View source for Medicine/en

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{{short description|field of study for diagnosing, treating and preventing disease}}
{{Infobox medical specialty
|title        = Medicine
|subdivisions =
|image        = [[File:Asklepios.3.jpg|alt=Marble statue of Asclephius on a pedestal, symbol of medicine in Western medicine|250px]]
|caption      = Statue of [[Wikipedia:Asclepius|Asclepius]], the [[:en:Greek God|Greek god]] of medicine, holding the symbolic [[Wikipedia:Rod of Asclepius|Rod of Asclepius]] with its coiled [[:en:Snake|serpent]]
|system       =
|diseases     =
|tests        =
|specialist   = [[Specialty (medicine)|Medical specialty]]
|glossary     = [[Glossary of medicine]]
}}
'''Medicine''' is the [[Wikipedia:science|science]] and [[:en:Praxis (process)|practice]] of caring for a patient, managing the [[diagnosis]], [[prognosis]], [[Preventive medicine|prevention]], [[therapy|treatment]],  [[Palliative care|palliation]] of their [[injury]] or [[disease]], and [[Health promotion|promoting their health]]. Medicine encompasses a variety of [[health care]] practices evolved to maintain and restore [[health]] by the [[prevention (medical)|prevention]] and [[therapy|treatment]] of [[illness]]. Contemporary medicine applies [[biomedical sciences]], [[biomedical research]], [[medical genetics|genetics]], and [[medical technology]] to [[diagnosis (medical)|diagnose]], treat, and prevent injury and disease, typically through [[pharmaceutical]]s or [[surgery]], but also through therapies as diverse as [[psychotherapy]], [[splint (medicine)|external splints and traction]], [[medical device]]s, [[biologic medical product|biologics]], and [[Radiation (medicine)|ionizing radiation]], amongst others.

Medicine has been practiced since [[Prehistoric medicine|prehistoric times]], and for most of this time it was an [[Wikipedia:art|art]] (an area of skill and knowledge), frequently having connections to the [[Wikipedia:religion|religious]] and [[:en:philosophy|philosophical]] beliefs of local culture. For example, a [[medicine man]] would apply [[herbs]] and say [[Wikipedia:prayer|prayer]]s for healing, or an ancient [[Wikipedia:philosopher|philosopher]] and [[Wikipedia:physician|physician]] would apply [[bloodletting]] according to the theories of [[Wikipedia:humorism|humorism]]. In recent centuries, since the [[Wikipedia:history of science|advent of modern science]], most medicine has become a combination of [[Wikipedia:art|art]] and [[Wikipedia:science|science]] (both [[:en:fundamental science|basic]] and [[:en:applied science|applied]], under the [[:en:umbrella term|umbrella]] of '''medical science'''). For example, while stitching technique for [[surgical suture|sutures]] is an art learned through practice, the knowledge of what happens at the [[cytology|cellular]] and [[molecular medicine|molecular]] level in the tissues being stitched arises through science.

Prescientific forms of medicine, now known as [[traditional medicine]] or ''folk medicine'', remain commonly used in the absence of scientific medicine, and are thus called [[alternative medicine]]. Alternative treatments outside of scientific medicine with safety and efficacy concerns are termed [[Wikipedia:quackery|quackery]].
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== Etymology ==

Medicine ({{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}}) is the [[Wikipedia:science|science]] and practice of the [[diagnosis]], [[Wikipedia:prognosis|prognosis]], [[therapy|treatment]], and [[Preventive medicine|prevention]] of [[disease]]. The word "medicine" is derived from [[Wikipedia:Latin|Latin]] ''medicus'', meaning "a physician".

