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History and Culture of Medicine

AHS 1600 Fall 2012
by

Shailendra Prasad

on 20 September 2012

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Transcript of History and Culture of Medicine

AHS 1600 Fall 2012 History and Culture of Medicine …avoiding therapeutic nihilism and overtreatment…
…. art as well as science…
…maybe within my power to take life…
…I do not treat a fever chart…
…prevention preferable to cure… Hippocratic oath - modern Used as a nausea medicine in pregnancy in the 1950s

Deformed babies noted

“phocomelia”

Led to formation and increased power of the FDA Thalidomide What is the purpose of
Medicine/Healthcare? “are we losing our soul”
Reductionistic
At least the writing is legible!
Consolidation of information Electronic medical record “ I love you from the bottom of my Liver” (!)

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 … teach medicine to the sons of my teacher…
…  I will not give a lethal drug
euthanasia, legal executions, medical abortions
… avoid violating the morals
revoke a physician's license for “ moral turpitude”
…not cut for stone
Surgery not recognized as a specialty
… good of the patient …highest priority
conflicting 'good purposes,’ Challenges to the oath Hippocratic Oath - Original
…prescribe …according to my ability and my judgment and never do harm…
…not give lethal drug to anyone… and … cause an abortion.
But I will preserve the purity of my life and my arts.
… not cut for stone, leave this to specialists in this art.
… good of my patients…. far from all intentional ill-doing and all seduction
…I will keep secret and will never reveal… The Creed of 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
Administration costs
Legal issues

Necessary evil Downside of Organized Medicine So why bother with all this? From Arab medicine- translation to Latin

Mostly from the 1200s CE

Slow spread

Start of Schools of Medicine in Italy (1400s) “Scientific medicine” in Europe Cause of illness

Medications

Creed of Medicine

Language of Medicine Place holders Science (Thinking)
Careful measurements
Looking for norms, patterns
‘reductions’
Unemotional
Art (Feeling)
Coaxing information
Beauty
Merging 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
Penicillin

Some from too much hype/faith
Opium Medications vs. “Eminence” based medicine

Not enough evidence for many things

Evidence changes! “Evidence Based Medicine” Growth into institutions

Buildup of scientific knowledge

Protection of people within the fold

Regulatory
Control of charlatans Organized Medicine Evil spirits

Minoans practiced trephination ~2500 BCE

Banishing evil spirits
Exorcism
Amulets and sacrifices Cause of illness How did we get here?

Where are we?

Medicine as a Science and an Art
what does that mean?

Continuation into future classes Objectives Cognitive base
Experiential learning
Continuity
Role Modeling
Mentorship REVITALIZING PROFESSIONALISM 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 REVITALIZATION 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 21st CENTURY CONCERNS Training is intellectual and involves knowledge
Work pursued primarily for others
Success should be measured by more than financial return

Justice Louis Brandeis A PROFESSION -Inui THE PROFESSION OF MEDICINE Where are we today? Great scientific discoveries in last 150 years
cellular > ultramicroscopic
great leaps in technology what next? Mistrust? Oregon Faith Healer gets probation in son's death abc news 9/20/2012 CQ +PQ >IQ Thomas Friedman
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