスの訪問看護婦と薬と赤ん坊を描いた[[:en:Marguerite Martyn|マルグリット・マーティン]]の絵（1918年）]]
[[:en:interdisciplinary team|学際的なチーム]]として協力し合いながら、医療従事者以外にも多くの高度な訓練を受けた[[health profession/ja|医療専門家]]が、現代医療の提供に携わっている。例えば、[[nurse/ja|看護師]]、[[emergency medical technician/ja|救急救命士]]と救急医療隊員、検査技師、[[pharmacists/ja|薬剤師]]、[[podiatry/ja|足病医]]、[[physiotherapists/ja|理学療法士]]、[[respiratory therapists/ja|呼吸療法士]]、[[speech therapy/ja|言語聴覚士]]、[[occupational therapy/ja|作業療法士]]、放射線技師、[[dietitian/ja|栄養士]]、[[bioengineering/ja|生物工学者]]、[[medical physics/ja|医学物理学者]]、[[surgeons/ja|外科医]]、[[surgeon's assistant/ja|外科医助手]]、[[surgical technologist/ja|外科技師]]などである。

人間の医学を支える範囲と科学は、他の多くの分野と重複している。病院に入院した患者は通常、主な問題点に基づいて特定のチーム、例えば循環器科チームのケアを受けるが、その後、主な問題点やその後の合併症・進展の診断や治療のために、他の専門分野、例えば外科や放射線科と連携することがある。

医師には多くの専門分野があり、以下に挙げるような特定の医学分野に特化したサブスペシャリゼーションがある。特定のサブスペシャリティがどの専門分野であるかについては、国によって違いがある。

医学の主な分野は以下の通りである：

* 医学の基礎科学：これはすべての医師が教育を受け、[[Biomedical research#Preclinical research/ja|生物医学研究]]に戻る者もいる。
* [[Medical specialties/ja|医薬品の専門分野]]
* [[Interdisciplinary sub-specialties of medicine/ja|学際的な分野]]、異なる専門分野が混在し、特定の場面で機能する。

=== 基礎科学 ===
* ''[[Anatomy/ja|解剖学]]''は、[[organism/ja|生物]]の物理的構造を研究する学問である。''巨視的''または''肉眼的解剖学''とは対照的に、細胞学と組織学は微視的構造を扱う。
* ''[[Biochemistry/ja|生化学]]''は、生体内で起こる化学、特に化学成分の構造と機能を研究する学問である。
* ''[[Biomechanics/ja|バイオメカニクス]]''とは、[[Mechanics/ja|力学]]の手法を用いて生体システムの構造と機能を研究する学問である。
* ''[[Biostatistics/ja|生物統計学]]''は、広義の生物学分野への統計学の応用である。生物統計学の知識は、医学研究の計画、評価、解釈に不可欠である。また、[[epidemiology/ja|疫学]]やエビデンスに基づく医療においても基礎となる。
* ''[[Biophysics/ja|生物物理学]]''は、[[physics/ja|物理学]]と[[physical chemistry/ja|物理化学]]の手法を用いて生物システムを研究する学際的な科学である。
* ''[[Cell biology/ja|細胞学]]''は、個々の[[cell (biology)/ja|細胞]]の顕微鏡的研究である。 
[[File:Albert Edelfelt - Louis Pasteur - 1885.jpg|thumb|''[[:ja:ルイ・パスツール|ルイ・パスツール]]''、1985年、[[:en:Albert Edelfelt|アルバート・エーデルフェルト]]作、彼の研究室にて]]
* ''[[Embryology/ja|発生学]]''とは、生物の初期発生を研究する学問である。
* ''[[Endocrinology/ja|内分泌学]]''とは、ホルモンとそれが動物の体全体に及ぼす影響についての研究である。
* ''[[Epidemiology/ja|疫学]]'' とは、病気の発生過程の人口統計学を研究する学問であり、伝染病の研究を含むが、これに限定されるものではない。
* ''[[Genetics/ja|遺伝学]]''とは、遺伝子の研究であり、[[biological inheritance/ja|生物学的遺伝]]における遺伝子の役割を研究する。
* ''[[Histology/ja|組織学]]''とは、光学[[microscopy/ja|顕微鏡]]、[[Electron microscope|電子顕微鏡]]、[[immunohistochemistory/ja|免疫組織化学]]によって[[biological tissue/ja|生体組織]]の構造を研究する学問である。
* ''[[Immunology/ja|免疫学]]''は[[immune system/ja|免疫系]]の学問であり、例えばヒトの自然免疫系と適応免疫系が含まれる。
* ''[[Lifestyle medicine/ja|生活習慣病学]]''は、[[chronic conditions/ja|慢性疾患]]とその予防法、治療法、改善法を研究する学問である。
* ''[[Medical physics/ja|医学物理学]]''は、物理学の原理を医薬品に応用する学問である。
* ''[[Microbiology/ja|微生物学]]''は、[[protozoa/ja|原生動物]]、[[bacterium/ja|細菌]]、[[fungus/ja|真菌]]、[[virus/ja|ウイルス]]などの[[microorganism/ja|微生物]]を研究する学問である。
* ''[[Molecular biology/ja|分子生物学]]''は、遺伝物質の[[DNA replication/ja|複製]]、[[Transcription (genetics)/ja|転写]]、[[Translation (biology)/ja|翻訳]]のプロセスの分子基盤を研究する学問である。
* ''[[Neuroscience/ja|神経科学]]''は、[[nervous system/ja|神経系]]の研究に関連する科学分野を含む。神経科学の主な焦点は、ヒトの脳と[[spinal cord/ja|脊髄]]の[[biology/ja|生物学]]と生理学である。関連する臨床専門分野には、[[neurology/ja|神経学]]、[[neurosurgery/ja|神経外科]]、[[psychiatry/ja|精神医学]]などがある。
* ''[[Nutrition science/ja|栄養科学]]'' (理論的焦点)および''[[dietetics/ja|栄養学]]'' (実践的焦点) は、飲食物と健康および疾病との関係、特に最適な食 事の決定に関する研究である。医療栄養療法は管理栄養士によって行われ、[[diabetes/ja|糖尿病]]、[[cardiovascular disease/ja|心血管疾患]]、体重・摂食[[mental illness/ja|障害]]、アレルギー、[[malnutrition/ja|栄養不良]]、[[neoplasia/ja|腫瘍性]]疾患などに処方される。