== Clinical practice ==
[[File:The Doctor Luke Fildes crop.jpg|thumb|upright=1.1|alt=Oil painting of medicine in the age of colonialism|''The Doctor'' by [[Wikipedia:Sir Luke Fildes|Sir Luke Fildes]] (1891)]]
[[File:Elizabeth Blackwell.jpg|thumb|[[Wikipedia:Elizabeth Blackwell|Elizabeth Blackwell]], the first female physician in the United States graduated from [[:en:State University of New York Upstate Medical University|SUNY Upstate]] (1847)]]
Medical availability and clinical practice varies across the world due to regional differences in culture and technology. Modern scientific medicine is highly developed in the [[Wikipedia:Western world|Western world]], while in [[:en:developing country|developing countries]] such as parts of Africa or Asia, the population may rely more heavily on [[traditional medicine]] with limited evidence and efficacy and no required formal training for practitioners.

In the [[:en:developed country|developed world]], [[evidence-based medicine]] is not universally used in clinical practice; for example, a 2007 survey of literature reviews found that about 49% of the interventions lacked sufficient evidence to support either benefit or harm.

In modern clinical practice, [[physicians]] and [[physician assistants]] personally assess patients in order to [[medical diagnosis|diagnose]], [[prognosis|prognose]], treat, and prevent disease using clinical judgment. The [[doctor-patient relationship]] typically begins an interaction with an examination of the patient's [[medical history]] and [[medical record]], followed by a medical interview and a [[physical examination]]. Basic diagnostic [[medical device]]s (e.g. [[stethoscope]], [[tongue depressor]]) are typically used. After examination for [[Medical sign|signs]] and interviewing for [[symptoms]], the doctor may order [[medical test]]s (e.g. [[blood test]]s), take a [[biopsy]], or prescribe [[pharmaceutical drug]]s or other therapies. [[Differential diagnosis]] methods help to rule out conditions based on the information provided. During the encounter, properly informing the patient of all relevant facts is an important part of the relationship and the development of trust. The medical encounter is then documented in the medical record, which is a legal document in many jurisdictions. Follow-ups may be shorter but follow the same general procedure, and specialists follow a similar process. The diagnosis and treatment may take only a few minutes or a few weeks depending upon the complexity of the issue.

The components of the medical interview and encounter are:
* Chief complaint (CC): the reason for the current medical visit. These are the '[[symptom]]s.' They are in the patient's own words and are recorded along with the duration of each one. Also called 'chief concern' or 'presenting complaint'.
* History of present [[illness]] (HPI): the chronological order of events of symptoms and further clarification of each symptom. Distinguishable from history of previous illness, often called past medical history (PMH). [[Medical history]] comprises HPI and PMH.
* Current activity: occupation, hobbies, what the patient actually does.
* [[Medication]]s (Rx): what drugs the patient takes including [[Medical prescription|prescribed]], [[over-the-counter drug|over-the-counter]], and [[Home remedy|home remedies]], as well as alternative and [[Herbalism|herbal medicines or remedies]]. [[Allergy|Allergies]] are also recorded.
* Past medical history (PMH/PMHx): concurrent medical problems, past hospitalizations and operations, injuries, past [[infectious disease]]s or [[vaccination]]s, history of known allergies.
* Social history (SH): birthplace, residences, marital history, social and economic status, habits (including [[diet (nutrition)|diet]], medications, [[:en:tobacco smoking|tobacco]], alcohol).
* [[Family history (medicine)|Family history]] (FH): listing of diseases in the family that may impact the patient. A [[Wikipedia:family tree|family tree]] is sometimes used.
* Review of systems (ROS) or ''systems inquiry'': a set of additional questions to ask, which may be missed on HPI: a general enquiry (have you noticed any [[Wikipedia:weight loss|weight loss]], change in sleep quality, fevers, lumps and bumps? etc.), followed by questions on the body's main organ systems ([[human heart|heart]], [[human lung|lungs]], [[digestive tract]], [[Urinary system|urinary tract]], etc.).

The [[physical examination]] is the examination of the patient for [[medical sign]]s of disease, which are objective and observable, in contrast to symptoms that are volunteered by the patient and not necessarily objectively observable. The healthcare provider uses sight, hearing, touch, and sometimes smell (e.g., in infection, [[uremia]], [[diabetic ketoacidosis]]). Four actions are the basis of physical examination: [[inspection (medicine)|inspection]], [[palpation]] (feel), [[percussion (medicine)|percussion]] (tap to determine resonance characteristics), and [[auscultation]] (listen), generally in that order although auscultation occurs prior to percussion and palpation for abdominal assessments.

