The practice of modern medicine

Ñòðàíèöà: 6/21

United States for whom recertification was required.

Theie is no national health service, as such, in the United Stales. Most physicians in the country have traditionally been in some form of private practice, whether seeing patients in their own offices. clinics, medical centres, or another type of facility and regardless of the patients' in­come. Doctors are usually compensated by such state and federally supported agencies as Medicaid (for treating the poor) and Medicare (for treating the elderly); not all doc­tors, however, accept poor patients. There are also some state-supported clinics and hospitals where the poor and elderly may receive free or low-cost treatment, and some doctors devote a small percentage of their time to treat­ment of the indigent. Veterans may receive free treatment at Veterans Administration hospitals, and the federal gov­ernment through its Indian Health Service provides med­ical services to American Indians and Alaskan natives, sometimes using trained auxiliaries for first-contact care.

In the rural United States first-contact care is likely to come from a generalist I he middle- and upper-income groups living in urban areas, however, have access to a larger number of primary medical care options. Children are often taken to pediatricians, who may oversee the child's health needs until adulthood. Adults frequently make their initial contact with an internist, whose field is mainly that of medical (as opposed to surgical) illnesses; the internist often becomes the family physician. Other adults choose to go directly to physicians with narrower specialties, including dermatologists, allergists, gynecolo­gists, orthopedists, and ophthalmologists.

Patients in the United States may also choose to be treated by doctors of osteopathy. These doctors are fully qualified, but they make up only a small percentage of the country's physicians. They may also branch off into specialties, hut general practice is much more common in their group than among M.D.'s.

It used to be more common in the United States for physicians providing primary care to work independently, providing their own equipment and paying their own ancillary staff. In smaller cities they mostly had full hos­pital privileges, but in larger cities these privileges were more likely to be restricted. Physicians, often sharing the same specialties, are increasingly entering into group as­sociations, where the expenses of office space, staff, and equipment may be shared; such associations may work out of suites of offices, clinics, or medical centres. The increasing competition and risks of private practice have caused many physicians to join Health Maintenance Organizations (HMOs), which provide comprehensive medical. care and hospital care on a prepaid basis. Thå cost sav­ings to patient's are considerable, but they must use only the HMO doctors and facilities. HMOs stress preventive medicine and out-patient treatment as opposed to hospitalization as a means of reducing costs, a policy that has caused an increased number of empty hospital beds in the United States.

While the number of doctors per 100,000 population in the United States has been steadily increasing, there has been a trend among physicians toward the use of trained medical personnel to handle some of the basic services normally performed by the doctor. So-called physician extender services are commonly divided into nurse prac­titioners and physician's assistants, both of whom provide similar ancillary services for the general practitioner or specialist. Such personnel do not replace the doctor. Al­most all American physicians have systems for taking each other's calls when they become unavailable. House calls in the United Stales, as in Britain, have become exceedingly rare.

Ðåôåðàò îïóáëèêîâàí: 11/11/2009