Physician: Difference between revisions

Physician
	"The Doctor" by Luke Fildes
Occupation
Names	Doctor, physician, medical practitioner
Occupation type	Profession
Activity sectors	Medicine
Description
Competencies	Good memory, analytical mind, patience
Education required	Degree in medicine
Fields of; employment	Hospitals, clinics
Related jobs	Surgeon

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A physician, medical practitioner, doctor of medicine, or medical doctor practices medicine, and is concerned with maintaining or restoring human health through the study, diagnosis, and treatment of disease and injury. This is accomplished through a detailed knowledge of anatomy, physiology, diseases and treatment — the science of medicine — and its applied practice — the art or craft of medicine.

Etymology

The word physician φύσις (physis) and its derived adjective physikos, meaning "nature" and "natural". From this, amongst other derivatives came the Vulgar Latin physicus, which meant a medical practitioner. After the Norman Conquest, the word entered Middle English via Old French fisicien, as early as 1100. Originally, physician meant a practitioner of physic (pronounced with a hard C). This archaic noun had entered Middle English by 1300 (via Old French fisique). Physic meant the art or science of treatment with drugs or medications (as opposed to surgery), and was later used both as a verb and also to describe the medications themselves.^[1]^[2]^[3]

In English, there have been many synonyms for physician, both old and new, with some semantic variation. The noun phrase medical practitioner is perhaps the most widely understood and neutral synonym. Medical practitioner is lengthy but inclusive: it covers both medical specialists and general practitioners (family physician, family practitioner), and historically would include physicians (in the narrow sense), surgeons or apothecaries. In England, apothecaries historically included those who now would be called general practitioners and pharmacists.

The term doctor (medical doctor) is older and shorter (see doctor of medicine), but can be confused with holders of other academic doctorates. Doctor (gen.: doctoris) means teacher in Latin and is an agentive noun derived from the verb docere ('teach').^[4] In French, médecin (doctor, physician) is a contraction of docteur médecin, a direct equivalent of doctor of medicine. In current French idiom, the term toubib, is now a synonym, derived from Arabic طبيب (tabīb, physician).

The Greek word ἰατρός (iatrós, doctor or healer) is often translated as physician. Ἱατρός is not preserved directly in English, but occurs in such formations as psychiatrist (translates from Greek as healer of the soul), podiatrist (foot healer), and iatrogenic disease (a disease caused by medical treatment). In Latin, medicus meant much what physician or doctor does now. Compare these translations of a well-known proverb (the nouns are in vocative case):

Ἰατρέ, θεράπευσον σεαυτόν (Greek New Testament: Luke, 4:23)
Medice, cura teipsum (from the Vulgate, early 5th century)
Physician, heal thyself (from the Authorized King James Version, 1611)

The ancient Romans also had the word archiater, for court physician. Archiater derives from the ancient Greek ἀρχιατρός (from ἄρχω + ἰατρός, chief healer). By contraction, this title has given modern German its word for physician: arzt.

Leech and leechcraft are archaic English words respectively for doctor and medicine.^[1] The Old English word for "physician", læċe, which is related to Old High German lāhhi and Old Irish liaig, lives on as the modern English word leech, as these particular creatures were formerly much used by the medical profession. Cognate forms for leech exist in Scandinavian languages: in modern Swedish as läkare, in Danish as læge, in modern Norwegian as lege (bokmål) or lækjar (nynorsk), and in Finnish as lääkäri. These Scandinavian words still translate as doctor or physician rather than as a blood-sucking parasite.

Modern Meanings of the word physician

In modern English, the term physician is used in two main ways, with relatively broad and narrow meanings respectively. This is the result of history and is often confusing. These meanings and variations are explained below.

Physician as any medical practitioner

Especially in North America, the title physician is now widely used in the broad sense, and applies to any legally qualified and licensed practitioner of medicine. In the United States and Canada, the term physician is used to describe those holding the degrees of Doctor of Medicine (MD) and Doctor of Osteopathic Medicine (DO). It is also used to describe the holders of medical degrees from other countries when practicing in North America (such degrees are typically MB BS, MB BChir etc which are sometimes equivalent to the US MD degree). The American Medical Association, established in 1847, uses physician in this broad sense to describe all its members.

Osteopaths are recognized as physicians (in the broad sense) in 48 countries, particularly in the USA. Internationally, there are variations in the DO degree. Osteopathic education includes teaching manipulative medicine. ^[5] In a few jurisdictions, physicians may also refer to holders of the Doctor of Naturopathic Medicine (ND degree).^[6] However, it should be noted that only those in the WHO Directory of Medical Schools ^[7] permitted to apply for medical licensure.^[8]

Physician as specialist in internal medicine

Physician is still widely used in its older, more narrow sense, especially outside North America. In this usage, a physician is a specialist in internal medicine or one of its many sub-specialties (especially as opposed to a specialist in surgery). This traditional meaning of physician conveys a sense of expertise in treatment by drugs or medications, rather than by the procedures of surgeons.^[9]

This older usage is at least six hundred years old in English: physicians and surgeons were once members of separate professions, and traditionally were rivals. The Shorter Oxford English Dictionary, third edition, gives a Middle English quotation making this contrast, from as early as 1400:

O Lord, whi is it so greet difference betwixe a cirugian and a physician.^[1]

Henry VIII granted a charter to the London Royal College of Physicians in 1518. It wasn't until 1540 that he granted the Company of Barber/Surgeons (ancestor of the Royal College of Surgeons) its separate charter. In the same year, the English monarch established the Regius Professorship of Physic at the University of Cambridge.^[10] Newer universities would probably describe such an academic as a professor of internal medicine. Hence, in the 16th century, physic meant roughly what internal medicine does now.