The clinical examination involves the study of:
* Vital signs including height, weight, body temperature, [[blood pressure]], [[pulse]], respiration rate, and hemoglobin [[oxygen saturation]]
* General appearance of the patient and specific indicators of disease (nutritional status, presence of jaundice, pallor or [[Nail clubbing|clubbing]])
* [[human skin|Skin]]
* Head, [[eye]], [[ear]], nose, and throat ([[HEENT examination|HEENT]])
* [[Cardiovascular]] ([[heart]] and [[blood vessel]]s)
* [[Respiratory]] (large airways and [[Human lung|lungs]])
* [[Abdomen]] and [[rectum]]
* Genitalia (and pregnancy if the patient is or could be pregnant)
* [[Musculoskeletal]] (including spine and extremities)
* [[Neurological]] (consciousness, awareness, brain, vision, [[cranial nerves]], spinal cord and [[Peripheral nervous system|peripheral nerves]])
* [[Psychiatry|Psychiatric]] (orientation, [[mental state examination|mental state]], mood, evidence of abnormal perception or thought).

It is to likely focus on areas of interest highlighted in the medical history and may not include everything listed above.

The treatment plan may include ordering additional [[medical laboratory]] tests and [[medical imaging]] studies, starting therapy, referral to a specialist, or watchful observation. Follow-up may be advised. Depending upon the [[health insurance]] plan and the [[managed care]] system, various forms of "[[utilization review]]", such as prior authorization of tests, may place barriers on accessing expensive services.

The medical decision-making (MDM) process involves analysis and synthesis of all the above data to come up with a list of possible diagnoses (the [[differential diagnosis|differential diagnoses]]), along with an idea of what needs to be done to obtain a definitive diagnosis that would explain the patient's problem.

On subsequent visits, the process may be repeated in an abbreviated manner to obtain any new history, symptoms, physical findings, and lab or imaging results or specialist consultations.

== Institutions ==
[[File:Pellegrinaio Santa Maria della Scala n5.jpg|thumb|alt=Color fresco of an ancient hospital setting|The Hospital of [[:en:Santa Maria della Scala (Siena)|Santa Maria della Scala]], fresco by [[Wikipedia:Domenico di Bartolo|Domenico di Bartolo]], 1441–1442]]
Contemporary medicine is in general conducted within [[health care system]]s. Legal, [[Wikipedia:credential|credential]]ing and financing frameworks are established by individual governments, augmented on occasion by international organizations, such as churches. The characteristics of any given health care system have significant impact on the way medical care is provided.

From ancient times, Christian emphasis on practical charity gave rise to the development of systematic nursing and hospitals and the [[Wikipedia:Catholic Church|Catholic Church]] today remains the largest non-government provider of medical services in the world. Advanced industrial countries (with the exception of the [[Wikipedia:United States|United States]]) and many [[:en:Developing country|developing countries]] provide medical services through a system of [[universal health care]] that aims to guarantee care for all through a [[single-payer health care]] system, or compulsory private or co-operative [[health insurance]]. This is intended to ensure that the entire population has access to medical care on the basis of need rather than ability to pay. Delivery may be via private medical practices or by state-owned hospitals and clinics, or by charities, most commonly by a combination of all three.

Most [[:en:tribe|tribal]] societies provide no guarantee of healthcare for the population as a whole. In such societies, healthcare is available to those that can afford to pay for it or have self-insured it (either directly or as part of an employment contract) or who may be covered by care financed by the government or tribe directly.

[[File:Drug ampoule JPN.jpg|thumb|upright|alt=collection of glass bottles of different sizes|Modern drug [[ampoule]]s]]

Transparency of information is another factor defining a delivery system. Access to information on conditions, treatments, quality, and pricing greatly affects the choice by patients/consumers and, therefore, the incentives of medical professionals. While the US healthcare system has come under fire for lack of openness, new legislation may encourage greater openness. There is a perceived tension between the need for transparency on the one hand and such issues as patient confidentiality and the possible exploitation of information for commercial gain on the other.

