Intro to MedicineThomas J. Albert, Jr., M.D.

What is the purpose of this course?

• Explore medical career options

• Meet medical professionals

• Explore other areas in the health field

• Learn a bit about medical school, internship, residency, and medical practice

Who is a physician?

• An authorized practitioner of medicine, as one graduated from a college of medicine or osteopathy and licensed by the appropriate board

• Two kinds of doctors: M.D. and D.O.

What is medicine?

• The art and science of the diagnosis and treatment of disease and the maintenance of health.

• The nonsurgical treatment of disease.

• Medicine is large heading over the two

What is “Diagnosis”?• Determination of the nature of a case of a disease based on

symptoms (history), signs (physical examination), and laboratory or imaging studies during life.– Asthma– Heart Disease– Kidney Disease– Epilepsy– Diabetes– High Blood Pressure

• 80% of diagnoses are made by H&P• “Doctor, listen to the patient.”• “Don’t lab the patient, till you’ve touched the patient.”• Don’t assume

Symptoms & Signs

• History (symptoms/subjective) –what the patient says; helps decide examination

• Physical examination (signs/objective) –Doctor’s examination determined on history

• Laboratory Studies (signs/objective) –look at certain aspects of examination

• Imaging Studies (signs/objective) –X-rays, ultrasound, etc. Determined by lab

What is “treatment”?

• Management and care of the patient or the combating of disease or disorder, may be medical/pharmacological, radiological, or surgical in method, also called “therapy.”

• R and X

• Many kinds of treatment within radiological, medical, etc.

What is “prognosis”?

• A forecast of the probable course and outcome of a disorder.

• “How much time do I have left?”

• Doctor has an obligation to tell the patient everything

Medical Abbreviations

• Abbreviations because it is just easier (?)

• Hx—history

• PE—physical examination

• Lab—laboratory studies

• Dx—diagnosis (DDx: differential Dx)

• Rx—treatment

• Px—prognosis

What is surgery?

• That branch of medicine which treats diseases, injuries, and deformities by manual or operative methods.

• Many different types of surgery, for almost every organ in the body

How does one become a physician?

• High School

• College

• Professional School

• [Do not commit a major crime.] –well duh!

Chapters of 4

• Live life for today and tomorrow…

• Take it one step at a time…

• Keep life in balance….

• Family, friends, work (school)…

• One-year, four-year, and eight-year plans…

• Don’t be like that bee there…you’d be doin’ it all wrong…[Baloo the Bear, 1960s]

High School

• GPA• Sciences

-life sciences-physical sciences (chem & physics)-math (including calculus)

• Business courses• Hobby• Develop socially --network

College

• The Roach Story –study with a buddy

• The Buddy in the Law School Story –prepare for med. School entrance exam

• Coffee Houses, Libraries –study anywhere that makes you study

College

• Falling out of the blocks –do not screw your first semester of college

• The Greek Debacle –social life is important

• Independence means responsibility

• Don’t be a Jack of too many moves –don’t do too much, you will fall out of the blocks

More on College

• Work hard—play hard.

• No work hard—no play hard.

• No play till the work is done.

College Again

• GPA is everything.

• GPA is everything.

• GPA is everything, especially science GPA.

College is the Key

• Your MCAT is also everything.

• MCAT is mucho importante’.

• MCAT is worthy of mega-preparation.

College

• Have an extra dimension –extra-curricular

• Maybe a musical instrument

• Or a sport (not car)

• Or acting, voice, student government, etc…

M.D.

• [Latin] Medici’nae Doc’tor

• Doctor of Medicine

• Graduate of medical school

D.O.

• Doctor of Osteopathy

• Graduate of osteopathic school

Osteopathy

• A system of therapy based on the theory that the body is capable of making its own remedies against disease and other toxic conditions when it is in normal structural relationship and has favorable environmental conditions and adequate nutrition

Osteopathy

• The system utilizes generally accepted physical methods of diagnosis and therapy, while emphasizing the importance of normal body mechanics and manipulative methods of detecting and correcting faulty structure

• Vs. homeopathy (use of medicines)

After professional school?

• Internship – one year where you learn to practice medicine

• Residency – two to many years “ ”

• Fellowship – optional one to three years

• Preparation for Board Examination –several years, your first years of practice. Board exams are oral (25% fail. People asking questions about patients cared for) and written (10% fail. One large exam).

Intern/Internship (vs. Internist)

• Doctor just got out of medical school: the position or term of a medical graduate serving and residing in a hospital preparatory to being licensed to practice medicine

• Internist: a physician who specializes in the diagnosis and medical treatment of diseases and disorders of the internal structures of the human body (internal medicine.)

