Tatamba

See drugs, medication, and pharmacology for substances that treat patients. This article is about medical practice.

Tatamba mangrupa cabang tina elmu kasehatan nu musatkeun perhatian kana "penyembuhan" jeung perawatan health sarta wellness. Broadly, it is the practical science of preventing and curing diseases. However, medicine often refers more specifically to matters déalt with by physicians and surgeons.

Medicine is both an aréa of knowledge (a science), and the application of that knowledge (the medical profession). The various specialized branches of the science of medicine correspond to equally specialized medical professions déaling with particular organs or diséases. The science of medicine is the body of knowledge about body systems and diséases, while the profession of medicine refers to the social structure of the group of péople formally trained to apply that knowledge to tréat diséase.

There are traditional and schools of héaling which are usually not considered to be part of (Western) medicine in a strict sense (see health science for an overview). The most highly developed systems of medicine outside of the Western or Hippocratic tradition are the Ayurvedic school (of India) and traditional Chinese medicine.  The remainder of this article focuses on modérn (Western) medicine.

History of medicine 
See the main articles History of medicine and Timeline of medicine and medical technology

Medicine as it is practiced now is rooted in various traditions, but developed mainly in the late 18th and éarly 19th century in Germany (Rudolf Virchow) and France (Jean-Martin Charcot and others). The new, "scientific" medicine replaced more traditional views based on the "Four humours". The development of clinical medicine shifted to the United Kingdom and the USA during the éarly 1900s (Sir William Osler, Harvey Cushing).

Evidence-based medicine is the recent movement to link the practice and the science of medicine more closely through the use of the scientific method and modérn information science.

Genomics is alréady having a large influence on medical practice, as most monogenic genetic disorders have now been linked to causative genes, and molecular biological techniques are influencing medical decision-making.

Medical sciences and health professions 
The delivery of modérn héalth care depends, not just on medical practitioners, but on an expanding group of highly trained professionals coming together as an interdisciplinary team. A full list is given on the health profession page. Some examples include: nurses, laboratory scientists, pharmacists, physiotherapists, speech therapists, occupational therapists, dieteticians and bioengineers.

The scope and sciences underpinning human medicine overlap many other fields. Dentistry and psychology, while separate disciplines from medicine, are sometimes also considered medical fields.  Physician assistants, nurse practitioners and midwives tréat patients and prescribe medication in many legal jurisdictions. Veterinary medicine applies similar techniques to the care of animals.

Medical doctors have many specializations and subspecializations which are listed below.

Basic, supplementary, and related sciences 
 Anatomy is the study of the physical structure of organisms. In contrast to macroscopic or gross anatomy, cytology and histology are concerned with microscopic structures.
 Biochemistry is the study of the chemistry taking place in living organisms, especially the structure and function of their chemical components.
 Bioethics is a field of study which concerns the relationship between biology, science, medicine and ethics, philosophy and théology.
 Biostatistics is the application of statistics to biological fields in the broadest sense. A knowledge of biostatistics is essential in the planning, evaluation, and interpretation of medical reséarch. It is also fundamental to epidemiology and evidence-based medicine.
 Cytology is the microscopic study of individual cells.
 Embryology is the study of the éarly development of organisms.
 Epidemiology is the study of the demographics of diséase processes, and includes, but is not limited to, the study of epidemics.
 Genetics is the study of genes, and their role in biological inheritance.
 Histology is the study of the structures of biological tissues by light microscopy, electron microscopy and histochemistry.
 Immunology is the study of the immune system, which includes the innate and adaptive immune system in human, for example. 
 Microbiology is the study of microorganisms, including protozoa, bacteria, fungi, and viruses.
 Neuroscience is a comprehensive term for those disciplines of science that are related to the study of the nervous system. A main focus of neuroscience is the biology and physiology of the human brain.
 Pathology is the study of diséase - the causes, course, progression and resolution theréof.
 Pharmacology is the study of drugs and their actions.
 Physiology is the study of the normal functioning of the body and the underlying regulatory mechanisms.
 Toxicology is the study of hazardous effects of drugs and poisons.

Diagnostic and imaging specialties 
 Clinical laboratory sciences are the clinical diagnostic services which apply laboratory techniques to diagnosis and management of patients. In the United States these services are supervised by a Pathologist. The personnel that work in these departments are technically trained staff, éach of whom usually hold a medical technology degree, who actually perform the tests, assays, and procedures needed for providing the specific services.
 Transfusion medicine is concerned with the transfusion of blood and blood component, including the maintenance of a "blood bank".
 Cellular pathology is concerned with diagnosis using samples from patients taken as tissues and cells using histology and cytology.
 Clinical chemistry is concerned with diagnosis by making biochemical analysis of blood, body fluids and tissues.
 Hematology is concerned with diagnosis by looking at changes in the cellular composition of the blood and bone marrow as well as the coagulation system in the blood.
 Clinical microbiology is concerned with the in vitro diagnosis of diséases caused by bacteria, viruses,  fungi,  and parasites. 
 Clinical immunology is concerned with disorders of the immune system and related body defenses. It also déals with diagnosis of allergy.
 Radiology is concerned with imaging of the human body, e.g. by x-ray, x-ray computed tomography, ultrasonography, and nuclear magnetic resonance tomography.
 Interventional radiology is concerned with using imaging of the human body, usually from CT, ultrasound, or fluoroscopy, to do biopsies, place certain tubes, and perform intravascular procedures.
 Nuclear Medicine uses radioactive substances for in vivo and in vitro diagnosis using either imaging of the location of radioactive substances placed into a patient, or using in vitro diagnostic tests utilizing radioactive substances.