The [[health professional]]s who provide care in medicine comprise multiple [[Wikipedia:profession|profession]]s such as [[Doctor of Medicine|medics]], [[Nursing|nurses]], [[Physical therapy|physio therapists]], and [[psychologist]]s. These professions will have their own [[:en:Professional ethics|ethical standards]], professional education, and bodies. The medical profession have been conceptualized from a [[Medical sociology#The Medical Profession|sociological perspective]].

=== Delivery ===
{{See also|Health care|clinic|hospital|hospice}}

Provision of medical care is classified into primary, secondary, and tertiary care categories.

[[File:Nurses at Butawin Urban Clinic, PNG (10711159465).jpg|thumb|alt=photograph of three nurses|Nurses in [[Wikipedia:Kokopo|Kokopo]], [[Wikipedia:East New Britain|East New Britain]], [[Wikipedia:Papua New Guinea|Papua New Guinea]]|upright]]
[[Primary care]] medical services are provided by [[physician]]s, [[physician assistant]]s, [[nurse practitioner]]s, or other health professionals who have first contact with a patient seeking medical treatment or care. These occur in physician offices, [[clinic]]s, [[nursing home]]s, schools, home visits, and other places close to patients. About 90% of medical visits can be treated by the primary care provider. These include treatment of acute and chronic illnesses, [[preventive care]] and [[health education]] for all ages and both sexes.

[[Secondary care]] medical services are provided by [[medical specialist]]s in their offices or clinics or at local community hospitals for a patient referred by a primary care provider who first diagnosed or treated the patient. Referrals are made for those patients who required the expertise or procedures performed by specialists. These include both [[ambulatory care]] and [[inpatient]] services, [[Emergency department]]s, [[intensive care medicine]], surgery services, [[physical therapy]], [[childbirth|labor and delivery]], [[endoscopy]] units, diagnostic [[Medical laboratory|laboratory]] and [[medical imaging]] services, [[Hospice care|hospice]] centers, etc. Some primary care providers may also take care of hospitalized patients and deliver babies in a secondary care setting.

[[Tertiary care]] medical services are provided by specialist hospitals or regional centers equipped with diagnostic and treatment facilities not generally available at local hospitals. These include [[Wikipedia:trauma center|trauma center]]s, [[burn (injury)|burn]] treatment centers, advanced [[neonatology]] unit services, [[organ transplant]]s, high-risk pregnancy, [[radiation therapy|radiation]] [[oncology]], etc.

Modern medical care also depends on information – still delivered in many health care settings on paper records, but increasingly nowadays by [[Electronic health record|electronic means]].

In low-income countries, modern healthcare is often too expensive for the average person. International healthcare policy researchers have advocated that "user fees" be removed in these areas to ensure access, although even after removal, significant costs and barriers remain.

[[Wikipedia:Separation of prescribing and dispensing|Separation of prescribing and dispensing]] is a practice in medicine and pharmacy in which the [[physician]] who provides a [[medical prescription]] is independent from the  [[pharmacist]] who provides the [[prescription drug]]. In the [[Wikipedia:Western world|Western world]] there are centuries of tradition for separating pharmacists from physicians. In Asian countries, it is traditional for physicians to also provide drugs.

== Branches ==
[[File:Drawing by Marguerite Martyn of a visiting nurse with medicine and four babies, 1918.jpg|thumb|left|Drawing by [[Wikipedia:Marguerite Martyn|Marguerite Martyn]] (1918) of a visiting nurse in St. Louis, Missouri, with medicine and babies]]
Working together as an [[Wikipedia:interdisciplinary team|interdisciplinary team]], many highly trained [[health profession]]als besides medical practitioners are involved in the delivery of modern health care. Examples include: [[nurse]]s, [[emergency medical technician]]s and paramedics, laboratory scientists, [[pharmacists]], [[podiatry|podiatrists]], [[physiotherapists]], [[respiratory therapists]], [[speech therapy|speech therapists]], [[occupational therapy|occupational therapists]], radiographers, [[dietitian]]s, and [[bioengineering|bioengineers]], [[medical physics|medical physicists]], [[surgeons]], [[surgeon's assistant]], [[surgical technologist]].

