Реферат: The practice of modern medicine
Реферат: The practice of modern medicine
1. Health care and its
2. ORGANIZATION OF HEALTH
3. Levels of health care.
4. Costs of health care.
5. ADMINISTRATION OF PRIMARY
6. MEDICAL PRACTICE IN.
8. United Stales.
11. Other developed
12. MEDICAL PRACTICE IN
15. ALTERNATIVE OR COMPLEMENTARY
16. SPECIAL PRACTICES AND FIELDS OF
17. Specialties in medicine.
19. Industrial medicine.
20. Family health care.
22. Public health practice.
23. Military practice.
24. CLINICAL RESEARCH
25. Historical notes.
26. Clinical observation.
27. Drug research.
29. SCREENING PROCEDURES
THE PRACTICE OF MODERN MEDICINE
Health care and its delivery
The World Health
Organization at its 1978 international, conference held in the Soviet Union
produced the Alma-Ata Health Declaration, which was designed to serve governments
as a basis for planning health care that would reach people at all levels of
society. The declaration reaffirmed that "health, which is a state of
complete physical, mental and social well-being, and not merely the absence of
disease or infirmity, is a fundamental human rit.nl and that the attainment of
the highest possible level of health is a most important world-wide social goal
whose realization requires the action of many other social and economic sectors
in addition to the health sector." In its widest form the practice of
medicine, that is to say the promotion and care of health, is concerned with
"It is generally the goal
of most countries to have their health services organized in such a way to
ensure that individuals, families, and communities obtain the maximum benefit
from current knowledge and technology available for the promotion, maintenance,
and restoration of health. In order to play their part in this process,
governments and other agencies are faced with numerous tasks, including the
following: (1) They must obtain as much information as is possible on the size,
extent, and urgency of their needs; without accurate information, planning can
be misdirected. (2) These needs must then be revised against the resources
likely to be available in terms of money, manpower, and materials; developing
countries may well require external aid to supplement their own resources. (3)
Based on their assessments, countries then need to determine realistic
objectives and draw up plans. (4) Finally, a process of evaluation needs to be
built into the program; the lack of reliable information and accurate
assessment can lead to confusion, waste, and inefficiency.
Health services of
any nature reflect a number "I interrelated characteristics, among which
the most obvious but not necessarily the most important from a national point
of view, is the curative function; that is to say caring for those already ill.
Others include special services that deal with particular groups (such as
children or pregnant women) and with specific needs such as nutrition or
immunization; preventive services, the protection of the health both of
individuals and of communities; health education; and, as mentioned above, the
collection and analysis of information.
Levels of health care.
In the curative domain there are
various forms оf medical practice.
They may be thought of generally as forming a pyramidal structure, with three
tiers representing increasing degrees of specialization and technical
sophistication but catering to diminishing numbers of patients as they are
filtered out of the system at a lower level. Only those patients who require
special attention or treatment should reach the second (advisory) or third
(specialized treatment) tiers where the cost per item of service becomes
increasingly higher. The first level represents primary health care, or first
contact care, or which patients have their initial contact with the health-care
Primary health care
is an integral part of a country's health maintenance system, of which it forms
the largest and most important part. As described in the declaration of
Alma-Ata, primary health care should be "based on practical
scientifically sound and socially acceptable methods and technology made
universally accessible to individuals in the community through their full
participation and at a cost that the community and country can afford to
maintain at every stage of then development." Primary health care in the
developed countries is usually the province of a medically qualified physician;
in the developing countries first contact care is often provided by
nonmedically qualified personnel.
The vast majority of
patients can be fully dealt with at the primary level. Those who cannot are
referred to the second tier (secondary health care, or the referral services)
for the opinion of a consultant with specialized knowledge or for X-ray
examinations and special tests. Secondary health care often requires the
technology offered by a local or regional hospital. Increasingly, however, the
radiological and laboratory services provided by hospitals are available
directly to the family doctor, thus improving his service to palings and
increasing its range. The third tier of health care employing specialist
services, is offered by institutions such as leaching hospitals and units
devoted to the care of particular groups—women, children, patients with mental
disorders, and so on. The dramatic differences in the cost of treatment at the
various levels is a matter of particular importance in developing countries,
where the cost of treatment for patients at the primary health-care level is
usually only a small fraction of that at the third level- medical costs at any
level in such countries, however, are usually borne by the government.
Ideally, provision of
health care at all levels will be available to all patients; such health care
may be said to be universal. The well-off, both in relatively wealthy
industrialized countries and in the poorer developing world, may be able to get
medical attention from sources they prefer and can pay for in the private
sector. The vast majority of people in most countries, however, are dependent
in various ways upon health services provided by the state, to which they may
contribute comparatively little or, in the case of poor
countries, nothing at all.
Costs of health care. The costs to
national economics of providing health care are considerable and have been
growing at a rapidly increasing rate, especially in countries such as the
United States, Germany, and Sweden; the rise in Britain has been less rapid.