* ''[[Pathology as a science/ja|科学としての病理学]]''は、病気の原因、経過、進行、解決に関する研究である。
* ''[[Pharmacology/ja|薬理学]]''は、薬物とその作用に関する学問である。
* ''[[Gynecology/ja|婦人科学]]''とは、女性の生殖システムを研究する学問である。
* ''[[Photobiology/ja|光生物学]]''とは、[[non-ionizing radiation/ja|非電離放射線]]と生物との相互作用を研究する学問である。 
* ''[[Physiology/ja|生理学]]''とは、身体の正常な機能とその基礎にある調節機構を研究する学問である。
* ''[[Radiobiology/ja|放射線生物学]]''とは、[[ionizing radiation/ja|電離放射線]]と生物との相互作用を研究する学問である。
* ''[[Toxicology/ja|毒物学]]''とは、薬物や[[poison/ja|毒物]]の有害作用に関する学問である。

===専門分野===
{{Main/ja|Medical specialty/ja}}
広義の「医学」にはさまざまな専門分野がある。英国では、ほとんどの専門分野に独自の団体や大学があり、独自の入学試験を行っている。これらは総称してロイヤル・カレッジ（Royal Colleges）と呼ばれるが、現在、すべてのカレッジが「ロイヤル」という言葉を使用しているわけではない。専門分野の発展は、新しい技術（効果的な麻酔法の開発など）や仕事の方法（救急診療科など）によって推進されることが多い。新しい専門分野は、医師の統一組織の形成や、独自の試験を実施する威信につながる。

医学界では、専門医は通常2つのカテゴリーに大別される： 「医学」と「外科学」である。「医学」は手術以外の医療行為を指し、その下位専門科のほとんどは、内科の予備訓練を必要とする。英国では伝統的に、[[:en:Royal College of Physicians|王立医師協会]]（MRCP）の会員資格試験、またはスコットランドやアイルラ ンドではそれに相当する大学の会員資格試験に合格することで証明されてい た。「外科」 は手術医学の実践を指し、この分野のほとんどのサブ スペシャリティは、一般外科の予備訓練が必要であり、 英国では[[:en:Royal College of Surgeons of England|英国王立外科学会]]（Royal College of Surgeons of England：MRCS）の会員資格につながる。現在、医学の中には、放射線学、病理学、麻酔学な ど、これらのカテゴリーのどちらにも当てはまりにくい 専門分野もある。たとえば麻酔科は、王立麻酔科医学会となる前に、まず王立外科医学会（MRCS/FRCSが必要だった）の[[:ja:学部|学部]]として発展し、[[:en:Royal College of Anaesthetists|王立麻酔科医学会]]（FRCA）の会員になるには、王立麻酔科医学会（FRCA）の試験を受ける必要がある。

===外科の専門分野===
{{Main/ja|Surgery/ja}}
[[File:Surgeons at Work.jpg|thumb|[[operating room/ja|手術室]]での外科医たち]]
'''外科'''は古くからある医薬の専門分野であり、[[disease/ja|病気]]や[[injury/ja|怪我]]などの病的状態の調査や治療、身体機能や見た目の改善、あるいは破裂した不要な部分（例えば[[Perforated eardrum|a perforated ear drum/ja|鼓膜穿孔]]など）の修復のために、患者に対して手技や器具を用いた手術を行う。外科医はまた、病棟で術前、術後、潜在的な手術候補者を管理しなければならない。センターによっては、[[anesthesiology/ja|麻酔科]]は外科の一分野ではないが、（歴史的・ロジスティックな理由から）外科の一部門となっているところもある。[[ophthalmology/ja|眼科]]や[[dermatology/ja|皮膚科]]など、他の医薬品専門分野でも外科的手技 を用いることがあるが、それ自体は外科のサブスペシャリ ティとはみなされない。

米国では、医学部卒業後、最低5年間の外科研修が必 要である。外科の副専門分野は、7年以上必要な場合が多 い。さらに、フェローシップは1～3年である。レジデンシー後のフェローシップは競争率が高い ため、多くの研修生はさらに2年間、研究に専念する。このように、医学部卒業後10年以上経たないと、外科研修が終了しない場合もある。さらに、外科研修は非常に困難で時間のかかるものである。

外科のサブスペシャリティには、一般外科の研修医訓練を受けた後、医師が専門とする可能性のある分野と、別の研修医訓練を持ついくつかの外科分野がある。一般外科専門医研修後に目指すことができる外科的下位 専門分野： 

* [[General surgery/ja|一般外科]]
* [[Bariatric surgery/ja|肥満外科]]
* [[Cardiac surgery/ja|心臓血管外科]] - 別の心臓血管外科レジデンシー・トラックを 通じて追求することもできる
* [[Colorectal surgery/ja|大腸肛門外科]]
* [[Endocrine surgery/ja|内分泌外科]]
* [[Hand surgery/ja|手の外科]]
* 肝・膵・胆道外科
* [[Minimally-invasive surgery/ja|低侵襲手術]]
* [[Surgical oncology/ja|外科腫瘍学]]
* [[Pediatric surgery/ja|小児外科]]
* [[Plastic surgery/ja|形成外科]] - 別の形成外科レジデンシーコースで目指すこともできる
* 外科クリティカルケア
* [[Organ transplantation/ja|移植外科]]
* [[Trauma surgery/ja|外傷外科]]
* [[Vascular surgery/ja|血管外科]] - 別の血管外科レジデンシーコースを 通じて目指すこともできる

医学の中の他の外科専門分野には、それぞれ個別のレジデンシー・トレーニングがある：

* [[Dermatology/ja|皮膚科]]
* [[Neurosurgery/ja|脳神経外科]]
* [[Ophthalmology/ja|眼科]]
* [[Oral and maxillofacial surgery/ja|口腔・顎顔面外科]]
* [[Orthopedic surgery/ja|整形外科]]
* [[Otorhinolaryngology/ja|耳鼻咽喉科]]
* [[Podiatry/ja|足病学外科]] - 医学部での研修を受けず、足病学で別の研修を受ける
* [[Urology/ja|泌尿器科]]

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==== Internal medicine specialty ====
