MA-201 Book Notes Ch. 2 Medical Science: History and Practice
History of Medicine
Early human attempts to practice medicine are evidenced by drawings, bony remains, and archaic surgical tools.
Folk medicine used trial-and-error to identify medicinal plants and distinguish them from poisonous ones.
Ailments often attributed to supernatural causes (demons, evil spirits, offended gods); treatments aimed to remove perceived evil intruders from the body (e.g., a demon or a worm).
First doctors were shamans, witch doctors, or sorcerers, often called "medicine men" and "medicine women."
In 3000 BC, Babylonian physicians practiced under the Code of Hammurabi, which included laws and penalties for medical errors (e.g., a doctor who killed a patient during surgery would have his hands cut off).
Contributions of Ancient Civilizations
Early Egyptian medicine included remedies, surgical treatments, and sanitation rules that formed a basis for modern medicine.
Jewish culture introduced practices for personal hygiene, sanitary food preparation, and public health.
Early Greek practitioners used nonpoisonous snakes for wound treatment; symbolized by the caduceus (a staff with two snakes).
Ancient Indian herbal remedies documented as early as 800 BC.
Chinese culture recorded observations about human blood pulses around and, with Japanese culture, practiced acupuncture.
Many ancient remedies are still in use:
Opium from the poppy plant for pain relief (now morphine).
Digitalis from foxglove to regulate and strengthen the heartbeat.
Sulfur and cayenne pepper to stop bleeding.
Chamomile and licorice to aid digestion.
Cranberries to treat urinary tract infections.
Early Medicine
Hippocrates (from the 5th century ) is credited with pioneering scientific study of disease causes and is known as the Father of Western Medicine.
Transformation of medicine: Hippocrates moved medicine from mysticism and philosophy to scientific discovery and practice, emphasizing the body's natural healing abilities and forming clinical descriptions of diseases.
Medieval stagnation: From the to the century, medical progress was minimal due to poor hygiene, nutrition, and sanitation, leading to epidemics.
Hippocratic Oath: An ethical guide originating from Hippocrates' writings; includes principles such as working for the patient's good, doing no harm, avoiding deadly drugs, avoiding advice that could cause death, and maintaining patient confidentiality. It is still referenced in modern medical school graduation ceremonies.
Box 2-1: The Hippocratic Oath
The oath emphasizes commitment to ethical medical practice, including treating teachers and their families with respect and sharing knowledge freely with students.
Key components include prioritizing patient benefit, avoiding harm, not prescribing deadly medicines, not giving advice that could cause death, and confidentiality.
It concludes with a conditional blessing and curse, promising a good life if kept and a bad life if violated.
Important early figures:
Galen ( –): Greek physician who emphasized anatomy and founded experimental physiology.
William Harvey ( –): English physician who contributed to anatomy and physiology and theorized blood circulation.
Zacharias Janssen ( –): Dutch eyeglass maker who invented the microscope by combining two lenses.
Antonie van Leeuwenhoek ( –): Dutch scientist who first observed bacteria, calling them "tiny little beasties."
Medicine During the Eighteenth and Nineteenth Centuries
Formal medical training in England and Scotland:
England: aspiring doctors trained as apprentices.
18th century: medical schools established in Edinburgh and Glasgow.
19th century advancements:
Accurate documentation of anatomy and physiology improved understanding of the body.
Innovations like sophisticated microscopes, injection materials, and the ophthalmoscope advanced practice.
Ignaz Semmelweis and puerperal sepsis:
Identified contaminated clothing and hands as sources of puerperal sepsis.
Implemented hand disinfection and clean clothing, significantly reducing disease incidence.
Key medical figures and contributions:
John Hunter: Developed surgery and surgical pathology into a science.
Edward Jenner: Created the first smallpox vaccine.
Rene Laennec: Invented the stethoscope.
Louis Pasteur: Established bacteriology and proved decay is caused by bacteria.
Joseph Lister: Introduced antiseptic techniques in surgery.
Paul Ehrlich: Discovered treatment for syphilis; contributed to microbiology and immunology.
Daniel Hale Williams: Performed the first successful heart surgery.
Other major advances:
William Roentgen: Discovered X-rays.
Pierre and Marie Curie: Discovered radium.
Sigmund Freud: Worked in psychiatry.
American contributions:
William Morton and Crawford Long: Demonstrated ether as a general anesthetic.
Walter Reed: Helped conquer yellow fever, aiding the Panama Canal.
Medicine During the Twentieth Century
Early 20th-century advances: death rates from diseases like tuberculosis and diphtheria decreased; overall mortality declined due to improved care; morbidity focus increased.
