# Scouting/BSA/Medicine Merit Badge
## Key Historical Figures in Medicine

Discuss with your counselor the influence that EIGHT of the following people had on the history of medicine:
Hippocrates of Cos (c. 460 BC - 377 BC) was an Ancient Greek physician, is commonly regarded as one of the most outstanding figures in medicine of all time and has been called the father of medicine.
William Harvey (April 1, 1578 - June 3, 1657) was a doctor who first correctly described in exact detail the circulatory system of blood being pumped around the body by the heart.
Anton van Leeuwenhoek (October 24, 1632 - August 26, 1723) was a tradesman and scientist from Delft, in the Netherlands. He is best known for his contribution to improvement of the microscope and his contributions towards the establishment of cell biology. Using his handcrafted microscope he was the first to observe and describe muscles fibres, bacteria, spermatozoa and blood flow in capillaries (small blood vessels).
Edward Jenner (May 17, 1749 - January 26, 1823) was an English country doctor practicing in Berkeley, Gloucestershire, England, made famous by his invention of the vaccine.
Florence Nightingale (May 12, 1820 - August 13, 1910) - The Lady With The Lamp - was the pioneer of modern nursing.
Louis Pasteur (December 27, 1822 - September 28, 1895) was a French scientist who was a pioneer in microbiology.
Gregor Mendel was born on July 22, 1822, in Heinzendorf, Austria (now Hyncice, Czech Republic). He studied the inheritance of traits in pea plants, discovering the basic laws of inheritance. He is often called the father of genetics.
Joseph Lister, 1st Baron Lister (April 5, 1827-February 10, 1912) was a famous British surgeon who promoted the idea of sterile surgery while working at the Glasgow Infirmary. He came from a rich Quaker home in Yorkshire.
Robert Koch (December 11, 1843 - May 27, 1910) was a German physician. He became famous for the discovery of the tubercle bacillus (1882) and the cholera bacillus (1883) and for his development of Koch's postulates. He was awarded the Nobel Prize in Physiology or Medicine in 1905. He is considered one of the founders of bacteriology.
Wilhelm Röntgen (March 27, 1845 - February 10, 1923) was a German physicist, of the University of Würzburg, who, on November 8, 1895, produced wavelengths of electromagnetic radiation that are now known as x-rays. The machine which Röntgen built to emit these rays, was the x-ray machine.
Marie (November 7, 1867 – July 4, 1934) and Pierre Curie (May 15, 1859 – died April 19, 1906) were pioneers in the early field of radiation. Both were Nobel Laureates in recognition of the extraordinary services they have rendered by their joint researches on the radiation phenomena.
Walter Reed (September 13, 1851 - November 23, 1902) was an American Army surgeon who led a team which discovered that yellow fever is transmitted by mosquitos rather than direct contact. This insight opened entire new fields of epidemiology and biomedicine and most immediately allowed the resumption and completion of work on the Panama Canal (1904-14) by the United States.
Karl Landsteiner (June 14, 1868 - June 26, 1943), was an Austrian biologist. In 1909 he developed the modern system of classification of blood groups and later identified agglutins and Rhesus factor for which he won the 1930 Nobel Prize in Physiology and Medicine.
Alexander Fleming (August 6, 1881 - March 11, 1955) a Scottish biologist and pharmacologist. Fleming published many articles on bacteriology, immunology, and chemotherapy. His best-known achievements are the discovery of the enzyme lysozyme in 1922 and isolation of the antibiotic substance penicillin from the fungus Penicillium notatum in 1928, for which he shared the Nobel Prize in Physiology or Medicine in 1945
Jonas Salk (October 28, 1914 - June 23, 1995) is the discoverer/inventor of the vaccine for Polio which proved to be the first successful vaccine against a virus. The vaccine provides the recipient with immunity against Polio, and was seminal in the near eradication of a once widely-feared disease.
James D. Watson and Francis Crick are American molecular biologist who are best known as the co-discoverers of the structure of DNA. This earned them the 1962 Nobel Prize in Physiology and Medicine and a correct understanding of how "the molecular structure of nucleic acids transfer information in living material".[1]

