Medical doctor
A medical doctor, also known as a physician or medical practitioner, is a health professional who practices medicine. Medicine aims to promote, maintain or restore health through the study, diagnosis, prognosis and treatment of disease, injury, and other physical and mental conditions.
Doctors may focus on certain disease categories, types of patients, and methods of treatment, known as specialities. Others work in general practice, providing continuing and comprehensive medical care to individuals, families. Medical practice requires both thorough knowledge of the medical sciences—such as anatomy, physiology, diseases, and their treatment—and strong competence in applying this knowledge in practice, which forms the art or craft of the profession.
Both the role of doctors and the meaning of the word itself vary around the world. Degrees and other qualifications vary widely, but there are some common elements, such as medical ethics requiring that doctors show consideration, compassion, and benevolence for their patients.
Terminology
The term doctor commonly refers to medical practitioners across the world, but may also be applied to holders of non-medical doctoral degrees. While the term physician is used in North America to refer to medical practitioners in a general sense, in the United Kingdom and countries influenced by British English this word refers to specialists in internal medicine specifically.British and Commonwealth
The British meaning of the term physician is the original one, and is used in opposition to surgeon, which refers to a specialist in surgery. This meaning of physician conveys a sense of expertise in treatment with drugs, rather than with the manual procedures used by a surgeon. The English word physician is at least nine hundred years old: physicians and surgeons were once members of separate professions, and traditionally were rivals. The Shorter Oxford English Dictionary, third edition, gives a Middle English quotation making this contrast, from as early as 1400: "O Lord, whi is it so greet difference betwixe a cirugian and a physician." Henry VIII granted a charter to the London Royal College of Physicians in 1518. It was not until 1540 that he granted the Company of Barber-Surgeons its separate charter. In the same year, the English monarch established the Regius Professorship of Physic at the University of Cambridge. Newer universities would probably describe such an academic as a professor of internal medicine. Hence, in the 16th century, physic meant roughly what internal medicine does now.This original use is common in much of the world including the United Kingdom and other Commonwealth countries, as well as in places as diverse as Brazil, Hong Kong, Indonesia, Japan, Ireland, and Taiwan. In such places, the more general terms doctor or medical practitioner are used to describe any person whose practises medicine. In Britain, the use of the term "doctor" for medical practitioners is a courtesy and does not indicate possession of a doctorate; British doctors must have a Bachelor of Medicine, Bachelor of Surgery to practise. Community-oriented providers of primary care are called general practitioners, commonly abbreviated to GP.
North American
In the United States and Canada, the term physician describes all medical practitioners holding a professional medical degree. The American Medical Association, established in 1847, as well as the American Osteopathic Association, founded in 1897, both currently use the term physician to describe members. The AMA advocates for the definition of a physician as "an individual possessing degree of either a Doctor of Medicine or Doctor of Osteopathic Medicine." However, the American College of Physicians, established in 1915, use the term physician in its original sense. Specialists in internal medicine may be described as an internist. Another term, hospitalist, was introduced in 1996, to describe US specialists in internal medicine who work largely or exclusively in hospitals. Such "hospitalists" now make up about 19% of all US general internists, who are often called general physicians in Commonwealth countries. In North America, community-oriented providers of primary care are called family doctors or primary care physicians.The vast majority of physicians trained in the United States have a Doctor of Medicine degree, and use the initials M.D. A smaller number attend osteopathic medical schools and have a Doctor of Osteopathic Medicine degree and use the initials D.O. The World Directory of Medical Schools lists both MD and DO granting schools as medical schools located in the United States. After completion of medical school, physicians complete a residency in the specialty in which they will practice. Subspecialties require the completion of a fellowship after residency. Both MD and DO physicians participate in the National Resident Matching Program and attend ACGME-accredited residencies and fellowships across all medical specialties to obtain licensure. All boards of certification now require that physicians demonstrate, by examination, continuing mastery of the core knowledge and skills for a chosen specialty. Recertification varies by particular specialty between every seven and every ten years.