The older, more narrow usage of physician as an internist is common in the United Kingdom and other Commonwealth countries (such as Australia, Bangladesh, India, New Zealand, Pakistan, South Africa, Sri Lanka, Zimbabwe), as well as in places as diverse as Brazil, Hong Kong, Indonesia, Japan, Ireland, and Taiwan. In such places, the more general English terms doctor or medical practitioner are prevalent, describing any practitioner of medicine (whom an American would likely call a physician, in the newer, broad sense).^[11] In Commonwealth countries, specialist pediatricians and geriatricians are also described as specialist physicians who have sub-specialized by age of patient rather than by organ system.

"Physician and Surgeon"

Around the world, the combined term "Physician and Surgeon" is a venerable way to describe either a general practitioner, or else any medical practitioner irrespective of specialty.^[9]^[1] This usage still shows the older, narrower meaning of physician and preserves the old difference between a physician, as a practitioner of physic, and a surgeon. The term may be used by state medical boards in the United States of America, and by equivalent bodies in provinces of Canada, to describe any medical practitioner.

Social role

Physicians are traditionally considered to be members of a learned profession, because of the extensive training requirements, and also because of the occupation's special ethical and legal duties. Physicians are often members, or fellows of professional organizations such as the Royal College of Physicians in the United Kingdom.

Physicians commonly enjoy high social status, often combined with expectations of a high and stable income and job security. However, medical practitioners often work long and inflexible hours, with shifts at unsociable times, and may earn less than other professionals whose education is of comparable length^{[citation needed]}.

Some commentators have argued that physicians have duties to serve as role models for the general public in matters of health, for example by not smoking cigarettes. ^[12]

Education and training

Medical education and career pathways for doctors vary considerably across the world.

All medical practitioners

In all developed countries, entry-level medical education programs are tertiary-level courses, undertaken at a medical school attached to a university. Depending on jurisdiction and university, entry may follow directly from secondary school or require pre-requisite undergraduate education. The former commonly take five or six years to complete. Programs that require previous undergraduate education (typically a three or four year degree, often in Science) are usually four or five years in length. Hence, gaining a basic medical degree may typically take from five to eight years, depending on jurisdiction and university.

Following completion of entry-level training, newly graduated medical practitioners are often required to undertake a period of supervised practice before full registration is granted, typically one or two years. This may be referred to as "internship" or "conditional registration". Some jurisdictions (like the United States) require residencies for practice.

Medical practitioners hold a medical degree specific to the university from which they graduated. This degree qualifies the medical practitioner to become licensed or registered under the laws of that particular country, and sometimes of several countries, subject to requirements for internship or conditional registration.

Specialists in internal medicine

After graduation, medical practitioners often undertake further training in a particular field, to become a medical specialist. In North America, this is often referred to as residency training; in Commonwealth countries, such trainees are often called registrars.

This further training typically takes from three to six years, but can be longer depending on specialty and jurisdiction. Primary care is increasingly recognized as a specialty, and residency programmes in this field are becoming common. A medical practitioner who completes specialist training in internal medicine (or in one of its sub-specialties) is an internist, or a physician in the older, narrower sense.

In some jurisdictions, specialty training is begun immediately following completion of entry-level training, or even before. In other jurisdictions, junior medical doctors must undertake generalist (un-streamed) training for one or more years before commencing specialization. Hence, depending on jurisdiction, a specialist physician (internist) often does not achieve recognition as a specialist until twelve or more years after commencing basic medical training — five to eight years at university to obtain a basic medical qualification, and up to another nine years to become a specialist.

Regulation

In most jurisdictions, physicians (in either sense of the word) need government permission to practice. Such permission is intended to promote public safety, and often to protect the public purse, as medical care is commonly subsidized by national governments.

All medical practitioners

Among the English-speaking countries, this process is known either as licensure as in the United States, or as registration in the United Kingdom, other Commonwealth countries, and Ireland. Synonyms in use elsewhere include colegiación in Spain, ishi menkyo in Japan, autorisasjon in Norway, Approbation in Germany, and "άδεια εργασίας" in Greece. In France, Italy and Portugal, civilian physicians must be members of the Order of Physicians to practise medicine.

In some countries, including the United Kingdom and Ireland, the profession largely regulates itself, with the government affirming the regulating body's authority. The best known example of this is probably the General Medical Council of Britain. In all countries, the regulating authorities will revoke permission to practice in cases of malpractice or serious misconduct.

In the large English-speaking federations (United States, Canada, Australia), the licensing or registration of medical practitioners is done at a state or provincial level. Australian states usually have a "Medical Board," while Canadian provinces usually have a "College of Physicians and Surgeons." All American states have an agency which is usually called the "Medical Board", although there are alternate names such as "Board of Medicine," "Board of Medical Examiners", "Board of Medical Licensure", "Board of Healing Arts" or some other variation.^[13] After graduating from medical school, physicians who wish to practice in the U.S. usually take standardized exams, such as the USMLE for MDs, COMLEX-USA for DOs, the NBDE exams for dentists, the NBPME exams for podiatrists, or the NPLEX for naturopaths which enable them to obtain a certificate to practice from the appropriate state agency.

Specialists in internal medicine

Most countries have some method of officially recognizing specialist qualifications in all branches of medicine, including internal medicine. Sometimes, this aims to promote public safety by restricting the use of hazardous treatments. Other reasons for regulating specialists may include standardization of recognition for hospital employment and restriction on which practitioners are entitled to receive higher insurance payments for specialist services.