{{Main|Internal medicine}}
'''Internal medicine''' is the [[medical specialty]] dealing with the prevention, diagnosis, and treatment of adult diseases. According to some sources, an emphasis on internal structures is implied. 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]]s. 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.
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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.
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In the [[Wikipedia:Commonwealth of Nations|Commonwealth of Nations]] 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]].
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There are many subspecialities (or subdisciplines) of [[internal medicine]]:
{{refbegin|3}}
:*''[[Angiology]]/Vascular Medicine''
:*''[[Bariatrics]]''
:*''[[Cardiology]]''
:*''[[Critical care medicine]]''
:*''[[Endocrinology]]''
:*''[[Gastroenterology]]''
:*''[[Geriatrics]]''
:*''[[Hematology]]''
:*''[[Hepatology]]''
:*''[[Infectious disease (medical specialty)|Infectious disease]]''
:*''[[Nephrology]]''
:*''[[Neurology]]''
:*''[[Oncology]]''
:*''[[Pediatrics]]''
:*''[[Pulmonology]]/Pneumology/Respirology/chest medicine''
:*''[[Rheumatology]]''
:*''[[Sports Medicine]]''{{refend}}
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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 US. This difference does not apply in the UK where all doctors are now required by law to work less than 48 hours per week on average.
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==== Diagnostic specialties ====
* ''[[Clinical laboratory]] sciences'' are the clinical diagnostic services that 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.
* ''Diagnostic [[radiology]]'' is concerned with imaging of the body, e.g. by [[x-ray]]s, x-ray [[computed tomography]], [[ultrasonography]], and [[nuclear magnetic resonance]] [[tomography]]. Interventional radiologists can access areas in the body under imaging for an intervention or diagnostic sampling.
* ''[[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 that 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.
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==== Other major specialties ====
The following are some major medical specialties that do not directly fit into any of the above-mentioned groups:
* ''[[Anesthesiology]]'' (also known as ''anaesthetics''): concerned with the perioperative management of the surgical patient. The anesthesiologist's role during surgery is to prevent derangement in the vital organs' (i.e. brain, heart, kidneys) functions and postoperative pain. Outside of the operating room, the anesthesiology physician also serves the same function in the labor and delivery ward, and some are specialized in critical 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.
* ''[[Family medicine]]'', ''[[family practice]]'', ''[[general practice]]'' or ''primary care'' is, in many countries, the first port-of-call for patients with non-emergency medical problems. Family physicians often provide services across a broad range of settings including office based practices, emergency department coverage, inpatient care, and nursing home care.