The scope and sciences underpinning human medicine overlap many other fields. A patient admitted to the hospital is usually under the care of a specific team based on their main presenting problem, e.g., the cardiology team, who then may interact with other specialties, e.g., surgical, radiology, to help diagnose or treat the main problem or any subsequent complications/developments.

Physicians have many specializations and subspecializations into certain branches of medicine, which are listed below. There are variations from country to country regarding which specialties certain subspecialties are in.

The main branches of medicine are:
* Basic sciences of medicine; this is what every physician is educated in, and some return to in [[Biomedical research#Preclinical research|biomedical research]].
* [[Medical specialties]]
* [[Interdisciplinary sub-specialties of medicine|Interdisciplinary fields]], where different medical specialties are mixed to function in certain occasions.

=== Basic sciences ===
* ''[[Anatomy]]'' is the study of the physical structure of [[organism]]s. In contrast to ''macroscopic'' or ''gross anatomy'', ''cytology'' and ''histology'' are concerned with microscopic structures.
* ''[[Biochemistry]]'' is the study of the chemistry taking place in living organisms, especially the structure and function of their chemical components.
* ''[[Biomechanics]]'' is the study of the structure and function of biological systems by means of the methods of [[Mechanics]].
* ''[[Biostatistics]]'' is the application of statistics to biological fields in the broadest sense. A knowledge of biostatistics is essential in the planning, evaluation, and interpretation of medical research. It is also fundamental to [[epidemiology]] and evidence-based medicine.
* ''[[Biophysics]]'' is an interdisciplinary science that uses the methods of [[physics]] and [[physical chemistry]] to study biological systems.
* ''[[Cell biology|Cytology]]'' is the microscopic study of individual [[cell (biology)|cells]].
[[File:Albert Edelfelt - Louis Pasteur - 1885.jpg|thumb|''[[Louis Pasteur]]'', as portrayed in his laboratory, 1885 by [[Albert Edelfelt]]]]
* ''[[Embryology]]'' is the study of the early development of organisms.
* ''[[Endocrinology]]'' is the study of hormones and their effect throughout the body of animals.
* ''[[Epidemiology]]'' is the study of the demographics of disease processes, and includes, but is not limited to, the study of epidemics.
* ''[[Genetics]]'' is the study of genes, and their role in [[biological inheritance]].
* ''[[Histology]]'' is the study of the structures of [[biological tissue]]s by light [[microscopy]], [[Electron microscope|electron microscopy]] and [[immunohistochemistry]].
* ''[[Immunology]]'' is the study of the [[immune system]], which includes the innate and adaptive immune system in humans, for example.
* ''[[Lifestyle medicine]]'' is the study of the [[chronic conditions]], and how to prevent, treat and reverse them.
* ''[[Medical physics]]'' is the study of the applications of physics principles in medicine.
* ''[[Microbiology]]'' is the study of [[microorganism]]s, including [[protozoa]], [[bacterium|bacteria]], [[fungus|fungi]], and [[virus]]es.
* ''[[Molecular biology]]'' is the study of molecular underpinnings of the process of [[DNA replication|replication]], [[Transcription (genetics)|transcription]] and [[Translation (biology)|translation]] of the genetic material.
* ''[[Neuroscience]]'' includes those disciplines of science that are related to the study of the [[nervous system]]. A main focus of neuroscience is the [[biology]] and physiology of the human brain and [[spinal cord]]. Some related clinical specialties include [[neurology]], [[neurosurgery]] and [[psychiatry]].
* ''[[Nutrition science]]'' (theoretical focus) and ''[[dietetics]]'' (practical focus) is the study of the relationship of food and drink to health and disease, especially in determining an optimal diet. Medical nutrition therapy is done by dietitians and is prescribed for [[diabetes]], [[cardiovascular disease]]s, weight and eating [[mental illness|disorders]], allergies, [[malnutrition]], and [[neoplasia|neoplastic]] diseases.
* ''[[Pathology as a science]]'' is the study of disease—the causes, course, progression and resolution thereof.
* ''[[Pharmacology]]'' is the study of drugs and their actions.
* ''[[Gynecology]]'' is the study of female reproductive system.
* ''[[Photobiology]]'' is the study of the interactions between [[non-ionizing radiation]] and living organisms.
* ''[[Physiology]]'' is the study of the normal functioning of the body and the underlying regulatory mechanisms.
* ''[[Radiobiology]]'' is the study of the interactions between [[ionizing radiation]] and living organisms.
* ''[[Toxicology]]'' is the study of hazardous effects of drugs and [[poison]]s.

