The practice of modern medicine

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Expansion of knowledge both in depth and in range has encouraged the development of new forms of treatment that require high degrees of specialization, such as organ transplantation and exchange transfusion; the field of anesthesiology has grown increasingly complex as equipment and anesthetics have improved. New technologies have introduced microsurgery, laser beam surgery, and lens implantation (for cataract patients), all requiring the specialist's skill. Precision in diagnosis has markedly improved; advances in radiology, the use of ultrasound, computerized axial tomography (CAT scan), and nuclear magnetic resonance imaging are examples of the extension of technology requiring expertise in the field of medicine.

To provide more efficient service it is not uncommon for a specialist surgeon and a specialist physician to form a team working together in the field of, for example, heart disease. An advantage of this arrangement is that they can attract a highly trained group of nurses, technologists. operating room technicians, and so on, thus greatly improving the efficiency of the service to the patient. Such specialization is expensive, however, and has required an increasingly large proportion of the health budget of institutions, a situation that eventually has its financial effect on the individual citizen. The question therefore arises as to their cost-effectiveness. Governments of developing countries have usually found, for instance, that it is more cost-efficient to provide more people with basic care.

Teaching. Physicians in developed countries frequently prefer posts in hospitals with medical schools. Newly qualified physicians want to work there because doing so will aid their future careers, though the actual experience may be wider and better in a hospital without a medical school. Senior physicians seek careers in hospitals with medical schools because consultant, specialist, or professorial posts there usually carry a high degree of prestige. When the posts are salaried, the salaries are sometimes, but not always, higher than in a nonteaching hospital. Usually a consultant who works in private practice earns more when on the staff of a medical school.

In many medical schools there are clinical professors in each of the major specialtiessuch as surgery, internal medicine, obstetrics and gynecology and psychiatryand often of the smaller specialties as well. There are also professors of pathology, radiology, and radiotherapy. Whether professors or not, all doctors in teaching hospitals have the two functions of caring for the sick and educating students. They give lectures and seminars and are accompanied by students on ward rounds.

Industrial medicine. The Industrial Revolution greatly changed, and as a rule worsened, the health hazards caused by industry, while the numbers at risk vastly increased. In Britain the first small beginnings of efforts to ameliorate the lot of the workers in factories and mines began in 1802 with the passing of the first factory act, the Health and Morals of Apprentices Act. The factory act of 1838, however, was the first truly effective measure in the industrial field. It forbade night work for children and restricted their work hours to 12 per day. Children under 13 were required to attend School. A factory inspectorate was established, the inspectors being given powers of entry into factories and power of prosecution of recalcitrant owners. Thereafter there was a succession of acts with detailed regulations for safety and health in all industries. Industrial diseases were made notifiable, and those who developed any prescribed industrial disease were entitled to benefits.

: 11/11/2009