[[File:Changing lives for girls and women every week (12330467294).jpg|thumb|[[Gynecologist]] Michel Akotionga of [[Ouagadougou]], [[Burkina Faso]]]]
* ''[[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.
* ''[[Medical genetics]]'' is concerned with the diagnosis and management of hereditary disorders.
* ''[[Neurology]]'' is concerned with diseases of the nervous system. In the UK, neurology is a subspecialty of general medicine.
* ''[[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.
* ''[[Pharmaceutical medicine]]'' is the medical scientific discipline concerned with the discovery, development, evaluation, registration, monitoring and medical aspects of marketing of medicines for the benefit of patients and public health.
* ''[[Physical medicine and rehabilitation]]'' (or ''physiatry'') is concerned with functional improvement after injury, illness, or [[congenital disorder]]s.
* ''[[Podiatric medicine]]'' is the study of, diagnosis, and medical & surgical treatment of disorders of the foot, ankle, lower limb, hip and lower back.
* ''[[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 fields include [[psychotherapy]] and [[clinical psychology]].
* ''[[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.
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===Interdisciplinary fields=== <!--Interdisciplinary sub-specialties of medicine redirects here-->
Some interdisciplinary sub-specialties of medicine include:
* ''[[Aerospace medicine]]'' deals with medical problems related to flying and [[Human spaceflight|space travel]].
* ''[[Addiction medicine]]'' deals with the treatment of addiction.
* ''[[Medical ethics]]'' deals with [[ethic]]al and [[moral]] principles that apply values and judgments to the practice of medicine.
* ''[[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, type of weapon used to inflict trauma, reconstruction of the facial features using remains of deceased (skull) thus aiding identification.
* ''[[Gender-based medicine]]'' studies the biological and physiological differences between the human sexes and how that affects differences in disease.
* ''[[Hospice and Palliative Medicine]]'' 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]].
* ''[[Hospital medicine]]'' is the general medical care of hospitalized patients. Physicians whose primary professional focus is hospital medicine are called [[hospitalist]]s in the United States and [[Canada]]. The term Most Responsible Physician (MRP) or attending physician is also used interchangeably to describe this role.
* ''[[Laser medicine]]'' involves the use of lasers in the diagnostics 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 arts ([[literature]], theater, film, and [[visual arts]]) and their application to [[medical education]] and practice.
* ''[[Health informatics]]'' is a relatively recent field that deal with the application of computers 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.
* ''[[Occupational medicine]]'' 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.
* ''[[Pain management]]'' (also called ''[[pain medicine]]'', or ''algiatry'') is the medical discipline concerned with the relief of pain.
* ''[[Pharmacogenomics]]'' is a form of ''individualized medicine''.
* ''[[Podiatry|Podiatric medicine]]'' is the study of, diagnosis, and medical treatment of disorders of the foot, ankle, lower limb, hip and lower back.
* ''[[Sexual medicine]]'' is concerned with diagnosing, assessing and treating all disorders related to sexuality.
* ''[[Sports medicine]]'' deals with the treatment and prevention and rehabilitation of sports/exercise injuries such as [[muscle spasm]]s, [[muscle tear]]s, injuries to ligaments (ligament tears or ruptures) and their repair in [[sportsperson|athletes]], [[amateur]] and [[professional]].
* ''[[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.
* ''[[Travel medicine]]'' or ''emporiatrics'' deals with health problems of international travelers or travelers across highly different environments.
* ''[[Tropical medicine]]'' deals with the prevention and treatment of tropical diseases. It is studied separately in temperate climates where those diseases are quite unfamiliar to medical practitioners and their local clinical needs.
* ''[[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 department.
* [[Veterinary medicine]]; [[veterinarians]] apply similar techniques as physicians to the care of animals.
* ''[[Wilderness medicine (practice)|Wilderness medicine]]'' entails the practice of medicine in the wild, where conventional medical facilities may not be available.
* Many other [[health science]] fields, e.g. [[dietetics]]
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== Education and legal controls ==
{{Main|Medical education|Medical license}}
[[File:Medical students learning about stitches (2760577402).jpg|thumb|Medical students learning about stitches]]
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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]], 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. In Canada and the United States of America, a [[Doctor of Medicine]] degree, often abbreviated M.D., or a [[Osteopathic medicine in the United States|Doctor of Osteopathic Medicine]] degree, often abbreviated as D.O. and unique to the United States, must be completed in and delivered from a recognized university.
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Since knowledge, techniques, and medical technology continue to evolve at a rapid rate, many regulatory authorities require [[continuing medical education]]. Medical practitioners upgrade their knowledge in various ways, including [[medical journal]]s, seminars, conferences, and online programs.  A database of objectives covering medical knowledge, as suggested by national societies across the United States, can be searched at http://data.medobjectives.marian.edu/.
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[[File:Madrid (RPS 13-07-2010) Organización Médica Colegial de España, fachada.jpg|thumb|left|upright=0.8|Headquarters of the [[Wikipedia:Organización Médica Colegial de España|Organización Médica Colegial de España]], which regulates the medical profession in Spain]]
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.