Medical License

• Each state will issue to qualified physicians a permit entitling the the physician to practice medicine, without the permit it would be illegal.

• Texas State Board of Medical Examiners (TSBME): physician licensing agency in Texas.

Other Certificates

• Universal• DEA (Drug Enforcement Agency)

– need this to Rx controlled substances– national agency

• State wide• DPS (Dep’t of Public Safety)

– also need this to Rx controlled substances– state agency

Residency/Resident

• A graduate and licensed physician resident in a hospital receiving training in a specialty in a hospital.

Fellowship/Fellow

• An additional period of training at a hospital, beyond residency, in a medical or surgical sub-specialty.

Board Certification

• The process by which a physician, after completion of training, and initial practice experience, applies to, prepares for, and successfully passes a written and/or oral examination in their area of expertise and receives certification or documentation of such [Board Certified]

• Not to be confused with TSBME

What are the main areas in medicine?

Keep in mind that many specialties have several

“sub-specialties”

“Years of Study”

~Number of years AFTER MEDICAL SCHOOL to earn Board Certification.

~Residency, internship, fellowship, and all that stuff

What is a “primary care” physician?

• A physician, responsible for the general care of a patient; the “gate-keeper” responsible for referral to a specialist as needed; responsible for maintaining the general health of a patient, screening for and diagnosing diseases, and rendering treatment.

• Examples: internist, pediatrician, family practice, obgyn

What is a “specialist”?

• A physician whose medical practice is limited to some special area of medicine or surgery

• Examples: dermatologist, anesthesiologist, psychiatrist, neurologist, etc…

• A specialist does not do primary care, except an obgyn.

Allergy & Immunology

• A physician who specializes in the Dx and Rx of allergic conditions.

• 5 years of study

• Good lifestyle.

• Allergy season is good for them.

• Skin testing.

Anesthesiology

• A physician specialist (anesthesiologist) who administers an agent to abolish the sensation of pain (general, regional, or local anesthesia) usually induced to permit performance of surgery or other painful procedures

• 4 yrs of study• Not to be confused with an “anesthetist”, a person,

registered nurse, with additional training in the administration of anesthetics

Colon & Rectal Surgery

• A physician surgical sub-specialist who is trained in surgery of the large intestine, rectum, and anus.

• Years of Training: 6• You never know the field you might like…the

surgery.• You go thru med school, the wheel turns, you

might wind up here or there, doing this or that, no one knows, not even you.

Dermatologist

• A physician specially trained in the branch of medicine concerned with the Dx and Rx of diseases of the skin.

• Years of Study: 4• Good life-style.• Competitive, may need to do internal

medicine residency first.• Better butter-up the faculty in advance.

Emergency Medicine

• A physician specially trained to work in a hospital emergency department, diagnosing and treating a sudden threat to a patient’s health, an accident, or pressing need.

• Years of Study: 3• Work in shifts….lots of time off.• Always in demand. Busy at work.• No continuity of care.• ED—emergency department• ER—emergency room

You said “continuity of care” what’s that?

• This is where you follow a patient through either the diagnosis and treatment of a disease and possibly long-term follow-up…and in a greater sense….where you follow a patient through the years, and possibly decades, of their, and your, lives.

What’s the opposite of “continuity of care”?

• Where a specialist has a patient see them, perhaps referred by a primary care physician (PCP), who makes or confirms a diagnosis, and if appropriate, treats the patient medically or surgically, maybe does some follow-up, and sends the patient back to the PCP.

Which do you like?

• Continuity of care vs. in-and-out

• Sick or healthy patients

• Young patients

• Old patients.

• Man or woman patients

• Medical or surgical orientation

• Home life or hospital life

What is “acute”?

• Having severe symptoms and short course

Then what is “chronic”?

• Persisting for a long time.

• Diabetes, heart failure, hypertension, high cholesterol, etc….

• NB: sub-acute is longer than acute but less than chronic.

So, do you like….

• To treat patients with CHRONIC or ACUTE diseases.

• Young healthy person with an acute disease such as skin cyst that needs removal or an elderly person with multiple failing systems or young person with significant ailment such as cystic fibrosis or …..

Do you like the office or the hospital?

• For example, the dermatologist seeing office patients nearly all day

• Or….the heart surgeon in the OR (operating room) all day?

• Or…the obgyn bouncing between the office and L&D (Labor & Delivery) all day…

• Or…nearly endless permutations….

Family Practice

• A doctor trained to be a primary care physician for all family members, including all ages and genders, maintaining health and screening for, diagnosing, and treating common ailments, and referring patients to a specialist when necessary.

