History of Medicine People and Events

Hippocrates B.C. -lay groundwork for medical practice -diet, weather, rest, and recovery

Invention of Gunpowder Circa changed nature of war wounds -physicians had to adapt and use different treatments

William Harvey Early 1600’s -discovered that blood circulates through body by heart’s contractions

Antoine van Leeuwenhoek created microscopes to observe bacteria, protozoa, sperm, and structure of many cells

Edward Jenner discovered vaccination for smallpox -used fluid from cowpox sores

Florence Nightingale published Notes on Nursing -established foundation for nursing

Louis Pasteur explained how disease can be transmitted through air -classified various types of bacteria -developed vaccines for anthrax and rabies -developed process to sterilize milk

Gregor Mendel experimented with pea plants -revealed basic laws of inheritance -led to discovery of genes and DNA

Robert Koch discovered the bacteria that wound infections and tuberculosis -established set of rules proving that specific microorganisms cause specific illnesses

Wilhelm Conrad Roentgen discovered X-ray -is basis for field of radiology

Marie and Pierre Curie discovered radium -performed pioneer work -would lead to treatments for some forms of cancer

Walter Reed demonstrated that yellow fever can be transmitted by mosquitoes

Karl Landsteiner discovered A, B, and O blood groups -lay groundwork for safe blood transfusions

Alexander Fleming accidentally discovered that common mold produces penicillin -can stop growth of bacteria -first true antibiotic

Jonas Salk developed the killed polio vaccine *one of major causes of infant death and disability is nearly eliminated by vaccines

Joseph Lister Early 1900’s -introduced carbolic acids to sterilize surgical instruments and clean wounds

Hippocratic Oath (Original) I SWEAR by Apollo the physician, AEsculapius, and Health, and All-heal, and all the gods and goddesses, that, according to my ability and judgement, I will keep this Oath and this stipulation. TO RECHON him who taught me this Art equally dear to me as my parents, to share my substance with him, and relieve his necessities if required; to look up his offspring in the same footing as my own brothers, and to teach them this art, if they shall wish to learn it, without fee or stipulation; and that by precept, lecture, and every other mode of instruction, I will impart a knowledge of the Art to my own sons, and those of my teachers, and to disciples bound by a stipulation and oath according the law of medicine, but to none others. I WILL FOLLOW that system of regimen which, according to my ability and judgment, I consider for the benefit of my patients, and abstain from whatever is deleterious and mischievous. I will give no deadly medicine to any one if asked, nor suggest any such counsel; and in like manner I will not give a woman a pessary to produce abortion. WITH PURITY AND WITH HOLINESS I will pass my life and practice my Art. I will not cut persons laboring under the stone, but will leave this to be done by men who are practitioners of this work. Into whatever houses I enter, I will go into them for the benefit of the sick, and will abstain from every voluntary act of mischief and corruption; and, further from the seduction of females or males, of freemen and slaves. WHATEVER, IN CONNECTION with my professional practice or not, in connection with it, I see or hear, in the life of men, which ought not to be spoken of abroad, I will not divulge, as reckoning that all such should be kept secret. WHILE I CONTINUE to keep this Oath unviolated, may it be granted to me to enjoy life and the practice of the art, respected by all men, in all times! But should I trespass and violate this Oath, may the reverse be my lot!

Hippocratic Oath (Modern) I SWEAR in the presence of the Almighty and before my family, my teachers and my peers that according to my ability and judgment I will keep this Oath and Stipulation. TO RECKON all who have taught me this art equally dear to me as my parents and in the same spirit and dedication to impart a knowledge of the art of medicine to others. I will continue with diligence to keep abreast of advances in medicine. I will treat without exception all who seek my ministrations, so long as the treatment of others is not compromised thereby, and I will seek the counsel of particularly skilled physicians where indicated for the benefit of my patient. I WILL FOLLOW that method of treatment which according to my ability and judgment, I consider for the benefit of my patient and abstain from whatever is harmful or mischievous. I will neither prescribe nor administer a lethal dose of medicine to any patient even if asked nor counsel any such thing nor perform the utmost respect for every human life from fertilization to natural death and reject abortion that deliberately takes a unique human life. WITH PURITY, HOLINESS AND BENEFICENCE I will pass my life and practice my art. Except for the prudent correction of an imminent danger, I will neither treat any patient nor carry out any research on any human being without the valid informed consent of the subject or the appropriate legal protector thereof, understanding that research must have as its purpose the furtherance of the health of that individual. Into whatever patient setting I enter, I will go for the benefit of the sick and will abstain from every voluntary act of mischief or corruption and further from the seduction of any patient. WHATEVER IN CONNECTION with my professional practice or not in connection with it I may see or hear in the lives of my patients which ought not be spoken abroad, I will not divulge, reckoning that all such should be kept secret. WHILE I CONTINUE to keep this Oath unviolated may it be granted to me to enjoy life and the practice of the art and science of medicine with the blessing of the Almighty and respected by my peers and society, but should I trespass and violate this Oath, may the reverse by my lot.

