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The practice of modern medicine

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Co e s: 1. Heal h care a d i s delivery 2. ORGA IZA IO OF HEAL H SERVICES 3. Levels of heal h care. 4. Cos s of heal h care. 5. ADMI IS RA IO OF PRIMARY HEAL H CARE 6. MEDICAL PRAC ICE I . DEVELOPED COU RIES 7. Bri ai . 8. U i ed S ales. 9. Russia. 10. Japa . 11. O her developed cou ries. 12. MEDICAL PRAC ICE I DEVELOPI G COU RIES 13. Chi a 14. I dia. 15. AL ER A IVE OR COMPLEME ARY MEDICI E 16. SPECIAL PRAC ICES A D FIELDS OF MEDICI E 17. Special ies i medici e. 18. eachi g. 19. I dus rial medici e. 20. Family heal h care. 21. Geria rics. 22. Public heal h prac ice. 23. Mili ary prac ice. 24. CLI ICAL RESEARCH 25. His orical o es. 26. Cli ical observa io . 27. Drug research. 28. Surgery. 29. SCREE I G PROCEDURES HE PRAC ICE OF MODER MEDICI E Heal h care a d i s delivery he World Heal h Orga iza io a i s 1978 i er a io al, co fere ce held i he Sovie U io produced he Alma-A a Heal h Declara io , which was desig ed o serve gover me s as a basis for pla i g heal h care ha would reach people a all levels of socie y. he declara io reaffirmed ha "heal h, which is a s a e of comple e physical, me al a d social well- bei g, a d o merely he abse ce of disease or i firmi y, is a fu dame al huma ri . l a d ha he a ai me of he highes possible level of heal h is a mos impor a world-wide social goal whose realiza io requires he ac io of ma y o her social a d eco omic sec ors i addi io o he heal h sec or." I i s wides form he prac ice of medici e, ha is o say he promo io a d care of heal h, is co cer ed wi h his ideal.ORGA IZA IO OF HEAL H SERVICES "I is ge erally he goal of mos cou ries o have heir heal h services orga ized i such a way o e sure ha i dividuals, families, a d commu i ies ob ai he maximum be efi from curre k owledge a d ech ology available for he promo io , mai e a ce, a d res ora io of heal h. I order o play heir par i his process, gover me s a d o her age cies are faced wi h umerous asks, i cludi g he followi g: (1) hey mus ob ai as much i forma io as is possible o he size, ex e , a d urge cy of heir eeds; wi hou accura e i forma io , pla i g ca be misdirec ed. (2) hese eeds mus he be revised agai s he resources likely o be available i erms of mo ey, ma power, a d ma erials; developi g cou ries may well require ex er al aid o suppleme heir ow resources. (3) Based o heir assessme s, cou ries he eed o de ermi e realis ic objec ives a d draw up pla s. (4) Fi ally, a process of evalua io eeds o be buil i o he program; he lack of reliable i forma io a d accura e assessme ca lead o co fusio , was e, a d i efficie cy. Heal h services of a y a ure reflec a umber "I i errela ed charac eris ics, amo g which he mos obvious bu o ecessarily he mos impor a from a a io al poi of view, is he cura ive fu c io ; ha is o say cari g for hose already ill. O hers i clude special services ha deal wi h par icular groups (such as childre or preg a wome ) a d wi h specific eeds such as u ri io or immu iza io ; preve ive services, he pro ec io of he heal h bo h of i dividuals a d of commu i ies; heal h educa io ; a d, as me io ed above, he collec io a d a alysis of i forma io .