## Hippocratic Oath

Explain the Hippocratic Oath to your counselor, and compare the original version to a more modern one. Discuss to whom those subscribing to the original version of the oath owe the greatest allegiance.
* Original text of the Hippocratic Oath:
* Modern text (from the Declaration of Geneva):

## Patient-Physician Relationship

Discuss the health care "provider-patient" relationship with your counselor, and the importance of such a relationship in the delivery of quality care to the patient. Describe the role of confidentiality in this relationship.
* The essential nature of the Provider-Patient Relationship to the practice of medicine from the American Medical Association
** Informed Consent
** Ending the Patient-Physician Relationship
** Patient Confidentiality
** Patient Safety

## Generalist and Specialists with Medicine
### Describe the roles the following people play in the delivery of health care in your state.

* Physician - a person who practices some type of human biological medicine
* Chiropractor - A system of therapy in which disease is considered the result of abnormal function of the skeletal system
* Optometrist - studies the eyes and disorders of the eye
* Podiatrist - studies the feet and disorders of the foot
* Pharmacist - specialist in the use, function, and side effects of medication
* Psychologist - studies the mind and disorders of the mind
* Physician's assistant - are persons trained, certified, and licensed to take medical histories, conduct physical examinations, and diagnose and treat medical problems under the supervision of physicians.
* Nurse practitioner - a registered nurse who, through advanced training, is qualified to assume some of the duties and responsibilities formerly assumed only by a physician.
* Nurse-midwife - a registered nurse who has received additional training as a midwife, delivers infants, and provides antepartum and postpartum care
* Registered nurse - a graduate nurse who has passed a state board examination and been registered and licensed to practice nursing.
* Licensed vocational/practical nurse - a person who has not graduated from an accredited school of nursing but whose vocation is caring for the sick.
* Medical assistant - a person trained to assist medical professionals
* Emergency medical technician - stabilizes and cares for patients en route to advanced treatment
* Medical laboratory technologist - a health-care professional who performs laboratory testing and analysis.
* Radiologic technologist - a physician specializing in the use of radiant energy for diagnostic and therapeutic purposes.
* Physical therapist - therapist who treats injury or dysfunction with exercises and other physical treatments of the disorder.
* Occupational therapist - therapist who performs treatment or rehabilitation of physically or emotionally disabled people.
* Respiratory therapist - therapist who performs treatment or management of acute and chronic breathing disorders, as through the administration of medication in the aerosol form and the use of ventilators and other life support systems.

### Primary Care

Tell what is meant by the term "primary care" within medicine. Briefly describe the types of work done by the physicians in the following "core" areas. Describe the educational requirements for these areas of medicine
* Primary Care definitions:
** "Provision of health care that has the following six essential qualities -- accessible, acceptable, accountable, comprehensive, coordinated and continuing."
** "Provision of integrated, accessible health care services by clinicians who are accountable for addressing a large majority of personal health care needs, developing a sustained partnership with patients, and practicing in the context of family and community."
** "Provision of services that include health promotion, identification of individuals at special risk, early detection of serious disease, management of acute emergencies, rendering continuous care to chronically ill patients, and referring the enrollee to another provider when necessary."
* Primary Care Physician - training is accredited by the American College of Graduate Medical Education
** Internal medicine - 3 year accredited residency program which meets the clinical, academic, and related Internal Medicine objectives of the ACGME
** Family practice - 3 year accredited residency program which meets the clinical, academic, and related Family Medicine objectives of the ACGME
** Obstetrics/gynecology - 4 year accredited residency program which meets the clinical, academic, and related Obstetrics and Gynecology objectives of the ACGME
** Pediatrics - 3 year accredited residency program which meets the clinical, academic, and related Pediatrics objectives of the ACGME
** Psychiatry - 4 year accredited residency program which meets the clinical, academic, and related Psychiatry objectives of the ACGME
** Surgery - 5 year accredited residency program which meets the clinical, academic, and related Surgery objectives of the ACGME