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In the European Union, the profession of doctor of medicine is regulated. A profession is said to be regulated when access and exercise is subject to the possession of a specific professional qualification.
The regulated professions database contains a list of regulated professions for doctor of medicine in the EU member states, EEA countries and Switzerland. This list is covered by the Directive 2005/36/EC.
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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.
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== Medical ethics ==
{{Main|Medical ethics}}
[[File:HippocraticOath.jpg|thumb|upright|A 12th-century [[Byzantine empire|Byzantine]] manuscript of the [[Hippocratic Oath]]]]
Medical ethics is a system of moral principles that apply values and judgments to the practice of medicine. As a scholarly discipline, medical ethics encompasses its practical application in clinical settings as well as work on its history, philosophy, theology, and sociology. Six of the values that commonly apply to medical ethics discussions are:
* [[Autonomy#Medicine|autonomy]] – the patient has the right to refuse or choose their treatment. (''Voluntas aegroti suprema lex''.)
* [[Beneficence (ethics)|beneficence]] – a practitioner should act in the best interest of the patient. (''Salus aegroti suprema lex''.)
* [[Justice (ethics)|justice]] – concerns the distribution of scarce health resources, and the decision of who gets what treatment (fairness and equality).
* [[Primum non nocere|non-maleficence]] – "first, do no harm" (''primum non-nocere'').
* [[respect for persons]] – the patient (and the person treating the patient) have the right to be treated with dignity.
* [[truth]]fulness and [[honesty]] – the concept of [[informed consent]] has increased in importance since the historical events of the [[Doctors' Trial]] of the Nuremberg trials, [[Tuskegee syphilis experiment]], and others.
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Values such as these do not give answers as to how to handle a particular situation, but provide a useful framework for understanding conflicts. When moral values are in conflict, the result may be an ethical [[dilemma]] or crisis. Sometimes, no good solution to a dilemma in medical ethics exists, and occasionally, the values of the medical community (i.e., the hospital and its staff) conflict with the values of the individual patient, family, or larger non-medical community. Conflicts can also arise between health care providers, or among family members. For example, some argue that the principles of autonomy and beneficence clash when patients refuse [[blood transfusions]], considering them life-saving; and truth-telling was not emphasized to a large extent before the HIV era.
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== History ==
{{Main|History of medicine}}
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[[File:Imhotep-Louvre.JPG|thumb|left|upright|Statuette of ancient Egyptian physician [[Imhotep]], the first physician from antiquity known by name]]
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=== Ancient world ===
[[Prehistoric medicine]] incorporated plants ([[herbalism]]), animal parts, and minerals. In many cases these materials were used ritually as magical substances by priests, [[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]] examines the ways in which culture and society are organized around or impacted by issues of health, health care and related issues.
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Early records on medicine have been discovered from [[ancient Egyptian medicine]], [[Babylonian Medicine]], [[Ayurveda|Ayurvedic]] medicine (in the [[Indian subcontinent]]), [[classical Chinese medicine]] (predecessor to the modern [[traditional Chinese medicine]]), and [[ancient Greek medicine]] and [[Medicine in ancient Rome|Roman medicine]].
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In Egypt, [[Imhotep]] (3rd millennium BCE) is the first physician in history known by name. The oldest [[Egyptian medical papyri|Egyptian medical text]] is the ''[[Kahun Gynaecological Papyrus]]'' from around 2000 BCE, which describes gynaecological diseases. The ''[[Edwin Smith Papyrus]]'' dating back to 1600 BCE is an early work on surgery, while the ''[[Ebers Papyrus]]'' dating back to 1500 BCE is akin to a textbook on medicine.
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In China, archaeological evidence of medicine in Chinese dates back to the [[Bronze Age]] [[Shang Dynasty]], based on seeds for herbalism and tools presumed to have been used for surgery. The ''[[Huangdi Neijing]]'', the progenitor of Chinese medicine, is a medical text written beginning in the 2nd century BCE and compiled in the 3rd century.
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In India, the surgeon [[Sushruta]] described numerous surgical operations, including the earliest forms of [[plastic surgery]]. Earliest records of dedicated hospitals come from Mihintale in [[Sri Lanka]] where evidence of dedicated medicinal treatment facilities for patients are found.
[[File:HSAsclepiusKos retouched.jpg|thumb|upright=1.1|Mosaic on the floor of the [[Asclepieion]] of Kos, depicting [[Hippocrates]], with [[Wikipedia:Asklepius|Asklepius]] in the middle (2nd–3rd century)]]
In Greece, the [[Ancient Greek medicine|Greek physician]] [[Hippocrates]], the "father of modern medicine", laid the foundation for a rational approach to medicine. Hippocrates introduced the [[Hippocratic Oath]] for physicians, which is still relevant and in use today, and was the first to categorize illnesses as [[Acute (medical)|acute]], [[Chronic (medicine)|chronic]], [[Endemic (epidemiology)|endemic]] and epidemic, and use terms such as, "exacerbation, [[relapse]], resolution, crisis, [[paroxysm]], peak, and [[convalescence]]". The Greek physician [[Galen]] was also one of the greatest surgeons of the ancient world and performed many audacious operations, including brain and eye surgeries. After the fall of the [[Western Roman Empire]] and the onset of the [[Wikipedia:Early Middle Ages|Early Middle Ages]], the Greek tradition of medicine went into decline in Western Europe, although it continued uninterrupted in the [[:en:Eastern Roman Empire|Eastern Roman (Byzantine) Empire]].
