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History and Culture of Medicine 2014
Transcript of History and Culture of Medicine 2014
History and Culture of Medicine
Used as a nausea medicine in pregnancy in the 1950s
Deformed babies noted
Led to formation and increased power of the FDA
What is the purpose of
“are we losing our soul”
At least the writing is legible!
Consolidation of information
Electronic medical record
Use of Latin to use of common language
“Patients don’t read textbooks”
Advent of Electronic Medical Records
Language in Medicine
36 yo aa f ĉ ESRD 20 HTN, DM II, CAD, PVD on HD – MWF
SHx – EtoH, Tob, NonCompliance
Presents – CP, SOB x 3 days; N/V +; 4/10; mid chest, rad to neck
Language in Medicine
Costs $800 million to $ 2 billion /drug
Of 250 candidate drugs 10 get to phase I human trials
Phase I – safety trials in human volunteers
Phase II – small scale studies in target population
Phase III – large scale studies in target populations
New “designer” medications
Increased cost of care
Downside of Organized Medicine
So why bother with all this?
Influenced by Indian, Greek, Roman and Byzantine medical systems
Large and Complex Medical Literature
Cause of illness: Why?
Tools to heal: What?
Looking for norms, patterns
Art and Science of Medicine
Medicine is a science of uncertainty and an art of probability
-Sir William Osler
Voltaire, French philosopher
"The art of medicine consists of amusing the patient while nature cures the disease."
Some from careful observations
Lithium for depression
Idea that uric acid causes depression
Lithium given to form Lithium urate salt- that would be flushed from Kidney
Some from dumb luck
Some from too much hype/faith
vs. “Eminence” based medicine
Not enough evidence for many things
“Evidence Based Medicine”
Growth into institutions
Buildup of scientific knowledge
Protection of people within the fold
Control of charlatans
Minoans practiced trephination ~2500 BCE
Banishing evil spirits
Amulets and sacrifices
Explain how we got here?
What is the current state?
Medicine: Science and an Art - what does that mean?
Current strategy is inadequate
Production of highly skilled technicians but not necessarily true professionals
Must strike a balance between explicit teaching and experiential learning incorporating the values of professionalism
Acquisition of a knowledge base
Acquisition of skills
Acquisition of an understanding of ethical standards, social roles and responsibilities
THE APPRENTICESHIP OF PROFESSIONALISM
THE CHANGING FACE OF MEDICINE
Specialization of medicine
Patient Centered Care
Team based care
Newer models of care
Training is intellectual and involves knowledge
Work pursued primarily for others
Success should be measured by more than financial return
Justice Louis Brandeis
THE PROFESSION OF MEDICINE
Oregon Faith Healer gets probation in son's death
abc news 9/20/2012
CQ +PQ >IQ
Through examination of patient and inspection of symptoms, it is possible to determine the disease, etiology and future course of an illness.
If that fails, go back to magic
Ayurveda: "Complete Knowledge for Long Life"
8 branches of medicine
Areas of study: 7 years
Empirical observation grew from Taoist tradition
massage (tui na)
Practice of observing patients 700 BCE
Humoral Medicine System
"Father of Western Medicine"
rational systematic approach
Medicine in Western Roman Europe went into deep decline until Islamic influences in Spain in the 12th Century
Medical schools started in 1200s in Italy
3 yrs prelim training
5 years medical training
Translation of Islamic and Greek works into Latin
Increase in experimental investigation
Age of Enlightenment: 18th Century
Science held in high esteem
Physicians upgraded social status
Still, most of health field had no formal medical education and were self-taught
Hospitals became more common
Rise of Modern Medicine:
Hospital docs more systematic/analytical
Application of scientific method to medical research and EBM
WWI and WWII -> Surgical Advancements