Levels of heal h care. I he cura ive domai here are various forms оf medical prac ice. hey may be hough of ge erally as formi g a pyramidal s ruc ure, wi h hree iers represe i g i creasi g degrees of specializa io a d ech ical sophis ica io bu ca eri g o dimi ishi g umbers of pa ie s as hey are fil ered ou of he sys em a a lower level. O ly hose pa ie s who require special a e io or rea me should reach he seco d (advisory) or hird (specialized rea me ) iers where he cos per i em of service becomes i creasi gly higher. he firs level represe s primary heal h care, or firs co ac care, or which pa ie s have heir i i ial co ac wi h he heal h-care sys em. Primary heal h care is a i egral par of a cou ry's heal h mai e a ce sys em, of which i forms he larges a d mos impor a par . As described i he declara io of Alma-A a, primary heal h care should be "based o prac ical scie ifically sou d a d socially accep able me hods a d ech ology made u iversally accessible o i dividuals i he commu i y hrough heir full par icipa io a d a a cos ha he commu i y a d cou ry ca afford o mai ai a every s age of he developme ." Primary heal h care i he developed cou ries is usually he provi ce of a medically qualified physicia ; i he developi g cou ries firs co ac care is of e provided by o medically qualified perso el. he vas majori y of pa ie s ca be fully deal wi h a he primary level. hose who ca o are referred o he seco d ier (seco dary heal h care, or he referral services) for he opi io of a co sul a wi h specialized k owledge or for X-ray exami a io s a d special es s. Seco dary heal h care of e requires he ech ology offered by a local or regio al hospi al. I creasi gly, however, he radiological a d labora ory services provided by hospi als are available direc ly o he family doc or, hus improvi g his service o pali gs a d i creasi g i s ra ge. he hird ier of heal h care employi g specialis services, is offered by i s i u io s such as leachi g hospi als a d u i s devo ed o he care of par icular groups—wome , childre , pa ie s wi h me al disorders, a d so o . he drama ic differe ces i he cos of rea me a he various levels is a ma er of par icular impor a ce i developi g cou ries, where he cos of rea me for pa ie s a he primary heal h-care level is usually o ly a small frac io of ha a he hird level- medical cos s a a y level i such cou ries, however, are usually bor e by he gover me . Ideally, provisio of heal h care a all levels will be available o all pa ie s; such heal h care may be said o be u iversal. he well-off, bo h i rela ively weal hy i dus rialized cou ries a d i he poorer developi g world, may be able o ge medical a e io from sources hey prefer a d ca pay for i he priva e sec or. he vas majori y of people i mos cou ries, however, are depe de i various ways upo heal h services provided by he s a e, o which hey may co ribu e compara ively li le or, i he case of poor cou ries, o hi g a all. Cos s of heal h care. he cos s o a io al eco omics of providi g heal h care are co siderable a d have bee growi g a a rapidly i creasi g ra e, especially i cou ries such as he U i ed S a es, Germa y, a d Swede ; he rise i Bri ai has bee less rapid.

his re d has bee he cause of major co cer s i bo h developed a d developi g cou ries. Some of his co cer is based upo he lack of a y co sis e evide ce o show ha more spe di g o heal h care produces be er heal h. here is a moveme i developi g cou ries o replace he ype of orga iza io of heal h-care services ha evolved duri g Europea colo ial imes wi h some less expe sive, a d for hem, more appropria e, heal h-care sys em. I he i dus rialized world he growi g cos of heal h services has caused bo h priva e a d public heal h-care delivery sys ems o ques io curre policies a d o seek more eco omical me hods of achievi g heir goals. Despi e expe di ures, heal h services are o always used effec ively by hose who eed hem, a d resul s ca vary widely from commu i y o commu i y. I Bri ai , for example, be wee 1951 a d 1971 he dea h ra e fell by 24 perce i he weal hier sec io s of he popula io bu by o ly half ha i he mos u derprivileged sec io s of socie y. he achieveme of good heal h is relia upo more ha jus he quali y of heal h care. Heal h e ails such fac ors as good educa io , safe worki g co di io s, a favourable e viro me , ame i ies i he home, well-i egra ed social services, a d reaso able s a dards of livi g. I he developi g cou ries. he developi g cou ries differ from o e a o her cul urally, socially, a d eco omically, bu wha hey have i commo is a low average i come per perso , wi h large perce ages of heir popula io s livi g a or below he pover y level. Al hough mos have a small eli e class, livi g mai ly i he ci ies, he larges par of heir popula io s live i rural areas. Urba regio s i developi g a d some developed cou ries i he mid- a d la e 20 h ce ury have developed pocke s of slums, which are growi g because of a i flux of rural peoples. For lack of eve he simples measures, vas umbers of urba a d rural poor die each year of preve able a d curable diseases, of e associa ed wi h poor hygie e a d sa i a io , impure wa er supplies, mal u ri io , vi ami deficie cies, a d chro ic preve able i fec io s. he effec of hese a d o her depriva io s is reflec ed by he fi di g ha i he 1980s he life expec a cy a bir h for me a d wome was abou o e- hird less i Africa ha i was i Europe; similarly, i fa mor ali y i Africa was abou eigh imes grea er ha i Europe. he ex e sio of primary heal h- care services is herefore a high priori y i he developi g cou ries. he developi g cou ries hemselves, lacki g he proper resources, have of e bee u able o ge era e or impleme he pla s ecessary o provide required services a he village or urba poor level. I has, however, become clear ha he sys em of heal h care ha is appropria e for o e cou ry is of e u sui able for a o her. Research has es ablished ha effec ive heal h care is rela ed o he special circums a ces of he i dividual cou ry, i s people, cul ure, ideology, a d eco omic a d a ural resources. he risi g cos s of providi g heal h care have i flue ced a re d, especially amo g he developi g a io s o promo e services ha employ less highly rai ed primary heal h-care perso el who ca be dis ribu ed more widely i order o reach he larges possible propor io of he commu i y.

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