Thursday, May 22, 2008
Wednesday, May 21, 2008
Medicalization
Medicalization
Medicalization (or medicalisation) is the process by which health or behavior conditions come to be defined and treated as medical issues. The term refers to the process by which certain events or characteristics of everyday life become medical issues, and thus come within the purview of doctors and other health professionals to engage with, study, and treat. The process of medicalization typically involves changes in social attitudes and terminology, and usually accompanies (or is driven by) the availability of treatments. The medicalization of these life experiences has brought with it benefits, but at a price. And those costs, which are not just financial, are not always clear.
Medicalization (or medicalisation) is the process by which health or behavior conditions come to be defined and treated as medical issues. The term refers to the process by which certain events or characteristics of everyday life become medical issues, and thus come within the purview of doctors and other health professionals to engage with, study, and treat. The process of medicalization typically involves changes in social attitudes and terminology, and usually accompanies (or is driven by) the availability of treatments. The medicalization of these life experiences has brought with it benefits, but at a price. And those costs, which are not just financial, are not always clear.
Etymology and perception
Etymology and perception
The term medicalization entered academic and medical publications in the 1970s. The expansion of medical authority into the domains of everyday existence was promoted by doctors and was therefore a force to be rejected in the name of specific kinds of liberation.
About 30 years on, the definition of medicalization is more complicated, if for no other reason than because the term is so widely used. Many contemporary critics position pharmaceutical companies in the space once held by doctors as the supposed catalysts of social transformation. Titles such as the The making of a disease or Sex, drugs, and marketing critique the pharmaceutical industry for shunting everyday problems into the domain of professional biomedicine. At the same time, to suggest that society simply reject drugs or drug companies in much the same ways some have suggested it "liberate" itself from the medical system is implausible. The same drugs that treat deviances from societal norms also help many people live their lives. Even scholars who critique the societal implications of brand-name drugs generally remain open to these drugs' curative effects — a far cry from earlier calls for a revolution against the biomedical establishment.
The physician's role in this present-day notion of medicalization is similarly complex. On one hand, the doctor remains an authority figure who prescribes pharmaceuticals to patients. Whereas on the other, ubiquitous consumer-directed advertisements instruct patients to ask for particular drugs by name, thereby creating a conversation between consumer and drug company that threatens to cut the doctor out of the loop. The role of patients in this economy has also changed. Once regarded as passive victims of medicalization, patients can now occupy active positions as advocates, consumers, or even agents of change.
The term medicalization entered academic and medical publications in the 1970s. The expansion of medical authority into the domains of everyday existence was promoted by doctors and was therefore a force to be rejected in the name of specific kinds of liberation.
About 30 years on, the definition of medicalization is more complicated, if for no other reason than because the term is so widely used. Many contemporary critics position pharmaceutical companies in the space once held by doctors as the supposed catalysts of social transformation. Titles such as the The making of a disease or Sex, drugs, and marketing critique the pharmaceutical industry for shunting everyday problems into the domain of professional biomedicine. At the same time, to suggest that society simply reject drugs or drug companies in much the same ways some have suggested it "liberate" itself from the medical system is implausible. The same drugs that treat deviances from societal norms also help many people live their lives. Even scholars who critique the societal implications of brand-name drugs generally remain open to these drugs' curative effects — a far cry from earlier calls for a revolution against the biomedical establishment.
The physician's role in this present-day notion of medicalization is similarly complex. On one hand, the doctor remains an authority figure who prescribes pharmaceuticals to patients. Whereas on the other, ubiquitous consumer-directed advertisements instruct patients to ask for particular drugs by name, thereby creating a conversation between consumer and drug company that threatens to cut the doctor out of the loop. The role of patients in this economy has also changed. Once regarded as passive victims of medicalization, patients can now occupy active positions as advocates, consumers, or even agents of change.
Health care
Health care
A modern hospital building of the United Kingdom's National Health Service in Norfolk. The UK operates a system of publicly funded health care, free for everyone at the point of use.
Health care, or healthcare, is the prevention, treatment, and management of illness and the preservation of mental and physical well being through the services offered by the medical, nursing, and allied health professions. Health care embraces all the goods and services designed for your health, including “preventive, curative and palliative infections, whether directed to individuals or to populations”. The organised provision of such services may constitute a health care system. This can include specific governmental organizations such as, in the UK, the National Health Service or a cooperation across the National Health Service and Social Services as in Shared Care. Before the term "health care" became popular, English-speakers referred to medicine or to the health sector and spoke of the treatment and prevention of illness and disease.