References

^ ^a ^b ^c ^d Brown, Lesley (2002). The New shorter Oxford English dictionary on historical principles. Oxford [Eng.]: Clarendon. ISBN 0198612710.
^ Partridge, Eric (1966). Origins: a short etymological dictionary of modern English. New York: Macmillan. ISBN 0025948407.
^ Steinmetz, Sol; Barnhart, Robert K. (1999). Chambers dictionary of etymology. Edinburgh: Chambers. ISBN 0550142304.{{cite book}}: CS1 maint: multiple names: authors list (link)
^ Oxford English Dictionary, v. doctor.
^ "JAOA Letters" (PDF). Retrieved 2008-03-01.
^ "2008 Sunrise Review: Naturopathic Physicians" (PDF). 2008.
^ [1]
^ [2]
^ ^a ^b A Dictionary of Modern English Usage (Wordsworth Collection) (Wordsworth Collection). NTC/Contemporary Publishing Company. ISBN 1853263184.
^ "University of Cambridge: History of the School of Clinical Medicine". University of Cambridge. Retrieved 2008-02-05.
^ "The Royal Australasian College of Physicians: What are Physicians?". Royal Australasian College of Physicians. Retrieved 2008-02-05.
^ Appel, Jacob. Smoke and Mirrors: One Case for Ethical Obligations of the Physician as Public Role Model Cambridge Quarterly of Healthcare Ethics, Volume 18, Issue 01, January 2009, pp 95-100.
^ "AMA Links to state medical boards". Retrieved 2008-03-01.

[newSOED-1] Brown, Lesley (2002). The New shorter Oxford English dictionary on historical principles. Oxford [Eng.]: Clarendon. ISBN 0198612710.

[Partridge-2] Partridge, Eric (1966). Origins: a short etymological dictionary of modern English. New York: Macmillan. ISBN 0025948407.

[Chambers-3] Steinmetz, Sol; Barnhart, Robert K. (1999). Chambers dictionary of etymology. Edinburgh: Chambers. ISBN 0550142304.{{cite book}}: CS1 maint: multiple names: authors list (link)

[4] Oxford English Dictionary, v. doctor.

[5] "JAOA Letters" (PDF). Retrieved 2008-03-01.

[6] "2008 Sunrise Review: Naturopathic Physicians" (PDF). 2008.

[7] [1]

[8] [2]

[Fowler-9] A Dictionary of Modern English Usage (Wordsworth Collection) (Wordsworth Collection). NTC/Contemporary Publishing Company. ISBN 1853263184.

[10] "University of Cambridge: History of the School of Clinical Medicine". University of Cambridge. Retrieved 2008-02-05.

[11] "The Royal Australasian College of Physicians: What are Physicians?". Royal Australasian College of Physicians. Retrieved 2008-02-05.

[12] Appel, Jacob. Smoke and Mirrors: One Case for Ethical Obligations of the Physician as Public Role Model Cambridge Quarterly of Healthcare Ethics, Volume 18, Issue 01, January 2009, pp 95-100.

[13] "AMA Links to state medical boards". Retrieved 2008-03-01.