### Specialty Care

Tell what is meant by the term "specialty care" within medicine. Briefly describe the types of work done by the FIVE of the specialty areas of medicine shown below. Describe the additional educational requirements for these specialty areas of medicine.
* Specialty Care definitions:
** Description of Medical Specialties
** Typical a physician who has received additional education, experience, and expertise beyond a general residency in a accredited medical specialty program. The additional training is often called a fellowship, wherein they receive concentrated and specialized training. In the medical profession, specialists often serve as consultants, being called into difficult or challenging cases that are beyond the skill or training of a general physician.
* Specialty Care Physicians - training is also accredited by the American College of Graduate Medical Education
** Anesthesiology - 4 year accredited residency program which meets the clinical, academic, and related Anesthesia objectives of the ACGM
** Emergency Medicine - 3 year accredited residency program which meets the clinical, academic, and related Emergency Medicine objectives of the ACGM
** Infectious Disease - is a 1-3 year fellowship completed after a 3 year internal medicine residency program.
** Orthopedic Surgery - 5 year accredited residency program which meets the clinical, academic, and related Anesthesia objectives of the ACGM
** Vascular Surgery - is a minimum 2 year fellowship completed after a 5 year surgical residency program.
* Other Specialty Care Physicians
** Allergy/Immunology - specialization of disorders of the immune allergic/immune system.
** CardioThoracic Surgery - specialization in the surgical repair of cardiovascular system (congential abnormalities, heart transplant, coronary artery disease surgeries, etc) related disorders
** Colon and rectal surgery - specialization in the surgical repair of disorders of the lower gastrointestinal tract including the colon and rectum.
** Dermatology - specialization in the management of skin related disorders.
** Endocrinology - specialization in the management of the endocrine system, including the effect of hormones on metabolism, physiologic function, and overall health.
** Gastroenterology - specialization in the management of the gastrointestinal system (mouth to anus)
** Geriatric Medicine - specialization in the management of health, disease, and related ailments of aging.
** Hematology/Oncology - specialization in the management of cancer and blood related diseases.
** Nephrology - specialization in the management of kidney related disease.
** Neuro Surgery - specialization in the surgical management of nervous system disorders.
** Neurology - specialization in the medical management of nervous system disorders
** Nuclear medicine - specialization in the use of radioactivity in medicine (both imaging and treatment).
** Ophthalmologist - specialization in the management of the eye
** Otolaryngology - specialization in the management of the Ear, Nose, and Throat
** Pathology - specialization in the understanding of identification and cellular processes of disease.
** Physical Medicine and Rehabilitation - specialization in the management of patients requiring extensive rehabilitation.
** Plastic Surgery - specialization in the surgical management of traumatic and cosmetic repair of the body
** Preventive Medicine - specialization in public health and population based medicine
** Radiology - specialization in various technologies for imaging the human body as part of the diagnostic and treatment process.
** Rheumatology - specialization in the management of the joints and allied conditions of the connective tissues.
** Urology - specialization in the medical and surgical issues related to the kidneys, bladder, and reproductive systems.

### Office Visit

Visit a physician's office, preferably one who delivers "primary care" (This may be that of your counselor) and do the following:
* Discuss components of a medical history and physical examination (an official BSA health form may be used to guide this discussion), and become familiar with the instruments used.
* If this cannot be arranged, demonstrate to your counselor that you understand the components of a medical history and physical, and discuss the instruments involved.