Physician and surgeon
Around the world, the combined term physician and surgeon is used to describe either a general practitioner or any medical practitioner irrespective of specialty. This usage still shows the original meaning of physician and preserves the old difference between a physician, as a practitioner of physic, and a surgeon. The term may be used by state medical boards in the United States, and by equivalent bodies in Canadian provinces, to describe any medical practitioner.Shortage
Many countries in the developing world have the problem of too few doctors. In 2015, the Association of American Medical Colleges warned that the US will face a doctor shortage of as many as 90,000 by 2025. Long medical working hours, shift work and sleep deprivation contribute to medical errors.Social role and world view
Biomedicine
Within Western culture and over recent centuries, medicine has become increasingly based on scientific reductionism and materialism. This style of medicine is now dominant throughout the industrialized world, and is often termed biomedicine by medical anthropologists. Biomedicine "formulates the human body and disease in a culturally distinctive pattern", and is a world view learnt by medical students. Within this tradition, the medical model is a term for the complete "set of procedures in which all doctors are trained", including mental attitudes. A particularly clear expression of this world view, currently dominant among conventional doctors, is evidence-based medicine. Within conventional medicine, most doctors still pay heed to their ancient traditions:In this Western tradition, doctors are considered to be members of a learned profession, and enjoy high social status, often combined with expectations of a high and stable income and job security. However, medical practitioners often work long and inflexible hours, with shifts at unsociable times. Their high status is partly from their extensive training requirements, and also because of their occupation's special ethical and legal duties. The term traditionally used by doctors to describe a person seeking their help is the word patient. This word patient is an ancient reminder of medical duty, as it originally meant 'one who suffers'. The English noun comes from the Latin word patiens, the present participle of the deponent verb, patior, meaning 'I am suffering', and akin to the Greek verb and its cognate noun πάθος.
Alternative medicine
While contemporary biomedicine has distanced itself from its ancient roots in religion and magic, many forms of traditional medicine and alternative medicine continue to espouse vitalism in various guises: "As long as life had its own secret properties, it was possible to have sciences and medicines based on those properties". The US National Center for Complementary and Alternative Medicine classifies complementary and alternative medicine therapies into five categories or domains, including: alternative medical systems, or complete systems of therapy and practice; mind-body interventions, or techniques designed to facilitate the mind's effect on bodily functions and symptoms; biologically based systems including herbalism; and manipulative and body-based methods such as chiropractic and massage therapy.In considering these alternate traditions that differ from biomedicine, medical anthropologists emphasize that all ways of thinking about health and disease have a significant cultural content, including conventional western medicine.
Ayurveda, Unani medicine, and homeopathy are popular types of alternative medicine.
Doctors' own health
Some commentators have argued that doctors have duties to serve as role models for the general public in matters of health, for example by not smoking cigarettes. Indeed, in most western nations relatively few doctors smoke, and their professional knowledge does appear to have a beneficial effect on their health and lifestyle. According to a study of male doctors in the United States, life expectancy is slightly higher for doctors than lawyers or many other highly educated professionals. Causes of death which are less likely to occur in doctors than the general population include respiratory disease, alcohol-related deaths, rectosigmoid and anal cancers, and bacterial diseases.Doctors do experience exposure to occupational hazards, and there is a well-known aphorism that "doctors make the worst patients". Causes of death that are shown to be higher in doctors include suicide among doctors and self-inflicted injury, drug-related causes, traffic accidents, and cerebrovascular and ischaemic heart disease. Doctors are also prone to occupational burnout. This manifests as a long-term stress reaction characterized by poorer quality of care towards patients, emotional exhaustion, a feeling of decreased personal achievement, and others. A study by the Agency for Healthcare Research and Quality reported that time pressure was the greatest cause of burnout; a survey from the American Medical Association reported that more than half of all respondents chose "too many bureaucratic tasks" as the leading cause of burnout.