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Most of our knowledge of ancient [[Hebrew medicine]] during the [[:en:1st millennium BC|1st&nbsp;millennium&nbsp;BC]] comes from the [[Wikipedia:Torah|Torah]], i.e.&nbsp;the Five Books of [[Moses]], which contain various health related laws and rituals. The Hebrew contribution to the development of modern medicine started in the [[Wikipedia:Byzantine Era|Byzantine Era]], with the physician [[Wikipedia:Asaph the Jew|Asaph the Jew]].
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=== Middle Ages ===
[[File:Al-Risalah al-Dhahabiah.JPG|thumb|left|A manuscript of ''[[Wikipedia:Al-Risalah al-Dhahabiah|Al-Risalah al-Dhahabiah]]'' by [[Wikipedia:Ali al-Ridha|Ali al-Ridha]], the eighth Imam of [[Twelver|Shia Muslims]]. The text says: "Golden dissertation in medicine which is sent by Imam Ali ibn Musa al-Ridha, peace be upon him, to [[Wikipedia:al-Ma'mun|al-Ma'mun]]."]]
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The concept of hospital as institution to offer medical care and possibility of a cure for the patients due to the ideals of Christian charity, rather than just merely a place to die, appeared in the [[Wikipedia:Byzantine Empire|Byzantine Empire]].
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Although the concept of [[uroscopy]] was known to Galen, he did not see the importance of using it to localize the disease. It was under the Byzantines with physicians such of [[Theophilus Protospatharius]] that they realized the potential in uroscopy to determine disease in a time when no microscope or stethoscope existed. That practice eventually spread to the rest of Europe.
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After 750 CE, the Muslim world had the works of Hippocrates, Galen and Sushruta translated into [[Wikipedia:Arabic|Arabic]], and [[Islamic medicine|Islamic physicians]] engaged in some significant medical research. Notable Islamic medical pioneers include the [[:en:Persians|Persian]] [[Wikipedia:polymath|polymath]], [[Wikipedia:Avicenna|Avicenna]], who, along with Imhotep and Hippocrates, has also been called the "father of medicine". He wrote ''[[Wikipedia:The Canon of Medicine|The Canon of Medicine]]'' which became a standard medical text at many medieval European [[:en:University|universities]], considered one of the most famous books in the history of medicine. Others include [[:en:Abu al-Qasim al-Zahrawi|Abulcasis]], [[Wikipedia:Ibn Zuhr|Avenzoar|Ibn Zuhr|Avenzoar]], [[Wikipedia:Ibn al-Nafis|Ibn al-Nafis]], and [[Wikipedia:Averroes|Averroes]]. Persian  physician [[:en:Muhammad ibn Zakarīya Rāzi|Rhazes]] was one of the first to question the Greek theory of [[Wikipedia:humorism|humorism]], which nevertheless remained influential in both medieval Western and medieval [[Islamic medicine]]. Some volumes of [[:en:Muhammad ibn Zakarīya Rāzi|Rhazes]]'s work ''Al-Mansuri'', namely "On Surgery" and "A General Book on Therapy", became part of the medical curriculum in European universities. Additionally, he has been described as a doctor's doctor, the father of [[pediatrics]], and a pioneer of [[ophthalmology]]. For example, he was the first to recognize the reaction of the eye's pupil to light. The Persian [[Wikipedia:Bimaristan|Bimaristan]] hospitals were an early example of [[Wikipedia:public hospital|public hospital]]s.
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In Europe, [[Wikipedia:Charlemagne|Charlemagne]] decreed that a hospital should be attached to each cathedral and monastery and the historian [[Wikipedia:Geoffrey Blainey|Geoffrey Blainey]] likened the [[:en:Catholic Church and health care|activities of the Catholic Church in health care]] during the Middle Ages to an early version of a welfare state: "It conducted hospitals for the old and orphanages for the young; hospices for the sick of all ages; places for the lepers; and hostels or inns where pilgrims could buy a cheap bed and meal". It supplied food to the population during famine and distributed food to the poor. This welfare system the church funded through collecting taxes on a large scale and possessing large farmlands and estates. The [[Wikipedia:Benedictine|Benedictine]] order was noted for setting up hospitals and infirmaries in their monasteries, growing medical herbs and becoming the chief medical care givers of their districts, as at the great [[Wikipedia:Abbey of Cluny|Abbey of Cluny]]. The Church also established a network of [[Wikipedia:cathedral schools|cathedral schools]] and universities where medicine was studied. The [[Wikipedia:Schola Medica Salernitana|Schola Medica Salernitana]] in Salerno, looking to the learning of [[:en:Greeks|Greek]] and [[Wikipedia:Arab|Arab]] physicians, grew to be the finest medical school in Medieval Europe.