Internal Medicine

• Please see earlier slide for definition. • Years of Study: 3• This is the know-it-all diagnostician who

understands the all of human disease and physical dysfunction… all the internal on-goings… the mechanic of the human machine…medical, and not surgical, treatment.

• When you think of a “doctor” this is the one you think of first.

Neurological Surgery

• A physician specially trained in surgery of the nervous system, brain, spinal cord, and nerves

• 8 years of study….whoa...

• “brain surgeon”

Neurologist

• A physician trained in the medical, non-surgical, diagnosis and treatment of the nervous system

• Can do some nerve and muscle office procedures• Can diagnose a lot but many neurological

conditions are chronic, and some progressive, and some, severely so….

• 4 yrs of study

Nuclear Medicine

• A physician trained with the use of radioactive pharmaceuticals (radioactive drugs) used to diagnose or treat disease

• Example: to diagnose or treat a thyroid mass, tumor or cancer

• 4 years of study

Obstetrics & Gynecology

• A.k.a. obgyn or “baby doctor”• A physician specially trained in obstetrics, which

is the branch of medicine concerned with pregnancy, childbirth, and the period just after childbirth (postpartum); and gynecology, which is the area of medicine focusing on the health of, and diseases of, the non-pregnant female reproductive tract.

• 6 year of study

Ophthalmologist

• Physician dealing with the diagnosis and treatment of diseases of the eye (4 yrs of study)

• Do not confuse with: (another lecture) OPTOMETRIST: a non-medical doctor who specializes in measurement of the power of vision and adaptation of lenses for the aide in vision (Doctor of Optometry = O.D.)

OPTICIAN: a specialist in filling ophthalmic presciptions/lenses

Orthopaedic Surgery

• A.K.A. “bone doctor” or “orthopod” or “he-man doctor”

• Surgeon dealing with preservation and restoration of the function of the skeletal system and joints, and associated structures (ligaments, tenders, muscles, vasculature)

• The surgeon-carpenter with bolts, screws, plates, tools and power tools….

• 7 years of study

Otolaryngology

• A.K.A. ENT (ear-nose-throat doctor)› Oto—ear› Pharynx—throat› Larynx—voice-box, vocal cords

• Physician trained in the medical and surgical treatment of the ear, nose, and throat

• Think surgery and medicine and young and old and acute and chronic and office and OR…getting the picture?

• 5 years of study

Pathologist

• Physician specializing in diagnosing the essential nature of diseases, especially the changes in the body, tissues, or organs causing or caused by disease; applied to the solution of clinical problems, especially with the use of laboratory (lab) tests in making a clinical or surgical diagnosis

• Little contact with patients• 4 yrs of study

Pediatrician

• Physician dealing with the child and his/her development and care and with the diseases of children and its treatment

• Mainly office with general practice

• 3 years of study

• Many sub-specialties

Physical Medicine & Rehabilitation

• A.K.A. Physiatry (not psychiatry)

• Physician specializing with assisting patients in recovering from disease or injury that has limited their physical function

• Examples: after stroke or MVA

• Work with physical and occupational therapists (another lecture)

Plastic Surgery

• Surgeon specializing in building-up tissues or restoring a lost part, also cosmetic surgery, aesthetics

• Face-lifts, breast implants, cleft lip and palate repair, correcting facial or head birth defects, restoring a breast after breast cancer, etc…

• 7 yrs of study

Preventative Medicine

• Physician specializing in maintenance of health of group of people, familiar with the use of medical statistics and epidemiology

• May work for as a company physician or with large governmental agency (for example the NIH (National Institute of Health) or CDC (Center for Disease Control)

• 5 yrs of study

Psychiatry

• Physician specializing in the study, treatment, and prevention of mental illness

• 4 yrs study• Prescribes psychoactive medications• Works with counselors and social workers• Do not confuse with psychologist who is a non-

medical doctor (PhD in psychology) who treats patients with mental illness by counseling and not prescribing medications

Radiologist

• Physician specializing in the use of radiant energy (xray, ultrasound, magnetic resonance imaing) to diagnose or treat disease (4 yrs study)

• Nice life-style• Could be away from patients in the “reading

room” or “interventional radiologist” working with patients

• Work with xray technicians (another lecture)

General Surgery

• Physician trained to treat diseases, injuries, or deformities by manual or operative methods

• Many sub-specialties

• If you like to use your hands, this is it.

• In the OR.

• 5 yrs study

Thoracic Surgery

• Surgeon especially trained to operate on the thoracic (chest) and its contents (heart and lungs)

• 7 yrs of study

• Demanding career.

Urology

• Physician trained in the medical and surgical treatment of the urinary systems in females and the genital and urinary systems in males.

• 6-7 years of study