Four major developments:
Oncology: Study and treatment of cancer; development of chemotherapy.
Immunology: Advances in immune system understanding.
Endocrinology: Progress in glands and their functions.
Nutrition: Understanding vitamins, minerals, and dietary needs.
Discovery of antibiotics:
1928: Sir Alexander Fleming discovered penicillin, a mold that inhibited staphylococci.
Penicillin became one of the first chemicals used to treat infections; Fleming and two other scientists won the Nobel Prize for this work.
Immunology advances:
Vaccines against typhoid, tetanus, diphtheria, tuberculosis, yellow fever, influenza, and measles.
In the 1950s, Drs. Jonas Salk and Albert Sabin developed vaccines that eradicated polio.
Women in medicine:
Early barriers limited public appearance and opportunities.
Elizabeth Blackwell: First American female physician; earned degree in 1849 from Geneva Medical College; opened the New York Infirmary for Women and Children in 1857; the infirmary became a women’s medical college in 1867.
Florence Nightingale: Founder of modern nursing; Crimean War nurse; advocated nursing process and elevated nursing; known as "The Lady with the Lamp"; started the first nursing school in 1860 at St. Thomas' Hospital.
Clara Barton: Nurse in Civil War; established the American Red Cross; founded the Federal Bureau of Records to track injured and dead soldiers.
Modern Medicine and the Future:
Technological advancements have accelerated in the past 25 years; life expectancy is projected to increase; remote examination and communication improvements; robotics in surgeries; routine replacements (knee, hip, kidney, cornea).
Historical Medical Firsts and Breakthroughs
: First successful kidney transplant using a twin’s organ.
: Dr. Michael DeBakey invented the heart pump enabling open-heart surgery.
: Successful reattachment of a severed arm.
: Dr. Christian Barnard performed the first heart transplant.
: First totally implantable artificial heart placed in a patient.
Genetic engineering and breakthroughs:
: Development of genetic engineering increased vaccine production.
: Birth of the first test-tube baby.
: Cloning of the first sheep.
Human Genome Project:
Completed in 2001; mapped human genes and their positions on chromosomes.
Enabled routine screening of donor eggs for inherited diseases; facilitated DNA testing for criminal identification, genetic counseling, and disease treatment design.
Identification of genes causing Alzheimer’s disease, certain breast cancers, and cystic fibrosis.
Stem cell research:
Stem cells can develop into specialized cells and are crucial for future medical advancements.
Currently used to induce insulin production in diabetic patients' pancreas cells.
Future medical hopes:
Cure for AIDS and a vaccine for HIV.
Cloning organs to address donor shortages.
Improved treatments for mental illness; cures for heart disease, cancer, and obesity.
Methods to slow aging and regenerate brain and nerve cells to overcome paralysis.
Development of antibiotics that prevent bacterial resistance.
Rapid Vaccine Development
On 3/11/2020, the World Health Organization declared a global pandemic due to Covid-19.
By 12/2020, the U.S. FDA authorized emergency use of the Pfizer-BioNTech vaccine for individuals aged .
Rapid development and approval of the Covid-19 vaccine raised benefits-vs-risks concerns.
For comparison, the mumps vaccine took over 4 years to develop and approve.
The Covid-19 vaccines were the first to use mRNA technology, which teaches cells to create a protein to trigger an immune response.
The success of mRNA vaccines is expected to pave the way for future medical advancements.
Medical Practitioners
Medical-assistant training equips you to work with physicians in various specialties; interact with allied health professionals from diverse fields; understanding and respecting roles and educational requirements is crucial.
Credentials for medical practitioners include:
Medical doctors (MDs)
Osteopaths (DOs)
Chiropractors (DCs)
Each field has specific educational requirements and areas of practice.
The title of Doctor:
Doctoral degrees denote highest educational achievement; in medicine, indicates qualification to practice.
Various designations include:
Doctor of Chiropractic (DC)
Doctor of Dental Medicine (DMD)
Doctor of Dental Surgery (DDS)
Doctor of Education (EdD)
Doctor of Medicine (MD)
Doctor of Naturopathy (ND)
Doctor of Optometry (OD)
Doctor of Osteopathy (DO)
Doctor of Philosophy (PhD)
Doctor of Podiatric Medicine (DPM)
Chiropractors (DC) specialize in spinal manipulation; require two years of premedical study plus four years of chiropractic school; most states license chiropractors.
Naturopathic doctors (ND) emphasize holistic and natural healing; focus on prevention and comprehensive treatment; practice throughout the U.S.