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[[File:SantaMariaDellaScalaSienaBack.JPG|thumb|upright=1.2|Siena's [[:en:Santa Maria della Scala (Siena)|Santa Maria della Scala Hospital]], one of Europe's oldest hospitals. During the Middle Ages, the Catholic Church established universities to revive the study of sciences, drawing on the learning of Greek and Arab physicians in the study of medicine.]]
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However, the fourteenth and fifteenth century [[Wikipedia:Black Death|Black Death]] devastated both the Middle East and Europe, and it has even been argued that Western Europe was generally more effective in recovering from the pandemic than the Middle East. In the early modern period, important early figures in medicine and anatomy emerged in Europe, including [[Wikipedia:Gabriele Falloppio|Gabriele Falloppio]] and [[Wikipedia:William Harvey|William Harvey]].
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The major shift in medical thinking was the gradual rejection, especially during the [[Wikipedia:Black Death|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 [[:en:Nicolaus Copernicus|Copernicus]]'s rejection of [[Wikipedia:Ptolemy|Ptolemy]]'s theories on astronomy). Physicians like [[Vesalius]] improved upon or disproved some of the theories from the past. The main tomes used both by medicine students and expert physicians were [[Wikipedia:Materia Medica|Materia Medica]] and [[Wikipedia:Pharmacopoeia|Pharmacopoeia]].
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[[Wikipedia:Andreas Vesalius|Andreas Vesalius]] was the author of ''[[Wikipedia:De humani corporis fabrica|De humani corporis fabrica]]'', an important book on [[human anatomy]]. Bacteria and microorganisms were first observed with a microscope by [[Wikipedia:Antonie van Leeuwenhoek|Antonie van Leeuwenhoek]] in 1676, initiating the scientific field [[microbiology]]. Independently from [[Wikipedia:Ibn al-Nafis|Ibn al-Nafis]], [[Wikipedia:Michael Servetus|Michael Servetus]] rediscovered the [[pulmonary circulation]], but this discovery did not reach the public because it was written down for the first time in the "Manuscript of Paris" in 1546, and later published in the theological work for which he paid with his life in 1553. Later this was described by [[Wikipedia:Renaldus Columbus|Renaldus Columbus]] and [[Wikipedia:Andrea Cesalpino|Andrea Cesalpino]]. [[Wikipedia:Herman Boerhaave|Herman Boerhaave]] is sometimes referred to as a "father of physiology" due to his exemplary teaching in Leiden and textbook 'Institutiones medicae' (1708). [[Wikipedia:Pierre Fauchard|Pierre Fauchard]] has been called "the father of modern dentistry".
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=== Modern ===
[[File:Paul-Louis Simond injecting plague vaccine June 4th 1898 Karachi.jpg|thumb|left|[[Wikipedia:Paul-Louis Simond|Paul-Louis Simond]] injecting a plague vaccine in [[Wikipedia:Karachi|Karachi]], 1898]]
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Veterinary medicine was, for the first time, truly separated from human medicine in 1761, when the French veterinarian [[Wikipedia:Claude Bourgelat|Claude Bourgelat]] founded the world's first veterinary school in Lyon, France. Before this, medical doctors treated both humans and other animals.
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Modern scientific [[biomedical research]] (where results are testable and [[reproducible]]) began to replace early Western traditions based on herbalism, the Greek "[[Wikipedia:humorism|four humours|humorism|four humours]]" and other such pre-modern notions. The modern era really began with [[Wikipedia:Edward Jenner|Edward Jenner]]'s discovery of the [[smallpox vaccine]] at the end of the 18th century (inspired by the method of [[inoculation]] earlier practiced in Asia), [[Wikipedia:Robert Koch|Robert Koch]]'s discoveries around 1880 of the transmission of disease by bacteria, and then the discovery of [[antibiotic]]s around 1900.
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The post-18th century [[modernity]] period brought more groundbreaking researchers from Europe. From [[Wikipedia:Germany|Germany]] and Austria, doctors [[Wikipedia:Rudolf Virchow|Rudolf Virchow]], [[Wikipedia:Wilhelm Conrad Röntgen|Wilhelm Conrad Röntgen]], [[Wikipedia:Karl Landsteiner|Karl Landsteiner]] and [[Wikipedia:Otto Loewi|Otto Loewi]] made notable contributions. In the [[Wikipedia:United Kingdom|United Kingdom]], [[Wikipedia:Alexander Fleming|Alexander Fleming]], [[:en:Joseph Lister, 1st Baron Lister|Joseph Lister]], [[Wikipedia:Francis Crick|Francis Crick]] and [[Wikipedia:Florence Nightingale|Florence Nightingale]] are considered important. [[:en:Spain|Spanish]] doctor [[Wikipedia:Santiago Ramón y Cajal|Santiago Ramón y Cajal]] is considered the father of modern [[neuroscience]].