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@@ Line 1: / Line 1: @@
 {{otheruses3|Doctor}}
 {{distinguish|Physicist}}
 {{wiktionary|physician}}
 {{portal|Medicine}}
 {{Infobox Occupation
 | name= {{PAGENAME}}
 | image= [[File:The Doctor Luke Fildes.jpg|300px]]
+| caption= "The Doctor" by [[Luke Fildes]]
-| caption= "The Doctor" by [[Luke Fildes]] <ref><In 1949, Fildes' painting ''The Doctor'' was used by the [[American Medical Association]] in a campaign against a proposal for nationalized medical care put forth by President [[Harry S. Truman]]. The image was used in posters and brochures along with the slogan, "Keep Politics Out of this Picture" implying that involvement of the government in medical care would negatively affect the quality of care. 65,000 posters of ''The Doctor'' were displayed, which helped to raise public skepticism for the nationalized health care campaign.|http://correspondents.theatlantic.com/abraham_verghese/2009/06/the_ama_conflicted_in_its_interests.ph></ref>
-| official_names= physician, medical practitioner, doctor of medicine, medical doctor or simply ''doctor''
+| official_names= Doctor, physician, medical practitioner
 <!------------Details------------------->
 | type= [[Profession]]
-| activity_sector= [[Medicine]], [[Health care]]
+| activity_sector= [[Medicine]]
+| competencies= Good memory, analytical mind, patience
-| competencies= the [[ethics]], [[art]] & science of [[Medicine]], [[Analytical skill]]s, [[Critical thinking]]
-| formation= see [[Medical education]]
+| formation= Degree in medicine
-| employment_field= [[Clinic]]s, [[Hospital]]s
+| employment_field= [[Hospital]]s, [[clinic]]s
-| related_occupation= [[General practitioner]] or [[Family physician]], [[Surgeon]], other [[Medical specialist]]s
+| related_occupation= [[Surgeon]]
 | average_salary=
 }}
-A '''physician''' — also known as '''medical practitioner''', '''doctor of medicine''', '''medical doctor''', or simply '''doctor''' — practices the ancient [[profession]] of [[medicine]], which is concerned with maintaining or restoring human [[health]] through the study, [[Medical diagnosis|diagnosis]], and [[therapy|treatment]] of [[disease]] or [[injury]]. This properly requires both a detailed [[knowledge]] of the [[academic discipline]]s (such as [[anatomy]] and [[physiology]]) underlying diseases and their treatment — the [[science]] of medicine — and also a decent [[Competence (human resources)|competence]] in its applied practice — the art or [[craft]] of medicine.
+A '''physician''', '''medical practitioner''', '''doctor of medicine''', or '''medical doctor''' practices [[medicine]], and is concerned with maintaining or restoring human [[health]] through the study, diagnosis, and treatment of [[disease]] and [[injury]].  This is accomplished through a detailed knowledge of [[anatomy]], [[physiology]], diseases and [[therapy|treatment]] — the [[science]] of medicine — and its applied practice — the art or craft of medicine.
-Both the role of the '''physician''' and the meaning of the word itself vary significantly around the world, but as generally understood, the [[medical ethics|ethics of medicine]] require that '''physicians''' show [[consideration]], [[compassion]] and [[benevolent|benevolence]] for their [[patient]]s. <blockquote>
-Life is short, and Art long;<br />
-the crisis fleeting; experience perilous, and decision difficult.<br />
-The physician must not only be prepared to do what is right himself,<br />
-but also to make the patient, the attendants, and externals cooperate.<br />
-— First aphorism of [[Hippocrates]], ''circa'' 400BCE, from the [http://classics.mit.edu/Browse/browse-Hippocrates.html Hippocratic Corpus online (translated by Francis Adams)]<br />
-</blockquote>
 == Etymology ==
@@ Line 33: / Line 24: @@
 {{dablink|There are many other words that have a meaning similar to, but not exactly the same as, physician.}}
 The word physician  [[wikt:φύσις|φύσις]] (''physis'') and its derived adjective ''physikos'', meaning "nature" and "natural". From this, amongst other derivatives came the [[Vulgar Latin]] ''physicus'', which meant a medical practitioner. After the [[Norman Conquest]], the word entered [[Middle English]] via [[Old French]] ''fisicien'', as early as 1100. Originally, physician meant a practitioner of ''physic'' (pronounced with a hard C). This archaic noun had entered Middle English by 1300 (via Old French ''fisique''). ''Physic'' meant the art or science of treatment with drugs or medications (as opposed to [[surgery]]), and was later used both as a verb and also to describe the medications themselves.<ref name="newSOED">{{cite book |author=Brown, Lesley |title=The New shorter Oxford English dictionary on historical principles |publisher=Clarendon |location=Oxford [Eng.] |year=2002 |pages= |isbn=0198612710 |oclc= |doi=}}</ref><ref name="Partridge">{{cite book |author=Partridge, Eric |title=Origins: a short etymological dictionary of modern English |publisher=Macmillan |location=New York |year=1966 |pages= |isbn=0025948407 |oclc= |doi=}}</ref><ref name="Chambers">{{cite book |author=Steinmetz, Sol; Barnhart, Robert K. |title=Chambers dictionary of etymology |publisher=Chambers |location=Edinburgh |year=1999 |pages= |isbn=0550142304 |oclc= |doi=}}</ref>
 In English, there have been many [[synonym]]s for physician, both old and new, with some semantic variation. The noun phrase ''medical practitioner'' is perhaps the most widely understood and neutral synonym. Medical practitioner is lengthy but inclusive: it covers both [[Specialty (medicine)|medical specialists]] and [[general practitioner]]s (family physician, family practitioner), and historically would include physicians (in the narrow sense), surgeons or [[apothecary|apothecaries]]. In England, apothecaries historically included those who now would be called general practitioners and [[pharmacist]]s.
-The term doctor (''medical doctor'') is older and shorter (see [[doctor of medicine]]), but can be confused with holders of other academic doctorates. ''Doctor'' ([[Genitive case|gen.]]: ''doctoris'') means ''teacher'' in [[Latin language|Latin]] and is an [[agent noun]] derived from the verb ''docere'' ('teach').<ref>''[[Oxford English Dictionary]]'', v. ''doctor''.</ref> In [[French language|French]], [[wikt:médecin|médecin]] (doctor, physician) is a contraction of ''docteur médecin'', a direct equivalent of ''doctor of medicine''. In current French idiom, the term [[wikt:toubib|toubib]], is now a synonym, derived from [[Arabic]] طبيب (''tabīb'', physician).