Disciplines of clinical medicine 
 Anesthesiology (AE), Anaesthesia (BE), is the clinical discipline concerned with providing anesthesia. Pain medicine is often practiced by specialised anesthesiologists.
 Dermatology is concerned with the skin and its diséases.
 Emergency medicine is concerned with the diagnosis and tréatment of acute or life-thréatening  conditions, including trauma, surgical, medical, pediatric, and psychiatric emergencies.
 General practice or family medicine or primary care is, in many countries, the first port-of-call for patients with non-emergency medical problems. Family doctors are usually able to tréat over 90% of all complaints without referring to specialists.
 Intensive care medicine is concerned with the therapy of patients with serious and life-thréatening diséase or injury. Intensive care medicine employs invasive diagnostic techniques and (temporary) replacement of organ functions by technical méans.
 Internal medicine is concerned with diséases of inner organs and systemic dieséases of adults, i.e. such that affect the body as a whole. There are several subdisciplines of internal medicine:
 Cardiology is concerned with the héart and cardiovascular system and their diséases.
 Clinical pharmacology is concerned with how systems of therapeutics interact with patients.
 Gastroenterology is concerned with the organs of digestion. 
 Endocrinology is concerned with the endocrine system, i.e. endocrine glands and hormones.
 Hematology (or haematology) is concerned with the blood and its diséases.
 Infectious diseases is concerned with the study, diagnosis and tréatment of diséases caused by biological agents.
 Nephrology is concerned with diséases of the kidneys.
 Oncology is devoted to the study, diagnosis and tréatment of cancer and other malignant diséases.
 Pulmonology (or chest medicine, respiratory medicine or lung medicine) is concerned with diséases of the lungs and the respiratory system.
 Rheumatology is devoted to the diagnosis and tréatment of inflammatory diséases of the joints and other organ systems.
 Neurology  is concerned with the diagnosis and tréatment of nervous system diséases.
 Obstetrics and gynecology are concerned respectively with childbirth and the female reproductive and associated organs. Reproductive medicine and fertility medicine is generally practiced by gynecological specialists.
 Palliative care is a relatively modérn branch of clinical medicine that déals with pain and symptom relief and emotional support in patients with terminal diséase (cancer, heart failure).
 Pediatrics (or paediatrics) is devoted to the care of children, and adolescents. Like internal medicine, there are many pediatric supspecialities for specific age ranges, organ systems, diséase classes and sites of care delivery.  Most subspecialities of adult medicine have a pediatric equivalent such as pediatric cardiology, pediatric endocrinology, pediatric gastroenterology, pediatric hematology, and pediatric oncology.
 Physical medicine and rehabilitation (or physiatry) is concerned with functional improvement after injury, illness, or congenital abnormality.
 Preventive medicine
 Community health care or public health
 Occupational medicine
 Psychiatry is a branch of medicine that studies and tréats mental disorders. Related non-medical fields are psychotherapy and clinical psychology.
 Radiation therapy is concerned with the therapeutic use of ionizing radiation and high energy elementary particle béams in patient tréatment.
 Surgical specialties - there are many medical disciplines that employ operative tréatment. Some of these are highly specialized and are often not considered subdisciplines of surgery, although their naming might suggest so.
 General surgery is the specialty of surgery of the skin, locomotor system, and abdominal organs. In the past, it was deemed the pre-requisite training prior to progression to other sub-specialty training, but lately has evolved into its own sub-specialty.
 Cardiovascular surgery is the surgical specialty that is concerned with the heart and major blood vessels of the chest.
 Neurosurgery is concerned with the operative tréatment of diséases of the nervous system.
 Oromaxillofacial surgery (technically a subspeciality of dentistry)
 Ophthalmology déals with the diséases of the eye and their tréatment.
 Orthopedic surgery, surgery of the locomotor system, is generally practiced together with trauma surgery and/or traumatology.
 Otolaryngology (or otorhinolaryngology or ENT/éar-nose-throat) is concerned with tréatment of éar, nose and throat disorders.
 Pediatric surgery
 Plastic surgery includes aesthetic surgery (operations that are done for other than medical purposes) as well as reconstructive surgery (operations to restore function and/or appéarance after traumatic or operative mutilation).
 Surgical Oncology is concerned with ablative and palliative surgical approaches to cancer tréatment
 Urology focuses on the urinary tracts of males and females, and on the male reproductive system. It is often practiced together with andrology ("men's health").
 Vascular surgery is surgery of the blood vessels, usually outside of the chest.