=== Specialties ===
{{Main|Medical specialty}}
In the broadest meaning of "medicine", there are many different specialties. In the UK, most specialities have their own body or college, which has its own entrance examination. These are collectively known as the Royal Colleges, although not all currently use the term "Royal". The development of a speciality is often driven by new technology (such as the development of effective anaesthetics) or ways of working (such as emergency departments); the new specialty leads to the formation of a unifying body of doctors and the prestige of administering their own examination.

Within medical circles, specialities usually fit into one of two broad categories: "Medicine" and "Surgery". "Medicine" refers to the practice of non-operative medicine, and most of its subspecialties require preliminary training in Internal Medicine. In the UK, this was traditionally evidenced by passing the examination for the Membership of the [[Wikipedia:Royal College of Physicians|Royal College of Physicians]] (MRCP) or the equivalent college in Scotland or Ireland. "Surgery" refers to the practice of operative medicine, and most subspecialties in this area require preliminary training in General Surgery, which in the UK leads to membership of the [[Wikipedia:Royal College of Surgeons of England|Royal College of Surgeons of England]] (MRCS). At present, some specialties of medicine do not fit easily into either of these categories, such as radiology, pathology, or anesthesia. Most of these have branched from one or other of the two camps above; for example anaesthesia developed first as a [[:en:Faculty (teaching staff)|faculty]] of the Royal College of Surgeons (for which MRCS/FRCS would have been required) before becoming the [[Wikipedia:Royal College of Anaesthetists|Royal College of Anaesthetists]] and membership of the college is attained by sitting for the examination of the Fellowship of the Royal College of Anesthetists (FRCA).

==== Surgical specialty ====
{{Main|Surgery}}
[[File:Surgeons at Work.jpg|thumb|Surgeons in an [[operating room]]]]
'''Surgery''' is an ancient medical specialty that uses operative manual and instrumental techniques on a patient to investigate or treat a [[pathological]] condition such as [[disease]] or [[injury]], to help improve bodily function or appearance or to repair unwanted ruptured areas (for example, [[Perforated eardrum|a perforated ear drum]]). Surgeons must also manage pre-operative, post-operative, and potential surgical candidates on the hospital wards. In some centers, [[anesthesiology]] is part of the division of surgery (for historical and logistical reasons), although it is not a surgical discipline. Other medical specialties may employ surgical procedures, such as [[ophthalmology]] and [[dermatology]], but are not considered surgical sub-specialties per se.

Surgical training in the U.S. requires a minimum of five years of residency after medical school. Sub-specialties of surgery often require seven or more years. In addition, fellowships can last an additional one to three years. Because post-residency fellowships can be competitive, many trainees devote two additional years to research. Thus in some cases surgical training will not finish until more than a decade after medical school. Furthermore, surgical training can be very difficult and time-consuming.