+The term doctor (''medical doctor'') is older and shorter (see [[doctor of medicine]]), but can be confused with holders of other academic doctorates. ''Doctor'' ([[Genitive case|gen.]]: ''doctoris'') means ''teacher'' in [[Latin language|Latin]] and is an agentive noun derived from the verb ''docere'' ('teach').<ref>''[[Oxford English Dictionary]]'', v. ''doctor''.</ref> In [[French language|French]], [[wikt:médecin|médecin]] (doctor, physician) is a contraction of ''docteur médecin'', a direct equivalent of ''doctor of medicine''. In current French idiom, the term [[wikt:toubib|toubib]], is now a synonym, derived from [[Arabic]] طبيب (''tabīb'', physician).
 The [[Greek language|Greek]] word [[wikt:ἰατρός|ἰατρός]] (''iatrós'', doctor or healer) is often translated as physician. Ἱατρός is not preserved directly in English, but occurs in such formations as [[psychiatrist]] (translates from Greek as ''healer of the soul''), [[Podiatry|podiatrist]] (''foot healer''), and [[Iatrogenesis|iatrogenic disease]] (''a disease caused by medical treatment''). In Latin, [[wikt:medicus|medicus]] meant much what ''physician'' or ''doctor'' does now. Compare these translations of a well-known proverb (the nouns are in [[vocative case]]):
@@ Line 59: / Line 50: @@
 {{main|Medicine}}
-Especially in North America, the title ''physician'' is now widely used in the broad sense, and applies to any legally qualified and licensed practitioner of [[medicine]]. In the [[United States]] and [[Canada]], the term ''physician'' is used to describe those holding the degrees of [[Doctor of Medicine]] (MD) and [[Doctor of Osteopathic Medicine]] (DO).  It is also used to describe the holders of [[Doctor of Medicine|medical degrees]] from other countries when practicing in North America (such degrees are typically  [[Bachelor of Medicine and Surgery|MB BS, MB BChir ''etc'']] which are equivalent to the US MD degree).
+Especially in North America, the title ''physician'' is now widely used in the broad sense, and applies to any legally qualified and licensed practitioner of [[medicine]]. In the [[United States]] and [[Canada]], the term ''physician'' is used to describe those holding the degrees of [[Doctor of Medicine]] (MD) and [[Doctor of Osteopathic Medicine]] (DO).  It is also used to describe the holders of [[Doctor of Medicine|medical degrees]] from other countries when practicing in North America (such degrees are typically  [[Bachelor of Medicine and Surgery|MB BS, MB BChir ''etc'']] which are sometimes equivalent to the US MD degree). The [[American Medical Association]], established in 1847, uses ''physician'' in this broad sense to describe all its members.
+[[Osteopaths]] are recognized as physicians (in the broad sense) in 48 countries, particularly in the [[USA]]. Internationally, there are [[Doctor of Osteopathic Medicine#International variations in the DO degree|variations in the DO degree]]. Osteopathic education includes teaching manipulative medicine. <ref>{{cite web|url=http://www.jaoa.org/cgi/reprint/107/1/6.pdf |title= JAOA Letters |accessdate=2008-03-01}}</ref>  In a few jurisdictions, ''physicians'' may also refer to holders of the  [[Doctor of Naturopathic Medicine]] (ND degree).<ref>{{cite  web|url=http://www.dora.state.co.us/opr/archive/2008NaturopathicPhysiciansSunrise.pdf|title=2008 Sunrise Review: Naturopathic Physicians|year=2008}}</ref> However, it should be noted that only those in the [[WHO Directory of Medical Schools]] <ref>[http://imed.ecfmg.org/]</ref> permitted to apply for medical licensure.<ref>[http://www.ecfmg.org/2009ib/ibcert.html#img_define]</ref>
-The [[American Medical Association]], established in 1847, uses ''physician'' in this broad sense to describe all its members. However, the [[American College of Physicians]], established in 1915, does not: its title uses ''physician'' in an older, narrower sense, as discussed below.
 === ''Physician'' as specialist in internal medicine ===
@@ Line 67: / Line 58: @@
 {{main|Internal medicine}}
-''Physician'' is still widely used in its older, more narrow sense, especially outside North America. In this usage, a physician is a [[Medical specialist|specialist]] in [[internal medicine]] or one of its many sub-specialties (especially as opposed to a specialist in [[surgery]]). This traditional meaning of physician conveys a sense of expertise in treatment by drugs or medications, rather than by the procedures of surgeons.<ref name="Fowler">{{cite book |author= H.W. Fowler.|title=A Dictionary of Modern English Usage (Wordsworth Collection) (Wordsworth Collection) |publisher=NTC/Contemporary Publishing Company |location= |year= 1994|pages= |isbn=1853263184 |oclc= |doi=}}</ref>
+''Physician'' is still widely used in its older, more narrow sense, especially outside North America. In this usage, a physician is a [[Medical specialist|specialist]] in [[internal medicine]] or one of its many sub-specialties (especially as opposed to a specialist in [[surgery]]). This traditional meaning of physician conveys a sense of expertise in treatment by drugs or medications, rather than by the procedures of surgeons.<ref name="Fowler">{{cite book |author= |title=A Dictionary of Modern English Usage (Wordsworth Collection) (Wordsworth Collection) |publisher=NTC/Contemporary Publishing Company |location= |year= |pages= |isbn=1853263184 |oclc= |doi=}}</ref>
 This older usage is at least six hundred years old in English: physicians and surgeons were once members of separate professions, and traditionally were rivals. The [[Shorter Oxford English Dictionary]], third edition, gives a Middle English quotation making this contrast, from as early as 1400:
@@ Line 74: / Line 65: @@
 [[Henry VIII of England|Henry VIII]] granted a charter to the London [[Royal College of Physicians]] in 1518. It wasn't until 1540 that he granted the Company of Barber/Surgeons (ancestor of the [[Royal College of Surgeons]]) its separate charter. In the same year, the English monarch established the [[Regius Professor of Physic (Cambridge)|Regius Professorship of Physic]] at the [[University of Cambridge]].<ref>{{cite web | url = http://www.medschl.cam.ac.uk/about/history.html | title = University of Cambridge:  History of the School of Clinical Medicine | publisher = [[University of Cambridge]] | accessdate = 2008-02-05 }}</ref>  Newer universities would probably describe such an academic as a professor of [[internal medicine]]. Hence, in the 16th century, ''physic'' meant roughly what internal medicine does now.