This trend has been the cause of major concerns in both developed and
developing countries. Some of this concern is based upon the lack of any
consistent evidence to show that more spending on health care produces better
health. There is a movement in developing countries to replace the type of
organization of health-care services that evolved during European colonial
times with some less expensive, and for them, more appropriate, health-care
In the industrialized
world the growing cost of health services has caused both private and public
health-care delivery systems to question current policies and to seek more
economical methods of achieving their goals. Despite expenditures, health
services are not always used effectively by those who need them, and results
can vary widely from community to community. In Britain, for example, between
1951 and 1971 the death rate fell by 24 percent in the wealthier sections of
the population but by only half that in the most underprivileged sections of
society. The achievement of good health is reliant upon more than just the
quality of health care. Health entails such factors as good education, safe
working conditions, a favourable environment, amenities in the home, well-integrated
social services, and reasonable standards of living.
In the developing
countries. The developing countries differ from one another culturally, socially,
and economically, but what they have in common is a low average income per
person, with large percentages of their populations living at or below the
poverty level. Although most have a small elite class, living mainly in the
cities, the largest part of their populations live in rural areas. Urban
regions in developing and some developed countries in the mid- and late 20th
century have developed pockets of slums, which are growing because of an influx
of rural peoples. For lack of even the simplest measures, vast numbers of
urban and rural poor die each year of preventable and curable diseases, often
associated with poor hygiene and sanitation, impure water supplies,
malnutrition, vitamin deficiencies, and chronic preventable infections. The
effect of these and other deprivations is reflected by the finding that in the
1980s the life expectancy at birth for men and women was about one-third less
in Africa than it was in Europe; similarly, infant mortality in Africa was
about eight times greater than in Europe. The extension of primary health-care
services is therefore a high priority in the developing countries.
countries themselves, lacking the proper resources, have often been unable to
generate or implement the plans necessary to provide required services at the
village or urban poor level. It has, however, become clear that the system of
health care that is appropriate for one country is often unsuitable for
another. Research has established that effective health care is related to the
special circumstances of the individual country, its people, culture, ideology,
and economic and natural resources.
The rising costs of providing
health care have influenced a trend, especially among the developing nations
to promote services that employ less highly trained primary health-care
personnel who can be distributed more widely in order to reach the largest
possible proportion of the community. The principal medical problems to be
dealt with in the developing world include undernutrition, infection,
gastrointestinal disorders, and respiratory complaints. which themselves may
be the result of poverty, ignorance, and poor hygiene. For the most part, these
are easy to identity and to treat. Furthermore, preventive measures are usually
simple and cheap. Neither treatment nor prevention requires extensive
professional training: in most cases they can be dealt with adequately by the
"primary health worker," a term that includes all nonprofessional
In the developed
countries. Those concerned with providing health care in the developed countries
face a different set of problems. The diseases so prevalent in the Third World
have, for the most part, been eliminated or are readily treatable. Many of the
adverse environmental conditions and public health hazards have been
conquered. Social services of varying degrees of adequacy have been provided.
Public funds can be called upon to support the cost of medical care, and there
are a variety of private insurance plans available to the consumer.
Nevertheless, the funds that a government can devote to health care are limited
and the cost of modern medicine continues to increase thus putting adequate
medical services beyond the reach of many. Adding to the expense of modern
medical practices is the increasing demand for greater funding of health
education and preventive measures specifically directed toward the poor.
PRIMARY HEALTH CARE
In many parts of the world,
particularly in developing countries, people get their primary health care, or
first-contact care, where available at all, from nonmedically qualified
personnel; these cadres of medical auxiliaries are being trained in increasing
numbers to meet overwhelming needs among rapidly growing populations. Even
among the comparatively wealthy countries of the world, containing in all a
much smaller percentage of the world's population, escalation in the costs of
health services and in the cost of training a physician has precipitated some
movement toward reappraisal of the role of the medical doctor in the delivery
of first-contact care.
industrial countries, however, it is usually a trained physician who is called
upon to provide the first-contact care. The patient seeking first-contact care
can go either to a general practitioner or turn directly to a specialist. Which
is the wisest choice has become a subject of some controversy. The general practitioner,
however, is becoming rather rare in some developed countries. In countries
where he does still exist, he is being increasingly observed as an obsolescent
figure, because medicine covers an immense, rapidly changing, and complex
field of which no physician can possibly master more than a small fraction. The
very concept of the general practitioner, it is thus argued, may be absurd.
alternative to general practice is the direct access of a patient to a
specialist. If a patient has problems with vision, he goes to an eye
specialist, and if he has a pain in his chest (which he fears is due to his
heart), he goes to a heart specialist. One objection to this plan is that the
patient often cannot know which organ is responsible for his symptoms, and the
most careful physician, after doing many investigations, may remain uncertain
as to the cause. Breathlessness—a common symptom—may be due to heart disease,
to lung disease, to anemia, or to emotional upset. Another common symptom is
general malaise—feeling run-down or always tired; others are headache, chronic
low backache, rheumatism, abdominal discomfort, poor appetite, and
constipation. Some patients may also be overtly anxious or depressed. Among the
most subtle medical skills is the ability to assess people with such symptoms
and to distinguish between symptoms that are caused predominantly by emotional
upset and those that are predominantly of bodily origin. A specialist may be
capable of such a general assessment, but, often, with emphasis on his own
subject, he fails at this point. The generalist with his broader training is
often the better choice for a first diagnosis, with referral to a specialist as
the next option,
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