Medical Practice Acts regulate the practice of medicine within each state: licensure requirements, grounds for revocation, reporting, penalties for unlicensed practice; physicians may consult across state lines without licensure in each state.
Licensure:
Methods: examination, endorsement, or reciprocity.
Examination: each state has its own exam; FLEX (Federation Licensing Examination) and USMLE (three-step exam) facilitate reciprocity.
Endorsement: NBME exam; most U.S. physicians licensed by endorsement; foreign medical graduates must pass ECFMG certification and complete U.S. residency before taking state licensure exam.
Reciprocity: some states accept another state's license.
Registration: periodic re-registration with fees; CME requirements (e.g., 75 CME units every three years).
Professionalism and compliance:
Medical assistants assist with licensure renewal; maintain CME records; remind physicians of renewals.
AMA Code of Ethics emphasizes patient care and ethical practice; Hippocratic Oath practices closely mirrored.
Institutions must understand legal issues affecting practice.
Suspension and revocation:
Basis includes unprofessional conduct, criminal offenses (rape, murder, larceny, narcotics), or personal incapacity.
Felony or malpractice convictions do not automatically revoke license; due process requires state board hearing.
Types of Medical Practices
Early 20th century: solo practices were common; trends now show decline due to cost, practice changes, and legal challenges.
Alternative medical practices offer around-the-clock care and shared insurance, staff, and equipment costs.
Large health care systems (hospitals) increasingly own private physician practices, employing clinical and administrative staff.
Key practice models:
Solo Practice: physician alone; may share office space with others; administrative decisions centralized.
Sole Proprietorship: single physician owner; may employ others; owner bears expenses and liability.
Partnership: two or more physicians share business operations and liabilities.
Associate Practice: physicians share a facility and staff but do not share legal responsibility; each physician operates as if solo;
contracts specify responsibilities and patients should understand shared responsibility.Group Practice: three or more physicians share facility, expenses, income, personnel, equipment, and records; can be HMOs or IPAs; often organized as legal corporations.
Professional Corporation: physicians (and others) incorporate; board of directors; shareholders; benefits include tax advantages, fringe benefits, liability protection; corporation may outlive members.
Medical and Surgical Specialties
Advances have increased interest in specialization; specialists typically require more education and often earn higher incomes; professional liability insurance may be higher.
Major medical specialties include:
Allergy and Immunology: This specialty focuses on the diagnosis and treatment of allergic diseases, as well as immune system disorders, utilizing both medication management and immunotherapy options.
Anesthesiology: A specialty focused on providing anesthesia and pain relief during surgical procedures, as well as managing the patient’s vital signs and comfort before, during, and after surgery. (CRNAs can administer anesthetics)
Bariatrics: Focuses on the treatment of obesity and weight management through lifestyle interventions, medications, and surgical procedures.
Cardiology: A Branch of medicine dealing with disorders of the heart and blood vessels. (pediatric cardiology as a subspecialty)
Dermatology: Focuses on the diagnosis and treatment of skin disorders, including conditions such as acne, eczema, and psoriasis.
Emergency Medicine: A specialty focused on the diagnosis and treatment of acute illnesses and injuries that require immediate medical attention.
Endocrinology: The branch of medicine that deals with the endocrine system, its diseases, and their treatment.
Family Practice: Physicians who provide comprehensive care to patients of all ages, focusing on preventative measures and the management of chronic diseases.
Gastroenterology: A specialty focused on the diagnosis and treatment of disorders related to the gastrointestinal tract, including the stomach, intestines, liver, and pancreas.
Geriatric Medicine: Focuses on the health care of elderly patients, emphasizing the prevention and treatment of age-related diseases and the promotion of overall well-being.
Hematology: The study of blood, blood disorders, and the organs that form blood.
Hospitalist: A physician specializing in the delivery of comprehensive medical care to hospitalized patients.
Internal Medicine (with subspecialties):
Nephrology: A Specialty focused on kidney health, including diagnosis and treatment of kidney diseases.
Neurology: A branch of medicine focused on the diagnosis and treatment of disorders of the nervous system, including the brain, spinal cord, and peripheral nerves.
Nuclear Medicine: A branch of medicine that uses radioactive substances for the diagnosis and treatment of various diseases.
Obstetrics and Gynecology: A branch of medicine that focuses on childbirth, pregnancy, and the female reproductive system.
Oncology: The branch of medicine that deals with the prevention, diagnosis, and treatment of cancer.
Ophthalmology: The branch of medicine that deals with the diagnosis and treatment of eye disorders and diseases.