-Currently, a specialist physician in this older, narrower sense would probably be described in the [[United States]] as an ''internist''. Another term, ''hospitalist'', was introduced in 1996,<ref>{{cite journal |author=Wachter R, Goldman L |title=The emerging role of "hospitalists" in the American health care system |journal=N Engl J Med |volume=335 |issue=7 |pages=514–7 |year=1996 |pmid=8672160 |doi=10.1056/NEJM199608153350713}}</ref> to describe US specialists in [[internal medicine]] who work largely or exclusively in hospitals. Such 'hospitalists' now make up about 19% of all US '' general internists'',<ref>{{cite journal |author=Kuo Y.-F. ''et al.'' |title=Growth in the care of older patients by hospitalists in the United States|journal=N Engl J Med |volume=360 |issue=11 |pages=1102–1112 |year=2009|comment=See also editorial by Hamel M. B. ''et al.'' on pp1141-1143 of same issue |doi=10.1056/NEJMsa0802381 |pmid=19279342 |last1=Kuo |first1=YF |last2=Sharma |first2=G |last3=Freeman |first3=JL |last4=Goodwin |first4=JS}}</ref> who are often called ''general physicians'' in [[Commonwealth of nations|Commonwealth]] countries.
 The older, more narrow usage of physician as an internist is common in the [[United Kingdom]] and other [[Commonwealth of Nations|Commonwealth]] countries (such as [[Australia]], [[Bangladesh]], [[India]], [[New Zealand]], [[Pakistan]], [[South Africa]], [[Sri Lanka]], [[Zimbabwe]]), as well as in places as diverse as [[Brazil]], [[Hong Kong]], [[Indonesia]], [[Japan]], [[Republic of Ireland|Ireland]], and [[Taiwan]]. In such places, the  more general English terms ''doctor'' or ''medical practitioner'' are prevalent, describing any practitioner of medicine (whom an American would likely call a physician, in the newer, broad sense).<ref>{{cite web | url = http://www.racp.edu.au/index.cfm?objectid=49EF1EB5-2A57-5487-D74DBAFBAE9143A3 | title = The Royal Australasian College of Physicians:  What are Physicians? | accessdate = 2008-02-05 | publisher = [[Royal Australasian College of Physicians]] }}</ref>  In [[Commonwealth of Nations|Commonwealth]] countries, specialist [[pediatrics|pediatricians]] and [[geriatrics|geriatricians]] are also described as specialist physicians who have sub-specialized by age of patient rather than by [[Organ (anatomy)|organ]] system.
 === ''"Physician and Surgeon"'' ===
-Around the world, the combined term "Physician and Surgeon" is a venerable way to describe either a general practitioner, or else any medical practitioner irrespective of specialty.<ref name="newSOED"/><ref name="Fowler">{{cite book |author= H.W. Fowler.|title=A Dictionary of Modern English Usage (Wordsworth Collection) (Wordsworth Collection) |publisher=NTC/Contemporary Publishing Company |location= |year= 1994|pages= |isbn=1853263184 |oclc= |doi=}}</ref> This usage still shows the older, narrower meaning of physician and preserves the old difference between a physician, as a practitioner of ''physic'', and a [[surgeon]]. The term may be used by state medical boards in the United States of America, and by equivalent bodies in provinces of Canada, to describe any medical practitioner.
+Around the world, the combined term "Physician and Surgeon" is a venerable way to describe either a general practitioner, or else any medical practitioner irrespective of specialty.<ref name="Fowler">{{cite book |author= |title=A Dictionary of Modern English Usage (Wordsworth Collection) (Wordsworth Collection) |publisher=NTC/Contemporary Publishing Company |location= |year= |pages= |isbn=1853263184 |oclc= |doi=}}</ref><ref name="newSOED"/> This usage still shows the older, narrower meaning of physician and preserves the old difference between a physician, as a practitioner of ''physic'', and a [[surgeon]]. The term may be used by state medical boards in the United States of America, and by equivalent bodies in provinces of Canada, to describe any medical practitioner.
-=== Other designations ===
+== Social role ==
+Physicians are traditionally considered to be members of a learned [[profession]], because of the extensive training requirements, and also because of the occupation's special ethical and legal duties. Physicians are often members, or fellows of professional organizations such as the [[Royal College of Physicians]] in the United Kingdom.
+Physicians commonly enjoy high [[social status]], often combined with expectations of a high and stable income and [[job security]]. However, medical practitioners often work long and inflexible hours, with shifts at unsociable times, and may earn less than other professionals whose education is of comparable length{{Fact|date=June 2009}}.
-[[Osteopaths]] are recognized as physicians (in the broad sense) in 48 countries, particularly in the [[USA]]. Internationally, there are [[Doctor of Osteopathic Medicine#International variations in the DO degree|variations in the DO degree]]; osteopathic education includes teaching manipulative medicine. <ref>{{cite web|url=http://www.jaoa.org/cgi/reprint/107/1/6.pdf |title= JAOA Letters |accessdate=2008-03-01}}</ref>  In a few jurisdictions, ''physicians'' may also refer to holders of the  [[Doctor of Naturopathic Medicine]] (ND degree).<ref>{{cite  web|url=http://www.dora.state.co.us/opr/archive/2008NaturopathicPhysiciansSunrise.pdf|title=2008 Sunrise Review: Naturopathic Physicians|year=2008}}</ref> Note that only those graduating from faculties listed in the [[WHO Directory of Medical Schools]] <ref>[http://imed.ecfmg.org/]</ref> are able to apply for medical licensure in the relevant US jurisdiction, via the [[Educational Commission for Foreign Medical Graduates|ECFMG]].<ref>[http://www.ecfmg.org/2009ib/ibcert.html#img_define]</ref> In the USA, [[podiatrist]]s have a [[Podiatry|Doctor of Podiatric Medicine]] degree (DPM) and are referred to as podiatric physicians. In most hospitals, podiatrists typically fall under the Department of Surgery.<ref> [http://www.massdpms.org/index.php/what-is-a-podiatric-physician.html][http://www.gapma.com/PracticeAct/43.35.3.htm][http://www.uclahealth.org/body.cfm?xyzpdqabc=0&id=453&action=detail&limit_department=28&limit_division=1087].
-</ref>