Changes in the Hippocratic Oath -references to Greek gods replaced by general religious statement -promises about perpetuating healing arts from generation to generation have been removed -dietary statements have been generalized to meet the times -reference forbidding surgery has been removed -other minor changed to clarify language

Provider-Patient Relationship -patients must reveal personal information -communication is important -information must be confidential -patients must feel they can trust their provider

Delivery of Health Care in Missouri Roles and Requirements

Physician Chiropractor -practice of medicine and surgery -allopathic: can practice all aspects of these areas -osteopathic: emphasizes role of musculoskeletal system -college degree with four years of medical school -focuses on nerves and adjustment of spine -two years of college education and four years of training

Optometrist Podiatrist -diseases and disorders related to eye and vision -prescribe glasses, contacts, and other aids for vision -college degree and four years for an optometry degree -treatment of the foot -examination, diagnosis, treatment -college degree and four years for podiatric medicine degree

Pharmacist Psychologist -prepares and dispenses drugs -college degree and four years for pharmacy degree -diagnosis and treatment of behavioral disorders and mental and emotional illness -philosophy or psychology degree

Physician’s Assistant Nurse Practitioner -diagnostic, therapeutic, preventive, and health maintenance services under supervision of a physician -college degree and two years of additional training -assists patients with recovery from illness or injury -under supervision of physician -master’s degree in nursing and two years of clinical training

Nurse Midwife Registered Nurse -assists women in pregnancy and child birth -master’s degree in nursing and two additional years of clinical training -licensed by the state to care for the sick -two to four years of nursing training

Licensed Nurse Medical Assistant -provides basic care for patients under supervision of physician -one year of nursing training -performs broad range of clinical and administrative duties -two-year program

Emergency Medical Technician -recognize, assess, and manage medical emergencies hours of inspection Medical Laboratory Technologist -perform lab tests that play an important role in detection, diagnosis, and treatment of illnesses -two years of sicence and math and one year of clinical education

Radiologic Technologist Physical Therapist -uses imaging modalities involving X rays, magnetism, or ultrasound to perform radiologic procedures -two to four years of training -administer treatment of disorders or injuries with physical methods -college degree and six months of training

Occupational Therapist -administers treatments to aid people disabled by physical illness -college degree and six months of training Respiratory Therapist -all responsibilities dealing with respiratory care -usually a two year program

Primary Care -gives students a strong background in certain core subjects -internal medicine, family practice, obstetrics and gynecology, and pediatrics

Educational Requirements and Work for Specialty Careers

Internal Medicine -provide medical services for adults on a continuing basis -three years of residency training Family Practice -provide medical services for any individuals, usually consisting of a families -three years of residency training Obstetrics -specialize in care for pregnant women Gynecology -specialize in female reproductive system -four years of residency training Pediatrics -growth and development of patients from infancy to adolescence -three years of residency training Psychiatry -mental illness and emotional and behavioral problems -one year of internship and three years of residency training Surgery -management of disorders treated by operative surgery -five to six years of residency training

Types of Work for Specialty Careers

Allergy, Immunology -any form of allergy and the functioning of the immune system -internal medicine or pediatric residency and two years of fellowship training Anesthesiology -administer drugs that control pain and consciousness during surgery -four years residency training Cardiovascular Disease -problems related to heart and peripheral vessels -internal medicine residency and two years fellowship training Colon and Rectal Surgery -correct disorders in or remove tissues from small intestines, colon, or rectal area -surgical residency and one additional year of residency training Dermatology -conditions related to skin, hair, and nails -one year of training and three years residency training Emergency Medicine -broad range of life-threatening conditions -four years residency training

Endocrinology and Metabolism -treat disease by abnormal function of the endocrine glands -internal medicine residency and two years fellowship training Gastroenterology -manages disorders of the digestive system -internal medicine residency and two years fellowship training Geriatric Medicine -concerned with the care of the elderly -internal medicine residency and two years fellowship training Hematology -study of blood and blood disorders Oncology -diagnosis and treatment of cancer -internal medicine residency and one to two years of fellowship training Infectious Disease -treat diseases caused by wide variety of microorganisms -internal medicine residency and two years fellowship training Nephrology -concerned with functioning of the kidneys -internal residency and two years fellowship training

Neurological Surgery -surgical treatment of disorders of the nervous system -six to seven years residency training Neurology -study of the nervous system and its disorders -one year of training and three years of residency training Nuclear Medicine -use radioactive substances to study and treat disease -four years of residency training (two must be in approved clinical specialty) Ophthalmology -diagnosis and treatment of disorders that affect the eye -one year training and three to four years residency training Orthopedic Surgery -disorders of the bones and joints -five to six years residency training Otolaryngology, Head and Neck Surgery -treatments of disorders of the head and neck -five to six years residency training

Pathology -conduct lab studies of tissues and cells to help other physicians read diagnoses -four years residency training Physical Medicine and Rehabilitation, Sports Medicine -treat patients recovering from injury -two years of residency training Plastic, Reconstructive, and Maxillofacial Surgery -repair physical defects of skin -surgical residency and two years of residency training Preventive Medicine -prevention of disease by use of public health measures -two years of residency training Radiology -use testing to view almost any part of body -one year of training and three to four years of residency training Rheumatology -concerned with joint, muscle, and connective tissue -internal medicine residency and two years fellowship training

Thoracic, Cardiothoracic Surgery -perform operations on organs within chest cavity -surgical residency and two years additional residency Urology -investigation and treatment of disorders in the urinary tract -one year surgical internship and four years residency training Vascular Surgery -disease of blood vessels exclusives of those with the heart, lungs, and brain -surgical residency and one year residency training

Health Care and Delivery Systems

United States -provided on a fee-for-service basis -total amount of money spent on health care is based on what people are willing to pay -incentives for those who deliver health care to do a good job (because they are getting paid by insurance and patient) -difficult for those with low or no income (they cannot pay for it)

Canada -health care personnel are employed by agencies and paid fixed salaries -limits the services and treatments offered -no incentives to maintain the quality of work (because of the fixed pay rate)

Mexico -has both nationalized and market health care (nationalized dominates because of large poor population) -types of services offered are much more limited because not enough taxes come in -less sensitive to quality of work performed