In most developed countries and many developing countries health care is provided to everyone regardless of their ability to pay. The National Health Service, established in 1948 by Clement Atlee's Labour government in the United Kingdom, were the world's first universal health care system provided by government and paid for from general taxation. Alternatively, compulsory government funded health insurance with nominal fees can be provided, as in Italy. Other examples are Medicare in Australia, established in the 1970s by the Labor government, and by the same name Medicare was established in Canada between 1966 and 1984. Universal health care contrasts to the systems like health care in the United States or South Africa, though South Africa is one of the many countries attempting health care reform.The United States is the only wealthy, industrialized nation that does not provide universal health care.
A modern hospital building of the United Kingdom's National Health Service in Norfolk. The UK operates a system of publicly funded health care, free for everyone at the point of use.
Health care, or healthcare, is the prevention, treatment, and management of illness and the preservation of mental and physical well being through the services offered by the medical, nursing, and allied health professions. Health care embraces all the goods and services designed for your health, including “preventive, curative and palliative infections, whether directed to individuals or to populations”. The organised provision of such services may constitute a health care system. This can include specific governmental organizations such as, in the UK, the National Health Service or a cooperation across the National Health Service and Social Services as in Shared Care. Before the term "health care" became popular, English-speakers referred to medicine or to the health sector and spoke of the treatment and prevention of illness and disease.
In most developed countries and many developing countries health care is provided to everyone regardless of their ability to pay. The National Health Service, established in 1948 by Clement Atlee's Labour government in the United Kingdom, were the world's first universal health care system provided by government and paid for from general taxation. Alternatively, compulsory government funded health insurance with nominal fees can be provided, as in Italy. Other examples are Medicare in Australia, established in the 1970s by the Labor government, and by the same name Medicare was established in Canada between 1966 and 1984. Universal health care contrasts to the systems like health care in the United States or South Africa, though South Africa is one of the many countries attempting health care reform.The United States is the only wealthy, industrialized nation that does not provide universal health care.
Entry-level education
Entry-level education
Entry-level medical education programs are tertiary-level courses undertaken at a medical school. Depending on jurisdiction and university, these may be either undergraduate-entry (most of Europe, India, China), or graduate-entry programs (mainly Australia and Canada), or second entry degrees (United States).
Generally, initial training is taken at medical school. Traditionally initial medical education is divided between preclinical and clinical studies. The former consists of the basic sciences such as anatomy, physiology, biochemistry, pharmacology, pathology. The latter consists of teaching in the various areas of clinical medicine such as internal medicine, pediatrics, obstetrics and gynecology, psychiatry, and surgery. Increasingly, however, medical programs are using systems-based curricula in which learning is integrated, and several institutions do this.
There has been a proliferation of programmes that combine medical training with research (MD PhD) or management programmes (MD MBA), although this has been criticised.
Entry-level medical education programs are tertiary-level courses undertaken at a medical school. Depending on jurisdiction and university, these may be either undergraduate-entry (most of Europe, India, China), or graduate-entry programs (mainly Australia and Canada), or second entry degrees (United States).
Generally, initial training is taken at medical school. Traditionally initial medical education is divided between preclinical and clinical studies. The former consists of the basic sciences such as anatomy, physiology, biochemistry, pharmacology, pathology. The latter consists of teaching in the various areas of clinical medicine such as internal medicine, pediatrics, obstetrics and gynecology, psychiatry, and surgery. Increasingly, however, medical programs are using systems-based curricula in which learning is integrated, and several institutions do this.
There has been a proliferation of programmes that combine medical training with research (MD PhD) or management programmes (MD MBA), although this has been criticised.
Medical equipment
Medical equipment
This article needs additional citations for verification.Please help improve this article by adding reliable references. Unsourced material may be challenged and removed. (January 2008)
Medical equipment is designed to aid in the diagnosis, monitoring or treatment of medical conditions. These devices are usually designed with rigorous safety standards.
See also the main articles: implant, artificial limbs, corrective lenses, cochlear implants, dental implants, prosthetics (ocular, facial)
There are several basic types:
Diagnostic equipment includes medical imaging machines, used to aid in diagnosis. Examples are ultrasound and MRI machines, PET and CT scanners, and x-ray machines.
