Physician

A physician, medical practitioner, doctor of medicine, doctor of osteopathic 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.

[edit] Etymology
The word physician shares a common etymology with words such as physics and
metaphysics, physical, physique, and physiognomy. There are many other words that
have a meaning similar to, but not exactly the same as physician. The word physician
φύσις (physis) and its derived adjective physikos, meaning "nature" and "natural." From
this, among 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 ‫( طبيب‬tabīb, 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):

Medice, cura teipsum (from the Vulgate, early 5th century)

1
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 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.

[edit] Modern meanings

A doctor performing a typhoid vaccination, 1943.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.

[edit] Physician as any medical practitioner

Main article: 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 medical degrees from other countries when practicing in North
America (in the UK and other Commonwealth countries, 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, both MDs and DOs.

[edit] Physician as specialist (or subspecialist) in internal medicine

Main article: 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.[5]

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:

2
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.[6] 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.

These days, 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,[7] 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;[8]
such doctors are often called general physicians in Commonwealth countries.

This 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).[9] 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.

[edit] "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.[5][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.

[edit] Other designations

Osteopaths are recognized as physicians (in the broad sense) in 48 countries, particularly
in the USA. Internationally, there are variations in the D.O. degree. Osteopathic
education includes teaching manipulative medicine. [10] In a few jurisdictions, physician
may also refer to holders of the Doctor of Naturopathic Medicine (ND or NMD).[11]
However, it should be noted that only those with medical degrees from schools listed in
the WHO Directory of Medical Schools or the FAIMER International Medical Education
Directory [12] are permitted to apply for naturopathic medical licensure.[13] In the US,
podiatrists have a Doctor of Podiatric Medicine degree (DPM) and are referred to as
podiatric physicians and typically fall under the Department of Surgery in most
hospitals.[14]

3
Nurse practitioners (NPs) are not described as physicians; the American College of Nurse
Practitioners do not describe themselves this way. They are classified as advance practice
registered nurses/clinicians, also known as mid level healthcare providers [15]. Nurse
practitioners may perform work similar to that of physicians, especially within the realm
of primary care, but utilize advanced nursing models instead of medical models. 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 Assistants 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.

[edit] 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 or shorter [16] [17] [18].

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. [19]

[edit] Education and training

[edit] 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

4
under the laws of that particular country, and sometimes of several countries, subject to
requirements for internship or conditional registration.

[edit] 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.

[edit] 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.

[edit] 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

5
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.[20] 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.

[edit] 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.

[edit] Health and mortality

The professional knowledge and status of physicians appears to have an overall slightly
beneficial effect on their health. According to a study of male physicians,[21] life
expectancy is slightly higher for physicians than lawyers or many other highly educated
professionals.

The following causes are less likely than in the general population:[21]

• Alcoholism and alcohol-related deaths

• Rectal, rectosigmoidal, anal cancer
• Bacterial diseases
• Respiratory disease (including pneumonia, pneumoconioses, COPD; excluding
emphysema and other chronic airway obstruction)
• However, there is a well-known aphorism that "doctors make the worst patients".
[22] The following mortality causes are higher in physicians than in the general
population:[21]

• Traffic accidents
• Drug-related causes
• Accidental poisonings
• Hepatitis (exclusive chronic non-viral)
• Suicide/self-inflicted injury
• Malignant melanoma of the skin
• Alzheimer's disease
• Pancreatic cancer
• Cerebrovascular disease
• Ischemic heart disease