Medicine

I

Introduction

Medicine (Latin medicus, “physician”), the science and art of diagnosing, treating, and preventing disease and injury. Its goals are to help people live longer, happier, more active lives with less suffering and disability. Medicine goes beyond the bedside of patients. Medical scientists engage in a constant search for new drugs, effective treatments, and more advanced technology. In addition, medicine is a business. It is part of the health care industry, one of the largest industries in the United States, and among the leading employers in most communities.

Disease has been one of humanity's greatest enemies. Only during the last 100 years has medicine developed weapons to fight disease effectively. Vaccines, better drugs and surgical procedures, new instruments, and understanding of sanitation and nutrition have had a huge impact on human well-being. Like detectives, physicians and other health care professionals use clues to identify, or diagnose, a specific disease or injury. They check the patient's medical history for past symptoms or diseases, perform a physical examination, and check the results of various tests. After making a diagnosis, physicians pick the best treatment. Some treatments cure a disease. Others are palliative—that is, they relieve symptoms but do not reverse the underlying disease. Sometimes no treatment is needed because the disease will get better by itself.

While diagnosing disease and choosing the best treatment certainly require scientific knowledge and technical skills, health care professionals must apply these abilities in imaginative ways. The same disease may present very different symptoms in two patients, and a treatment that cures one patient may not work on another.

At the turn of the 20th century, many men and women were feeble by age 40. The average American born in 1900 had a life expectancy of 47.3 years. Effective treatments for disease were so scarce that doctors could carry all their drugs and instruments in a small black bag. By the end of the 20th century, medical advances had caused life expectancy to increase to 76 years. Modern health care practitioners can prevent, control, or cure hundreds of diseases. People today remain independent and physically active into their 80s and 90s. The fastest-growing age group in the population now consists of people aged 85 and over.

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This medical progress has been expensive. In 1998 Americans spent $1.1 trillion on health care, an average of $4,094 per person. In the same year, health care accounted for about 13.5 percent of the gross domestic product (GDP), about one-seventh of the country's total output. Spending has grown rapidly from earlier in the century. In 1940, for instance, the United States spent $4 billion on health care.

II

Health Care Professionals

Some 11.6 million people work in health care in the United States. They include about 778,000 physicians, 2.1 million registered nurses, and 160,000 dentists. Most of them work in health care services, which involve diagnosing and treating patients. Others work mainly in research, teaching, or administration of medical facilities.

A

Physicians

Physicians diagnose diseases and injuries, administer treatment, and advise patients on good diet and other ways to stay healthy. The United States has two kinds of physicians, the Doctor of Medicine (MD) and the Doctor of Osteopathy (DO). Both use medicines, surgery, and other standard methods of treating disease. DOs place special emphasis on problems involving the musculoskeletal system, which includes muscles, ligaments, bones, and joints.

Patients receive medical care from primary care doctors and specialists. Primary care doctors include general practitioners, family physicians, general internists, and general pediatricians. Many women also use obstetricians-gynecologists as primary care doctors. Patients usually consult a primary care doctor when they first become ill or injured. Primary care physicians can treat most common disorders, and provide comprehensive, lifelong care for individuals and families.

But medical knowledge has advanced so far that no physician can master an entire field of medicine. Primary care doctors may refer patients with unusually complicated problems to specialists with advanced training in a particular disease or field of medicine. Specialists may even concentrate in one particular area, and become subspecialists. Each specialist in internal medicine, for instance, is an expert in diagnosis and nonsurgical treatment of adult diseases. But some internists take advanced training to become subspecialists in treating adolescents, heart disease, elderly people, cancer, or arthritis. For more information about the areas that specialists treat, see the table on Medical Specialties.

B

Medical Education

Preparation for a career as a physician is long and demanding. It usually takes 11 years of study after high school to become a physician. The training typically includes four years of undergraduate or premedical study at a college or university; four years of medical school; and three years of advanced training in a residency. The exact length of study varies. Some colleges have a combined undergraduate and medical school program that lasts six years.

Premedical students usually major in science, or take some courses in biology, chemistry, biochemistry, mathematics, and physics. Medicine demands well-rounded individuals with knowledge of the humanities and social sciences, and courses in English, history, literature, art, music, sociology, and other fields are important. Many premedical students gain practical experience by taking summer jobs or volunteer positions in hospitals, clinics, or research laboratories.

Acceptance into a medical school requires excellent college grades, high scores on the Medical College Admission Test (MCAT), good letters of recommendation, and a personal interview with school officials. The United States has 144 medical schools. Of those, 125 award a Doctor of Medicine degree and 19 award a Doctor of Osteopathy. Students face very tough competition for admission to medical school. In 2000, more than 37,000 people applied for admission to medical school, but only 16,303 were accepted.

Education of a physician does not end with medical school graduation. New physicians must pass an examination for a state license to practice. Many then go into postgraduate education. MDs take a residency that lasts from one to seven years. DOs take an internship, which may be followed by a residency. During postgraduate education, physicians pursue advanced training and practical experience treating patients under the supervision of more experienced doctors. This postgraduate training usually takes place in a hospital or clinic.

To be recognized as a specialist in a particular field, a physician must pass a special examination and become board-certified. Physicians earn a certificate from the American Board of Medical Specialties, an organization in Atlanta, Georgia, that oversees the certification process.

Physicians who plan to go into research may obtain a doctoral degree in genetics, immunology, biochemistry, or another field. Some obtain still more training as postdoctoral fellows on the research teams of established scientists. Physicians who plan to specialize in public health may study for a master’s degree in that field.

After completing postgraduate education, physicians begin a lifetime of learning to keep current with new advances. They regularly read medical journals, take continuing education courses, and attend medical conferences.