Orthopedics: The branch of medicine concerned with the musculoskeletal system, including the diagnosis and treatment of conditions related to bones, joints, muscles, and ligaments.
Otorhinolaryngology (ENT): The branch of medicine that deals with the diagnosis and treatment of disorders of the ear, nose, and throat, as well as related areas of the head and neck.
Pathology: The study of diseases, including their causes, development, and consequences, which plays a crucial role in diagnosing and understanding various medical conditions.
Pediatrics: The branch of medicine that focuses on the health and medical care of infants, children, and adolescents, addressing their physical, emotional, and social well-being.
Physical Medicine and Rehabilitative Medicine: The branch of medicine that aims to enhance and restore functional ability and quality of life to those with physical impairments or disabilities, utilizing therapies and rehabilitation techniques.
Podiatry: The branch of medicine devoted to the diagnosis and treatment of conditions affecting the foot, ankle, and lower extremities, ensuring that individuals can maintain mobility and quality of life.
Psychiatry: A medical specialty that deals with the diagnosis, treatment, and prevention of mental disorders, focusing on emotional, psychological, and social well-being.
Pulmonology: A branch of medicine dealing with diseases involving the respiratory tract, focusing on conditions such as asthma, pneumonia, and lung cancer.
Radiology: The branch of medicine that uses imaging techniques to diagnose and manage diseases, including X-rays, MRIs, and CT scans.
Rheumatology: The branch of medicine that deals with the diagnosis and treatment of rheumatic diseases, which primarily affect the joints, muscles, and connective tissues.
Urology: The branch of medicine that focuses on the urinary tract system, including the kidneys, bladder, urethra, and the male reproductive organs.
Surgery specializations:
General surgery
Cardiovascular, Colorectal, Cosmetic/Plastic, Hand, Neurosurgery, Orthopedic, Oral (including periodontics and orthodontics), Thoracic.
Health Care Facilities
Hospitals are the largest employers in the U.S.; pressure to reduce costs; average length of stay decreasing; growing emphasis on outpatient care.
Outpatient and same-day surgery sites, home health agencies, physical therapy/rehabilitative and sports medicine clinics are increasingly common.
Health care settings:
Outpatient care: walk-in basis, no overnight stay.
Inpatient care: overnight or extended stays.
Freestanding or hospital-based outpatient surgical centers increasingly common; urgent care centers address nonemergent but urgent needs.
Patient-centered medical homes (PCMH) focus on coordinated care in one location with a team of specialists; emphasis on wellness, prevention, accessibility, and a welcoming environment.
Nursing Homes and Long-Term Care
Nursing homes originated in the 19th century to provide for older adults; quality improved with regulations and Medicare.
Many nursing homes are for-profit; some are owned by church groups.
Costs lead some patients to convert to Medicaid; facilities serve as rehabilitative bridges or long-term care.
Approximately 70% of people over 65 will need long-term services at some point (CMS).
Types of long-term care institutions:
Skilled Nursing Facility (SNF): 24-hour skilled nursing; recertified every 100 days to remain in SNF.
Intermediate Care Facility (ICF): not 24-hour skilled nursing; occupational/rehabilitative therapy; federal guidelines for Medicare funding.
Extended Care Facility (ECF): custodial care; not necessarily skilled personnel.
Assisted-Living Facility: separate apartments; fixed fee for meals/services.
Hospice: interdisciplinary care for terminally ill patients; care can be at home or hospice facility; Medicare covers part of end-of-life costs.
Hospice care includes nursing and personal care and pain management; generally does not treat the terminal illness itself; provides emotional support.
Education and Credentials
Educational requirements vary by state; a high school diploma or equivalency is necessary; postsecondary education may be required (vocational/technical schools, community colleges, or universities).
Health care institutions may require passing a national registration or certification exam for employment.
Career ladder in health care:
Professional: 4-year degree or higher; examples: Medical Doctor (MD), Pathologist, etc.
Technologist: 4-year college program; example: Medical Technologist (MT).
Technician: 2-year program; example: Medical Laboratory Technician (MLT).
Assistant: up to 1-year classroom/clinical; example: Laboratory Assistant.
Aide: on-the-job training; example: Laboratory Aide.
Certification: issued by professional organizations upon meeting standards and passing a certification exam.
Registration: administered by professional organizations; involves examinations and maintaining a qualified list.
Licensure: government-authorized to work in specific occupations (e.g., RN, LPN, PT).
Continuing education is essential to maintain licenses and certifications; CMAs require 60 CEUs every 5 years; RMAs follow AMT CCP; lifelong learning emphasized.