Therapeutic equipment includes infusion pumps, medical lasers and LASIK surgical machines.
Life support equipment is used maintain a patient's bodily function. These include medical ventilators, heart-lung machines, ECMO, and dialysis machines.
Medical monitors allow medical staff to measure a patient's medical state. Monitors may measure patient vital signs and other parameters including ECG, EEG, blood pressure, and dissolved gases in the blood.
Medical laboratory equipment automates or help analyze blood, urine and genes.
Diagnostic Medical Equipment may also be used in the home for certain purposes, e.g. for the control of diabetes mellitus
A Biomedical equipment technician or BMET is a vital component of the healthcare delivery system. Employed primarily by hospitals, BMETs are the people responsible for maintaining a facility's medical equipment.
This article needs additional citations for verification.Please help improve this article by adding reliable references. Unsourced material may be challenged and removed. (January 2008)
Medical equipment is designed to aid in the diagnosis, monitoring or treatment of medical conditions. These devices are usually designed with rigorous safety standards.
See also the main articles: implant, artificial limbs, corrective lenses, cochlear implants, dental implants, prosthetics (ocular, facial)
There are several basic types:
Diagnostic equipment includes medical imaging machines, used to aid in diagnosis. Examples are ultrasound and MRI machines, PET and CT scanners, and x-ray machines.
Therapeutic equipment includes infusion pumps, medical lasers and LASIK surgical machines.
Life support equipment is used maintain a patient's bodily function. These include medical ventilators, heart-lung machines, ECMO, and dialysis machines.
Medical monitors allow medical staff to measure a patient's medical state. Monitors may measure patient vital signs and other parameters including ECG, EEG, blood pressure, and dissolved gases in the blood.
Medical laboratory equipment automates or help analyze blood, urine and genes.
Diagnostic Medical Equipment may also be used in the home for certain purposes, e.g. for the control of diabetes mellitus
A Biomedical equipment technician or BMET is a vital component of the healthcare delivery system. Employed primarily by hospitals, BMETs are the people responsible for maintaining a facility's medical equipment.
Medical literature
Medical literature
Plates vi & vii of the Edwin Smith Papyrus at the Rare Book Room, New York Academy of Medicine
Medical literature refers to articles in journals and texts in books devoted to the field of medicine.
Contemporary and historic views regarding diagnosis, prognosis and treatment of medical conditions have been documented for thousands of years. The Edwin Smith papyrus is the first known medical treatise. Initially most described inflictions related to warfare. This was because war was the most important part of society and it was the most common way of contracting health problems.
Plates vi & vii of the Edwin Smith Papyrus at the Rare Book Room, New York Academy of Medicine
Medical literature refers to articles in journals and texts in books devoted to the field of medicine.
Contemporary and historic views regarding diagnosis, prognosis and treatment of medical conditions have been documented for thousands of years. The Edwin Smith papyrus is the first known medical treatise. Initially most described inflictions related to warfare. This was because war was the most important part of society and it was the most common way of contracting health problems.
Contemporary use of alternative medicine
Contemporary use of alternative medicine
Many people utilize mainstream medicine for diagnosis and basic information, while turning to alternatives for what they believe to be health-enhancing measures. Studies indicate that alternative approaches are often used in conventional medicine.
Edzard Ernst wrote in the Medical Journal of Australia that "about half the general population in developed countries use complementary and alternative medicine (CAM).Survey results released in May 2004 by the National Center for Complementary and Alternative Medicine, part of the United States National Institutes of Health, found that in 2002 62.1% of adults in the country had used some form of CAM in the past 12 months, though this figure drops to 36.0% if prayer specifically for health reasons is excluded. 25% of people who use CAM do so because a medical professional suggested it.Another study suggests a similar figure of 40%. A British telephone survey by the BBC of 1204 adults in 1998 shows that around 20% of adults in Britain had used alternative medicine in the past 12 months.
The use of alternative medicine in developed countries appears to be increasing. A 1998 study showed that the use of alternative medicine had risen from 33.8% in 1990 to 42.1% in 1997.In the United Kingdom, a 2000 report ordered by the House of Lords suggested that "...limited data seem to support the idea that CAM use in the United Kingdom is high and is increasing."