### Diagnostic Testing

Describe the characteristics of a good diagnostic test to screen for disease (e.g. routine blood pressure measurement). Explain briefly why diagnostic tests are not perfect.
Each diagnostic tests has different properties or abilities to accurately determine results. A good diagnostic test would be one in which the test is highly reliable for accurately diagnosing the condition of interest, would be inexpensive to administer, and would provide results quickly. In addition to how the test itself performs, one must ask if the result from test can be used to guide subsequent decisions on starting, stopping, or modifying treatment. Consequently, the practical value of a diagnostic test can only be assessed by taking into account subsequent health outcomes. In determining the value of various diagnostic tests, it is important to distinguish between these two features of the test (accuracy of the test itself) and (ability of the test to guide therapeutic decision making in altering health outcomes).
In terms of accuracy, diagnostic tests are judged by several characteristics, including:
* Sensitivity
* Specificity
* False Positive
* False Negative
| Actual condition | Actual condition |
Example, using pregnancy test results:
| Actual condition | Actual condition |

### Taking a Blood Pressure Reading

Show how to take a blood pressure reading and a pulse reading.
* Taking a Blood Pressure
* Anatomy of Blood Pressure:
| File:BP System.jpg Blood Pressure System | File:BP Measurement.gif Blood Pressure Measurement | Blood Pressure Equipment |

## Health Care System

* Discuss the roles medical societies, the insurance industry, and the government play in influencing the practice of medicine in the United States.
** Medical Societies. These groups, made up of physician members of a designated specialty or common interest, can have a significant influence over the way their specialty is practiced. The traditional role of these societies has been to certify or license or practice in the designated field. Medical societies can be very effective in protecting the interests of the society through political action groups, accelerate the sharing of best practices across the field, and as an organizing influence for ongoing education, specialization, and training.
** Insurance Industry - this industry has a major impact on medicine as it has developed into the primary means (~55%) whereby health care services are paid for. The essential idea behind insurance is to protect against risk - meaning that people are willing to pay insurance companies a known quantity of money (in the form of a monthly/annual "premium") to protect them against unknown medical expenses. Insurers often set the prices, determine if a medical expense meets their criteria for payment, and can significantly influence practice patterns by how they reimburse, or pay, for various healthcare services. Given the way the current insurance industry has been organized, they are often in an adversarial relationship with medical providers and the patients they serve.
** Government. In the United States, the government pays for ~45% of all health care expenses. As a result, they have significant ability to influence the way medicine is practiced, the way that it is paid for, and how the delivery of health care is legislated. Government needs to be careful of this influence, and the traditional accepted role of government is not to intervene with the free market, but rather create an environment of standards, interoperability, and similar policies that enable
* Briefly tell how your state monitors the quality of health care within its borders, and how it provides care to those who do not have health insurance.
** Monitoring Quality - There are multiple quality organizations in the state of California. Medical Societies police themselves through a combination of licensure, certification, and ongoing education. Medical Boards are created as to ensure that standards of care are set and maintained by those who practice within that specialty. In addition, there are multiple public-private initiatives within the state to measure, monitor, and report the quality of care within the State.
** Caring for those with no health insurance - This is an extremely challenging problem as there are more than 45 million people in the United States who do not have health insurance. In California, approximately 7 million people are uninsured. Governor Arnold Schwarzenegger has proposed for sweeping changes in California's health care system to ensure that all Californians can obtain health care insurance. He presented the outline of his proposal in February 2007, and later called a special session of the state legislature in the fall of 2007, to debate the proposal. The essential concept is that we must provide insurance to all through a "shared responsibility" which includes taxes to businesses, hospitals, and physicians; some combination of touch credits/vouchers for the uninsured, and an increased public health awareness on prevention and healthy choices.

## Global Health Care Delivery

Compare and discuss with your counselor the health care delivery systems in the United States, Sweden, and China.
* United States
** US Health Care Preview
* Sweden
** In Sweden, the publicly funded medical system is comprehensive and compulsory. Physician and hospital services take a small patient fee, but their services are funded through the taxation scheme of the County Councils of Sweden. There is a small private insurance industry in Sweden.
** WHO Statistics on Sweden
** Some positive results of this form of healthcare
* China
** Who Statistics on China also at: http://www.ncbi.nlm.nih.gov/pubmed/8985446

## Health Care Volunteer

Serve as a volunteer at a health-related event or facility in your community (e.g. blood drive, "health fair", blood pressure screening, etc.) approved by your counselor.

## External links

* Medicine Merit Badge with Workbook PDF, current requirements, and resources.
* Earning Merit Badges in the Boy Scouts of America
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