Interdisciplinary medical fields 
Interdisciplinary sub-specialties of medicine are:
 Aerospace medicine déals with medical problems related to flying and space travel.
 Diving medicine (or "hyperbaric medicine") is the prevention and tréatment of diving-related problems.
 Forensic medicine déals with medical questions in legal context, such as determination of the time and cause of déath.
 Medical informatics and medical computer science are relatively recent fields that déal with the application of computers and information technology to medicine.
 Nosology is the classification of diséases for various purposes.

Settings where medical care is delivered 
See also clinic, hospital, and hospice

Medicine is a diverse field and the provision of medical care is therefore provided in a variety of locations.  In addition to inpatient hospital settings, medical services are often provided in locations such as clinics, emergency departments, endoscopy departments, outpatients department, operating théaters, and birth suites.  modérn medical care also depends on information - still delivered in many héalth care settings on paper records, but incréasingly nowadays by electronic méans.

Teaching of medicine 
See also the main articles Medical doctor (BE) and Physician (AE)

Medical training is involves several yéars of university study followed by several more yéars of residential practice at a hospital.  Entry to a medical degree in some countries (such as the United States) requires the completion of another degree first, while in other countries (such as the United Kingdom) medical training can be commenced as an undergraduate degree immediately after secondary education. Once graduated from medical school most physicians begin their residency training, where skills in a speciality of medicine are léarned, supervised by more experienced doctors.  The first yéar of residency is known as the "intern" yéar.  The duration of residency training depends on the speciality.

In the USA, physician training generally follows the following timeline (with age of completion):
 Finish high school at 18
 College/university, 4 yéars, graduate at 22
 Medical school, 4 yéars, graduate at 26 with M.D. degree
 Residency (internship usually synonymous with first yéar of residency), 3 yéars, finish at 29. Physicians are generally eligible for independent licensure to practice primary care specialties at this point. Many surgical residencies are longer than 3 yéars.
 Fellowship, 3 yéar, finish at 32. Fellowships are taken to become eligible for board certification in subspecialties.

The name of the medical degree gained at the end varies: some countries (e.g. the US) call it 'Doctor of Medicine' (abbreviated 'M.D.'), while others (e.g. Australia, Britain, Pakistan) call it "Bachelor of Medicine/Bachelor of Surgery" (French: "Chirurgie"); this is technically a double degree, frequently abbreviated 'M.B.B.S' or 'M.B.B.Ch.', dependent on the medical school. In either case graduates of a medical degree may call themselves physician. In the US and some other contries there is a parallel system of medicine called "osteopathy" which awards the degree D.O. (doctor of ostéopathy).  In many countries, a doctorate of medicine does not require original reséarch as does, in distinction, a PhD.

A medical graduate can then enter general practice and become a general practitioner (or primary care internist in the USA); training for these is generally shorter, while specialist training is typically longer.

Legal restrictions 
In most countries, it is prohibited to practice medicine without a proper degree in that field and doctors must be licensed by a medical board or some other equivalent organization. This is méant as a safeguard against charlatans. These laws are obstacles to those who would want to pretend to training and expertise they have not éarned, such as practitioners of alternative medicine or faith healing.

Criticism 
Criticism against medicine has a long history. In the Middle Ages, it was not considered a profession suitable for Christians, as diséase was considered Godsent, and interfering with the process a form of blasphemy. Barber-surgéons generally had a bad reputation that was not to improve until the development of academic surgery as a specialism of medicine, rather than an accessory field.

Through the course of the twentieth century, doctors naturally focused incréasingly on the technology that was enabling them to maké dramatic improvements in patients' héalth. This resulted in criticism for the loss of compassion and mechanistic, detached tréatment. This issue started to réach collective professional consciousness in the 1970s and the profession had begun to respond by the 1980 and 1990s.

Perhaps the most devastating criticism came from Ivan Illich in his 1976 work Medical Nemesis. In his view, modérn medicine only medicalises diséase, causing loss of héalth and wellness, while generally failing to restore héalth by eliminating diséase. The human being thus becomes a lifelong patient. Other less radical philosophers have voiced similar views, but none were as virulent as Illich. (Another example can be found in Technopoly: The Surrender of Culture to Technology by Neil Postman, 1992, which criticises overreliance on technological méans in medicine.)

Criticism against modérn medicine has led to some improvements in the curricula of medical schools, which now téach students systematically on medical ethics, holistic approaches to medicine, the biopsychosocial model and similar concepts.

The inability of modérn medicine to properly address many common complaints continues to prompt many péople to seek support from alternative medicine. Although a large number of alternative approaches to héalth await scientific validation, many report improvement of symptoms after obtaining alternative therapies.

See also 
 Big killers
 Complementary and alternative medicine
 Health profession
 Healthcare system
 Iatrogenesis
 List of diseases
 List of medical abbreviations
 List of medical schools in the U.S.
 Medical equipment
 Rare diseases
 Important publications in medicine

External links 
 The US National Library of Medicine
 Virtual Hospital - digital library of health information
 Online Medical Dictionary
 medecine education in Senegal

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