+Some commentators have argued that physicians have duties to serve as role models for the general public in matters of health, for example by not smoking cigarettes. <ref>Appel, Jacob. Smoke and Mirrors: One Case for Ethical Obligations of the Physician as Public Role Model ''Cambridge Quarterly of Healthcare Ethics'', Volume 18, Issue 01, January 2009, pp 95-100. </ref>
-[[Nurse practitioner]]s (NPs) are not described as physicians;  the [http://www.acnpweb.org/ American College of Nurse Practitioners] do not describe themselves this way.  They are classified as ''advance practice registered nurses/clinicians'', and are also known as ''mid-level'' (healthcare) ''practitioners'' in US government regulations.<ref> http://www.deadiversion.usdoj.gov/21cfr/cfr/1300/1300_01.htm#b28 </ref>  Nurse practitioners may perform work similar to that of physicians, especially within the realm of [[primary care]], but use [[nursing theory|advanced nursing models]] instead of [[medical model]]s. The scope of practice for a Nurse Practitioner in the United States is defined by individual state boards of registration in nursing, as opposed to state boards of registration in medicine. [[Physician Assistant]]s are also classified as midlevel advance practice clinicians, have a similar scope of practice as nurse practitoners, and are regulated by state boards of registration in medicine.
-== Social role and world view==
-{{main|Medical anthropology|Medical history}}
-===Physicians in ''biomedicine''===
-Within [[Western culture]] and over recent centuries, [[Medicine|conventional Western medicine]] has become increasingly based on scientific [[reductionism]] and [[materialism]]. This style of medicine is now dominant throughout the industrialized world, and is often termed '''Biomedicine''' by [[Medical anthropology|medical anthropologists]].<ref name="hahn1">{{cite book |editor1-first= R.A. Hahn|editor1-last= A. D. Gaines|title= Physicians of western medicine  |year= 1985|publisher=  D. Reidel|location=   Dordrecht (Netherlands)|isbn= 90-277-1790-7|pages= 3–22| chapter= Chapter 1: Introduction (by editors)}}</ref>  Biomedicine "formulates the human body and disease in a culturally distinctive pattern",<ref name="Good94">{{cite book |author=Good, Byron J |title=Medicine, rationality, and experience: an anthropological perspective (based on the Lewis Henry Morgan Lectures, at the University of Rochester, NY, in March 1990)|publisher=Cambridge University Press |location=Cambridge, UK |year=1994 |pages= 65, 65–87 | chapter= Chapter 3 |isbn=0-521-42576-X (pbk) |oclc= |doi=}}</ref> and is a [[world view]] learnt by medical students. Within this tradition,  the [[medical model]] is a term for the complete "set of procedures in which all doctors are trained" (R. D. Laing, 1972),<ref name="Laing71">{{cite book |author=Laing, R.D. |title=The politics of the family and other essays |publisher=Tavistock Publications |location=London |year=1971 |isbn= |oclc= |doi=}}</ref> including mental attitudes. A particularly clear expression of this world view, currently dominant among conventional physicians, is [[evidence-based medicine]]. Within conventional Western medicine, most physicians still pay heed to their ancient traditions:
-<blockquote> The critical sense and sceptical attitude of the [[Hippocrates|Hippocratic school]] laid the foundations of modern medicine on broad lines, and we owe to it: ''first'', the emancipation of medicine from the shackles of priestcraft and of caste; ''secondly'', the conception of medicine as an art based on accurate observation, and as a science, an integral part of the science of man and of nature; ''thirdly'', the high moral ideals, expressed in that most "memorable of human documents" (Gomperz), the [[Hippocratic oath]]; and ''fourthly'', the conception and realization of medicine as the profession of a cultivated gentleman.<br />
-— [[William Osler|Sir William Osler]], ''Chauvanism in Medicine'' (1902)<ref name="osler1">{{cite journal |author=Osler, Sir William|title=Chauvanism in medicine: address to the Canadian Medical Association, Montreal (17 September 1902)|journal=The Montreal Medical Journal |volume=XXXI |issue= |pages= |year=1902}}</ref>
-</blockquote>
-In this [[Western culture|Western]] tradition, physicians are considered to be members of a learned [[profession]], and enjoy high [[social status]], often combined with expectations of a high and stable income and [[job security]]. However, medical practitioners often work long and inflexible hours, with shifts at unsociable times. Their high status is  partly from their extensive training requirements, and also because of their occupation's special [[Medical ethics|ethical]] and [[Medical jurisprudence|legal]] duties. The term traditionally used by physicians to describe a person seeking their help is the word ''patient'' (although one who visits a physician for a routine [[check-up]] may also be so described). This word [[wikt:patient|patient]] is an ancient reminder of medical duty, as it originally meant 'one who suffers'. The English noun comes from the [[Latin]] word ''patiens'', the [[present participle]] of the [[deponent verb|deponent]] verb, [[wikt:patior|patior]], meaning 'I am suffering,' and akin to the [[Ancient Greek|Greek]] verb πάσχειν (= ''paskhein'', to suffer) and its cognate noun [[wikt:πάθος|πάθος]] (= [[wikt:pathos|pathos]]).<ref name="newSOED"/><ref name="Partridge"/>
-Physicians in the narrow sense (specialist physicians or internists — see above) are commonly members or fellows of professional organizations, such as the [[American College of Physicians]] or the [[Royal College of Physicians]] in the United Kingdom, and such hard-won membership is itself a mark of status.
-=== Complementary and alternative medicine ===
-While contemporary [[Medicine|biomedicine]] has distanced itself from its ancient roots in religion and magic, many forms of [[traditional medicine]]<ref name="galdston63tradmed">{{cite book |editor1-first= Iago|editor1-last= Galdston|title= Man's image in medicine and anthropology: Monograph IV, Institute of social and historical medicine, New York Academy of Medicine|year= 1963 |publisher=International Universities Press |location=New York |pages=43–334 |chapter=Part 1: Medicine and primitive man (5 chapters); Part 2: Medical man and medicine man in three North American Indian societies (3 chapters) }}</ref> and [[Alternative medicine|'''complementary and alternative medicine''']] (CAM) continue to espouse [[vitalism]] in various guises: 'As long as life had its own secret properties, it was possible to have sciences and medicines based on those properties' ([[Richard Grossinger|Grossinger]] 1980).