In developing nations, access to essential medicines is severely restricted by lack of resources and poverty. Traditional remedies, often closely resembling or forming the basis for alternative remedies, may comprise primary health care or be integrated into the health care system. In Africa, traditional medicine is used for 80% of primary health care, and in developing nations as a whole over one third of the population lack access to essential medicines.
Many people utilize mainstream medicine for diagnosis and basic information, while turning to alternatives for what they believe to be health-enhancing measures. Studies indicate that alternative approaches are often used in conventional medicine.
Edzard Ernst wrote in the Medical Journal of Australia that "about half the general population in developed countries use complementary and alternative medicine (CAM).Survey results released in May 2004 by the National Center for Complementary and Alternative Medicine, part of the United States National Institutes of Health, found that in 2002 62.1% of adults in the country had used some form of CAM in the past 12 months, though this figure drops to 36.0% if prayer specifically for health reasons is excluded. 25% of people who use CAM do so because a medical professional suggested it.Another study suggests a similar figure of 40%. A British telephone survey by the BBC of 1204 adults in 1998 shows that around 20% of adults in Britain had used alternative medicine in the past 12 months.
The use of alternative medicine in developed countries appears to be increasing. A 1998 study showed that the use of alternative medicine had risen from 33.8% in 1990 to 42.1% in 1997.In the United Kingdom, a 2000 report ordered by the House of Lords suggested that "...limited data seem to support the idea that CAM use in the United Kingdom is high and is increasing."
In developing nations, access to essential medicines is severely restricted by lack of resources and poverty. Traditional remedies, often closely resembling or forming the basis for alternative remedies, may comprise primary health care or be integrated into the health care system. In Africa, traditional medicine is used for 80% of primary health care, and in developing nations as a whole over one third of the population lack access to essential medicines.
Alternative medicine
Alternative medicine
Alternative medicine practices are based on unscientific belief systems or philosophies. They may incorporate spiritual, metaphysical, or religious underpinnings, untested practices, pre-modern medical traditions, or newly developed approaches to healing. If an alternative medical approach, previously unproven according to orthodox scientific or regulatory methodologies, is subsequently shown to be safe and effective, it may then be adopted by conventional practitioners and no longer considered "alternative."
"Alternative medicine" is often categorized together with complementary medicine using the umbrella term Complementary and alternative medicine or CAM.
Alternative medicine practices are based on unscientific belief systems or philosophies. They may incorporate spiritual, metaphysical, or religious underpinnings, untested practices, pre-modern medical traditions, or newly developed approaches to healing. If an alternative medical approach, previously unproven according to orthodox scientific or regulatory methodologies, is subsequently shown to be safe and effective, it may then be adopted by conventional practitioners and no longer considered "alternative."
"Alternative medicine" is often categorized together with complementary medicine using the umbrella term Complementary and alternative medicine or CAM.
Education
Education
An image of a 1901 examination in the faculty of medicine.
Main articles: Medical education and Medical school
Medical education is education connected to the practice of being a medical practitioner, either the initial training to become a physician or further training thereafter.
Medical education and training varies considerably across the world, however typically involves entry level education at a university medical school, followed by a period of supervised practice (internship and/or residency) and possibly postgraduate vocational training. Continuing medical education is a requirement of many regulatory authorities.
Various teaching methodologies have been utilized in medical education, which is an active area of educational research.
An image of a 1901 examination in the faculty of medicine.
Main articles: Medical education and Medical school
Medical education is education connected to the practice of being a medical practitioner, either the initial training to become a physician or further training thereafter.
Medical education and training varies considerably across the world, however typically involves entry level education at a university medical school, followed by a period of supervised practice (internship and/or residency) and possibly postgraduate vocational training. Continuing medical education is a requirement of many regulatory authorities.
Various teaching methodologies have been utilized in medical education, which is an active area of educational research.
Basic sciences
Basic sciences
Anatomy is the study of the physical structure of organisms. 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.
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.
Cytology is the microscopic study of individual cells.
Embryology is the study of the early development of organisms.
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 tissues by light microscopy, electron microscopy and immunohistochemistry.
Immunology is the study of the immune system, which includes the innate and adaptive immune system in humans, for example.
Microbiology is the study of microorganisms, including protozoa, bacteria, fungi, and viruses.
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.
Nutrition 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 diseases, weight and eating disorders, allergies, malnutrition, and 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.
Physiology is the study of the normal functioning of the body and the underlying regulatory mechanisms.