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From New Zealand and Australia came [[Wikipedia:Maurice Wilkins|Maurice Wilkins]], [[Wikipedia:Howard Florey|Howard Florey]], and [[Wikipedia:Frank Macfarlane Burnet|Frank Macfarlane Burnet]].
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Others that did significant work include [[Wikipedia:William Williams Keen|William Williams Keen]], [[Wikipedia:William Coley|William Coley]], [[Wikipedia:James D. Watson|James D. Watson]] (United States); [[Wikipedia:Salvador Luria|Salvador Luria]] (Italy); [[Wikipedia:Alexandre Yersin|Alexandre Yersin]] (Switzerland); [[Wikipedia:Kitasato Shibasaburō|Kitasato Shibasaburō]] (Japan); [[Wikipedia:Jean-Martin Charcot|Jean-Martin Charcot]], [[Wikipedia:Claude Bernard|Claude Bernard]], [[Wikipedia:Paul Broca|Paul Broca]] (France); [[Wikipedia:Adolfo Lutz|Adolfo Lutz]] (Brazil); [[Wikipedia:Nikolai Korotkov|Nikolai Korotkov]] (Russia); [[:en:William Osler|Sir William Osler]] (Canada); and [[Wikipedia:Harvey Cushing|Harvey Cushing]] (United States).
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As science and technology developed, medicine became more reliant upon [[medication]]s. Throughout history and in Europe right until the late 18th century, not only animal and plant products were used as medicine, but also human body parts and fluids. [[Pharmacology]] developed in part from [[herbalism]] and some drugs are still derived from plants ([[atropine]], [[ephedrine]], [[warfarin]], [[aspirin]], [[digoxin]], [[vinca alkaloid|''vinca'' alkaloids]], [[taxo]]l, [[hyoscine hydrobromide|hyoscine]], etc.). [[Vaccine]]s were discovered by [[Wikipedia:Edward Jenner|Edward Jenner]] and [[Wikipedia:Louis Pasteur|Louis Pasteur]].
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The first antibiotic was [[arsphenamine]] (Salvarsan) discovered by [[Wikipedia:Paul Ehrlich|Paul Ehrlich]] in 1908 after he observed that bacteria took up toxic dyes that human cells did not. The first major class of [[antibiotic]]s was the [[Sulfonamide (medicine)|sulfa drugs]], derived by German chemists originally from [[azo dye]]s.
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[[File:Sydänlääkkeen pakkausta lääketehdas Starilla vuonna 1953. Kuva Vapriikin kuva-arkisto. (16248845637).jpg|thumb|Packaging of [[Cardiology|cardiac medicine]] at the Star pharmaceutical factory in [[Wikipedia:Tampere|Tampere]], [[Wikipedia:Finland|Finland]] in 1953.]]
Pharmacology 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]] and [[human evolution]] is having increasingly significant 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]], [[evolution]], and [[genetics]] are influencing medical technology, practice and decision-making.
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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 modern global [[information science]], which allows as much of the available evidence as possible to be collected and analyzed according to standard protocols that are then disseminated to healthcare providers. The [[Wikipedia:Cochrane Collaboration|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.
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== Quality, efficiency, and access ==
[[Evidence-based medicine]], prevention of [[medical error]] (and other "[[iatrogenesis]]"), and avoidance of [[unnecessary health care]] are a priority in modern medical systems. These topics generate significant political and public policy attention, particularly in the United States where healthcare is regarded as excessively costly but [[population health]] metrics lag similar nations.
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Globally, many [[:en:Developing country|developing countries]] lack access to care and [[access to medicines]]. As of 2015, most wealthy developed countries provide [[Universal health care|health care to all citizens]], with a few exceptions such as the United States where lack of [[health insurance]] coverage may limit access.
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== See also ==
{{Portal|Medicine}}
{{Sister project links
|n = Health
|s = Category:Medicine
|b = Subject:Health sciences
|wikt = Category:Medicine
}}
{{Further|Outline of medicine|Outline of health|Glossary of medicine}}
{{Portal|Medicine}}
{{div col}}
* {{annotated link|Alternative medicine}}
* {{annotated link|List of causes of death by rate}}
* {{annotated link|List of disorders}}
* {{annotated link|List of important publications in medicine}}
* {{annotated link|Lists of diseases}}
* {{annotated link|Medical aid}}
* {{annotated link|Medical encyclopedia}}
* {{annotated link|Medical ethics}}
* {{annotated link|Medical equipment}}
* {{annotated link|Medical classification}}
* {{annotated link|Medical billing}}
* {{annotated link|Medical literature}}
* {{annotated link|Medical malpractice}}
* {{annotated link|Medical psychology}}
* {{annotated link|Medical sociology}}
* {{annotated link|Philosophy of healthcare}}
* {{annotated link|Quackery}}
* {{annotated link|Traditional medicine}}
{{div col end}}
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{{Medicine}}
{{Authority control}}
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[[Category:Medicine| ]]