Surgical subspecialties include those a physician may specialize in after undergoing general surgery residency training as well as several surgical fields with separate residency training. Surgical subspecialties that one may pursue following general surgery residency training: 

* [[General surgery]]
* [[Bariatric surgery]]
* [[Cardiac surgery|Cardiovascular surgery]] - may also be pursued through a separate cardiovascular surgery residency track
* [[Colorectal surgery]]
* [[Endocrine surgery]]
* [[Hand surgery]]
* Hepatico-Pancreatico-Biliary Surgery
* [[Minimally-invasive surgery|Minimally invasive surgery]]
* [[Surgical oncology]]
* [[Pediatric surgery]]
* [[Plastic surgery]] - may also be pursued through a separate plastic surgery residency track
* Surgical critical care
* [[Organ transplantation|Transplant surgery]]
* [[Trauma surgery]]
* [[Vascular surgery]] - may also be pursued through a separate vascular surgery residency track

Other surgical specialties within medicine with their own individual residency training:

* [[Dermatology]]
* [[Neurosurgery]]
* [[Ophthalmology]]
* [[Oral and maxillofacial surgery|Oral and Maxillofacial surgery]]
* [[Orthopedic surgery]]
* [[Otorhinolaryngology]]
* [[Podiatry|Podiatric surgery]] - do not undergo medical school training, but rather separate training in podiatry school
* [[Urology]]

==== 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 [[:en: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.

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.

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]].

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}}

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.

==== 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.

==== 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 [[Wikipedia:Ouagadougou|Ouagadougou]], [[Wikipedia:Burkina Faso|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.

===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 [[:en:Human spaceflight|space travel]].
* ''[[Addiction medicine]]'' deals with the treatment of addiction.
* ''[[Medical ethics]]'' deals with [[Wikipedia:ethic|ethic]]al and [[Wikipedia:moral|moral]] principles that apply values and judgments to the practice of medicine.
* ''[[Biomedical Engineering]]'' is a field dealing with the application of [[Wikipedia:engineering|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 [[Wikipedia:Evolution|evolutionary theory|Evolution|evolutionary theory]].
* ''[[Forensic medicine]]'' deals with medical questions in [[Wikipedia:legal|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 [[Wikipedia:Canada|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 [[Wikipedia:humanities|humanities]] ([[Wikipedia:literature|literature]], [[Wikipedia:philosophy|philosophy]], [[Wikipedia:ethics|ethics]], history and religion), [[Wikipedia:social science|social science]] ([[Wikipedia:anthropology|anthropology]], [[Wikipedia:cultural studies|cultural studies]], [[Wikipedia:psychology|psychology]], [[Wikipedia:sociology|sociology]]), and the arts ([[Wikipedia:literature|literature]], theater, film, and [[Wikipedia:visual arts|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 [[Wikipedia:information technology|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 [[:en:sportsperson|athletes]], [[Wikipedia:amateur|amateur]] and [[Wikipedia:professional|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]]

== Education and legal controls ==
{{Main|Medical education|Medical license}}
[[File:Medical students learning about stitches (2760577402).jpg|thumb|Medical students learning about stitches]]

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.

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/.

[[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.

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.

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.

== 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.

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.

== History ==
{{Main|History of medicine}}

[[File:Imhotep-Louvre.JPG|thumb|left|upright|Statuette of ancient Egyptian physician [[Imhotep]], the first physician from antiquity known by name]]

=== 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.

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]].

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.

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.

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]].

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]].

=== 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]]."]]

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]].

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.

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.

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.

[[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.]]

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]].

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]].

[[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".

=== 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]]

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.

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.

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]].

From New Zealand and Australia came [[Wikipedia:Maurice Wilkins|Maurice Wilkins]], [[Wikipedia:Howard Florey|Howard Florey]], and [[Wikipedia:Frank Macfarlane Burnet|Frank Macfarlane Burnet]].

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).

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]].

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.

[[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.

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.

== 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.

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.

== See also ==
{{Portal|Medicine}}
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|s = Category:Medicine
|b = Subject:Health sciences
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{{Further|Outline of medicine|Outline of health|Glossary of medicine}}
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* {{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}}
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