Toxicology is the study of hazardous effects of drugs and poisons.
Anatomy is the study of the physical structure of organisms. 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.
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.
Cytology is the microscopic study of individual cells.
Embryology is the study of the early development of organisms.
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 tissues by light microscopy, electron microscopy and immunohistochemistry.
Immunology is the study of the immune system, which includes the innate and adaptive immune system in humans, for example.
Microbiology is the study of microorganisms, including protozoa, bacteria, fungi, and viruses.
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.
Nutrition 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 diseases, weight and eating disorders, allergies, malnutrition, and 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.
Physiology is the study of the normal functioning of the body and the underlying regulatory mechanisms.
Toxicology is the study of hazardous effects of drugs and poisons.
Clinical skills
Clinical skills
A complete medical evaluation includes a medical history, a systems enquiry, a physical examination, appropriate laboratory or imaging studies, analysis of data and medical decision making to obtain diagnoses, and a treatment plan
The components of the medical history are:
Chief complaint (CC): the reason for the current medical visit. These are the 'symptoms.' They are in the patient's own words and are recorded along with the duration of each one. Also called 'presenting complaint.'
History of present illness / complaint (HPI): the chronological order of events of symptoms and further clarification of each symptom.
Current activity: occupation, hobbies, what the patient actually does.
Medications (DHx): what drugs the patient takes including prescribed, over-the-counter, and home remedies, as well as alternative and herbal medicines/herbal remedies. Allergies are also recorded.
Past medical history (PMH/PMHx): concurrent medical problems, past hospitalizations and operations, injuries, past infectious diseases and/or vaccinations, history of known allergies.
Social history (SH): birthplace, residences, marital history, social and economic status, habits (including diet, medications, tobacco, alcohol).
Family history (FH): listing of diseases in the family that may impact the patient. A 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 weight loss, fevers, lumps and bumps? etc), followed by questions on the body's main organ systems (heart, lungs, digestive tract, urinary tract, etc).
A complete medical evaluation includes a medical history, a systems enquiry, a physical examination, appropriate laboratory or imaging studies, analysis of data and medical decision making to obtain diagnoses, and a treatment plan
The components of the medical history are:
Chief complaint (CC): the reason for the current medical visit. These are the 'symptoms.' They are in the patient's own words and are recorded along with the duration of each one. Also called 'presenting complaint.'
History of present illness / complaint (HPI): the chronological order of events of symptoms and further clarification of each symptom.
Current activity: occupation, hobbies, what the patient actually does.
Medications (DHx): what drugs the patient takes including prescribed, over-the-counter, and home remedies, as well as alternative and herbal medicines/herbal remedies. Allergies are also recorded.
Past medical history (PMH/PMHx): concurrent medical problems, past hospitalizations and operations, injuries, past infectious diseases and/or vaccinations, history of known allergies.
Social history (SH): birthplace, residences, marital history, social and economic status, habits (including diet, medications, tobacco, alcohol).
Family history (FH): listing of diseases in the family that may impact the patient. A 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 weight loss, fevers, lumps and bumps? etc), followed by questions on the body's main organ systems (heart, lungs, digestive tract, urinary tract, etc).
Delivery systems
Delivery systems
Medicine is practiced within the medical system, which is a legal, credentialing and financing framework, established by a particular culture or government. The characteristics of a health care system have significant effect on the way medical care is delivered.
Most industrialized countries and many developing countries deliver health care though a system of universal health care which guarantees health care for all through a system of compulsory private or co-operative health insurance funds or via government backed social insurance. This insurance, (in effect, a form of taxation) ensures the entire population has access to medical care on the basis of need rather than ability to pay. The delivery systems may be provided by private medical practices or by state owned hospitals and clinics, or by charities.
Medicine is practiced within the medical system, which is a legal, credentialing and financing framework, established by a particular culture or government. The characteristics of a health care system have significant effect on the way medical care is delivered.
Most industrialized countries and many developing countries deliver health care though a system of universal health care which guarantees health care for all through a system of compulsory private or co-operative health insurance funds or via government backed social insurance. This insurance, (in effect, a form of taxation) ensures the entire population has access to medical care on the basis of need rather than ability to pay. The delivery systems may be provided by private medical practices or by state owned hospitals and clinics, or by charities.
Subscribe to:
Posts (Atom)