Strategies for lifelong learning include reading journals (CMA Today, AMT), monthly disease condition research, subscribing to publications, attending seminars.
National Health Care Skills Standards (NHCSS) and Career Clusters
Health care careers are categorized into NHCSS career clusters to guide curricula and competencies for entry-level and technical positions.
Therapeutic Cluster Careers: patient status, treatment, evaluation, data collection; examples include:
Medical Assistants (MAs) work with nurses, therapists, PAs, RTs, dietitians, dental hygienists, EMS, pharmacists, medical social workers, and surgical technologists.
Nurses: CNA (training and exam), LPN (1-year program), RN (2- or 4-year program; NCLEX), NP (RN with master’s degree; capable of diagnosing and prescribing).
Occupational Therapist (OT) and OT Assistant (2-year program).
Physical Therapist (PT) and PT Assistant (2-year program; licensure).
Physician Assistant (PA): master’s-level education and accreditation.
Respiratory Therapist (RT): certification/registration.
Dietitian: bachelor’s degree, internship, and registration.
Dental Hygienist: 2- or 4-year program; state exams.
EMS: EMR, EMT, AEMT, Paramedic.
Pharmacist: 5 years of education, internship, and state licensure.
Pharmacy Technician: vocational training and certification.
Diagnostic Cluster Careers: procedures to create a health picture (measuring, evaluating, reporting):
MAs may interact with diagnostic professionals or become GXMO/LXMO.
Ultrasound Technologist; X-ray Technologist (Radiologic Technologist) with ARRT registration; EEG Technician; Diagnostic Imaging Technician; Phlebotomist (venipuncture).
Certification/licensure vary by state; certs from ASCP, AMT, NCCT, NHA.
Laboratory Careers: testing, research, and clinical studies; labs can be independent, hospital-based, or physician-office.
MT/CLS: four-year medical technology program; board-certified by ASCP or AMT; responsibilities include supervising lab staff, quality assurance, and analysis.
MLT/CLT: two years of training; ASCP, AMT, etc.
Information Services Cluster Careers: health information management, coding, analysis, maintenance, and retrieval; MAs interact with records technicians.
Environmental Cluster Careers: biomedical equipment technicians.
Medical assistants are crucial to the allied health team and must understand their roles within the team.
Professionalism in the Workplace
Continuing education essential for medical assistants and professionals; employers should include CME in benefits; sharing knowledge from conferences maximizes investment.
Certification and registration frameworks include MLT/CLT/MT/CLS certifications and licensures (ASCP, AMT, NCCT, NHA).
Lifelong learning is crucial due to rapidly expanding knowledge in health care.
Health Information Technology and Medical Records
Health information technologists maintain permanent patient records; requires a 2-year associate degree; certification options include ART (Accredited Record Technician) and RHIT (Registered Health Information Technician); higher-level roles require a bachelor’s degree and RRA (Registered Records Administrator).
Medical transcriptionists transcribe dictations into written reports; require typing, medical terminology, and data processing skills; future may be affected by voice recognition.
Office management and unit clerks handle administrative duties; require strong supervision, time management, and communication.
Unit clerks manage clerical, reception, and communication duties in hospitals/clinics; require extensive medical terminology knowledge.
Summary
History of medicine divided into four periods: early medicine (around ), the eighteenth century, the nineteenth century, and the twentieth century.
Major advancements include:
Eradication of many deadly diseases through vaccines.
Decreased infections due to aseptic techniques and antibiotics.
Use of radium to treat diseases.
Inventions of the microscope and surgical instruments.
Discovery of anesthesia.
Improved understanding of anatomy and physiology.
Licensed physicians must complete every three years to maintain knowledge.
Medical assistants can work in various specializations and must understand the health care system to assist patients effectively.
The health care system includes inpatient facilities (hospitals, nursing homes, hospices) and ambulatory care settings.
Physicians choose their specialties after medical school rotations and complete a residency in that specialty; board certification requires an approved residency, passing an exam, and years of practice.
New specialties (e.g., bariatrics) emerge as subspecialties are needed; physicians can switch specialties via additional training and another residency.
Allied health professionals support physicians and include:
Therapeutic cluster careers (nurses, dietitians).
Diagnostic cluster careers (X-ray, ultrasound technologists).
Laboratory cluster careers (phlebotomists, clinical laboratory scientists).
Information services cluster careers (unit clerks, office managers).
Environmental cluster careers (biomedical equipment technicians).
Medical assistants are essential members of the allied health team and must understand their role within the team.