-<ref>{{cite journal |author=Grossinger, Richard |title=Planet medicine: from stone age shamanism to post-industrial healing |journal= |volume= |issue= |pages=116–131 |year=1980, 1982 (revised edition) |publisher= North Atlantic Books|location=Berkeley, CA, USA |isbn= 978-1-55643-369-6|pmid= |doi= }}</ref> The US National Center for Complementary and Alternative Medicine (NCCAM) classifies [[Complementary and alternative medicine|CAM]] therapies into five categories or domains, including:<ref name="titleComplementary and Alternative Medicine - U.S. National Library of Medicine Collection Development Manual">{{cite web |url=http://www.nlm.nih.gov/tsd/acquisitions/cdm/subjects24.html |title=Complementary and Alternative Medicine - U.S. National Library of Medicine Collection Development Manual |accessdate=2008-03-31 |format= |work=}}</ref> alternative medical [[system]]s, or complete systems of therapy and practice;[[bodymind|mind-body]] interventions, or techniques designed to facilitate the mind's effect on bodily functions and symptoms;biologically based systems, including [[herbalism]]; and manipulative and body-based methods, such as chiropractic and massage therapy.
-In considering these alternate traditions that differ from biomedicine (see above), [[medical anthropology|medical anthropologists]] emphasize that ''all'' ways of thinking about health and disease have a significant cultural content, including conventional western medicine.<ref name="hahn1"></ref><ref name="Good94"></ref><ref name="galdston63biomed">{{cite book |editor1-first= Iago|editor1-last= Galdston|title= Man's image in medicine and anthropology: Monograph IV, Institute of social and historical medicine, New York Academy of Medicine|year= 1963 |publisher=International Universities Press |location=New York |pages=477–520 |chapter=Part V: Culture and the practice of modern medicine (2 chapters)}}</ref><ref name="Joralemon99">{{cite book |author=Joralemon, DonaldJ |title=Exploring medical anthropology|publisher=Allyn and Bacon |location=Needham Heights, MA, USA |year=1999 |pages= 1–15 |chapter= chapter 1: What's so cultural about disease? |isbn=0-205-27006-9 (pbk) |oclc= |doi=}}</ref>
-===Physicians' own health===
-Some commentators have argued that physicians have duties to serve as role models for the general public in matters of health, for example by not smoking cigarettes. <ref>Appel, Jacob. Smoke and Mirrors: One Case for Ethical Obligations of the Physician as Public Role Model ''Cambridge Quarterly of Healthcare Ethics'', Volume 18, Issue 01, January 2009, pp 95-100. </ref> Indeed, in most western nations relatively few physicians smoke, and their professional knowledge does appear to have a beneficial effect on their health and lifestyle. According to a study of male physicians,<ref name=frank> Frank E, Biola H, Burnett CA. Mortality rates and causes among US physicians. Am J Prev Med. 2000;19:155-159.</ref> [[life expectancy]] is slightly higher for physicians than lawyers or many other highly educated professionals. Causes of death less likely in physicians than the general population include respiratory disease (including [[pneumonia]], [[pneumoconioses]], [[COPD]], but excluding [[emphysema]] and other [[chronic airway obstruction]]), alcohol-related deaths, rectosigmoidal & anal cancers, and bacterial diseases.<ref name=frank/>
-However… "By medicine life may be prolong'd, yet death will seize the Doctor too" ([[Cymbeline]]).<ref name="cymbeline">{{cite book |author=Shakespeare, William |title=Cymbeline (play): Act 5, Scene 5|location=London[Eng.] |year=(~1609, publ. 1623 }}</ref> Physicians are exposed to occupational hazards and temptations, and there is a well-known aphorism that "doctors make the worst patients". <ref name=schneck> Schneck A. A.; 'Doctoring' doctors and their families. Journal of the American Medical Association 1998; 280: 2039-2042</ref> Causes of death that may be higher in physicians than in the general population include suicide & self-inflicted injury, drug-related causes, and traffic accidents, as well as cerebrovascular & ischaemic heart disease.<ref name=frank/>
-===Desired behavior===
-Interviews with patients have indicated that the ideal physician would be confident, empathetic, humane, personal, forthright, respectful, and thorough. Incorporating clues to such behaviors may create a better [[doctor-patient relationship]].<ref name=idealphysician>[http://www.mayoclinicproceedings.com/content/81/3/338.full Patients' Perspectives on Ideal Physician Behaviors] Neeli M. Bendapudi, PhD, Leonard L. Berry, PhD, Keith A. Frey, MD, MBA, Janet Turner Parish, PhD and William L. Rayburn, MD </ref>
-Undesired behaviors are essentially the opposites, specially being insensitive or disrespectful, e.g. arrogance in dismissing the patient's input, disinterest in the patient as an individual, impatience in answering a patient's questions or callousness in discussing the patient's prognosis. Another undesired behavior is seemingly providing excellent service in the original visit but then failing to meet the created expectations about the speed or quality of follow-up service.<ref name=idealphysician/>
-Still, when having to choose between high technical quality and high interpersonal quality, two thirds of patients choose high technical quality. <ref>[http://www.ncbi.nlm.nih.gov/pubmed/16033487 Patients' preferences for technical versus interpersonal quality when selecting a primary care physician.] Fung CH, Elliott MN, Hays RD, Kahn KL, Kanouse DE, McGlynn EA, Spranca MD, Shekelle PG. PMID: 16033487</ref> Nevertheless, the level of technical quality may be hard for a non-professional to assess, which in reality results in a tendency of patients to primarily judge physicians on behavior. <ref name=idealphysician/>
 == Education and training ==
@@ Line 157: / Line 113: @@
 == See also ==
 * [[International medical graduate]]
-* [[National Doctor Database]]
 * [[List of physicians]]
 * [[List of medical schools]]
 * [[Residency (medicine)]]
 * [[Society of General Internal Medicine]]
 == References ==
 {{Commonscat|Physicians}}
 {{reflist|2}}
 {{medicine}}
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 [[Category:Healthcare occupations]]
 [[Category:Physicians| ]]
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