<aside> 💡 Health and Contextual Influences

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1. Outline the historical origins of the medical profession, and in particular, the legacy of Hippocrates.

   • 10, 000 - 6000 BCE = Prehistoric Medicine
     • Trepanning in neolithic era to get rid of evil spirits
   • 1600 BCE = Egyptian Medicine
     • Egyptian papyri outline: clinical symptoms, treatments, prognosis, herbal remedies, case studies
   • 600-500 BCE = Ancient Greece
     • Medicine was practiced by priests at temples of Asklepios - were clinics
     • Asklepios = son of Apollo, god of healing
     • Staff of Asklepios = international symbol of medicine | Athena gave Asklepios blood from Medusa's snakes | snakes represent regeneration
   • 5th Century BCE = Hippocrates:
     • Natural, not supernatural cause of disease
       • Described symptoms (hippocratic facies), potential treatments
       • Balance of four humors:
         • Blood, phlegm, black bile, yellow bile
         • imbalance = dyscrasia
       • Incorporation of four elements in treatment and diagnosis
         • Fire, air, water, earth
     • Predispositions to diseases like excessive drinking, poor living, fatigue, emotional strain
     • Encouraged hygiene, exercise, diet
     • Established a clinical school
     • Defined medicine as the disease, patient and physician
   • Hippocratic oath: ethics of medical practice
     • Beneficence
     • Nonmaleficence
     • Devotion of medicine, not fame/fortune
     • Respect teachers, teach others who come after you
     • Respect life
     • Refer to others (more skilled) when necessary
     • Confidentiality
     • Honor ‘social contract’ doctors have with society in return for benefits
   • Supreme effort to cast off the belief of supernatural influences
   • 5th Century BCE = Greeks
     • Theories can be tested and improved
   • 129-216 AD = Galen
     • Roman doctor 600 yrs after Hippocrates.
     • Unlike Hippocrates, believed body vehicle for the soul
     • His works translated all over
   • Medieval = Doctors were clerics
     • Doctors = clerics in monasteries (cure soul and body from sin)
     • Galen spiritual medical view embraced by Islamic and Christian Clergy
     • Monasteries became place of refuge for the sick as hospitals
     • Clinical schools were established in 10th century
   • Late Middle Ages = Barber-Surgeons
     • Church forbade clerics engaging in surgery/blood till early 16th century
     • Public turned to untrained practitioners: village women, barbers
     • Barber-surgeons’ more skilled in bloodletting, pulling teeth, lancing abscesses than surgeons
     • Physicians classically trained; permitted to do both surgery and to use medicines.
     • Surgeons joined a common Guild with Barbers sanctioned by King Henry VIII; legitimized surgical training
   • Middle Ages = Apothecaries
     • Apothecaries medieval pharmacies; diagnosed, prescribed, dispensed medicine (GPs)
     • Fraudulent, overprescribed for financial gain
     • Edict of Palermo separated the conflict of interest of diagnosis and selling medication
   • 18th-19th Century = General Practitioners
     • Apothecaries and barber-surgeons became ‘general practitioners’
     • Eventually separated to GP and pharmacist

2. Discuss the role of a doctor in the light of the WHO definition of health.

   "Health is a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity" - World Health Organization

   • Adopts a biopsychosocial (BPS) model of health and illness

   

   • Holistic approach to health
   • Practice patient centered care: trust and doctor-patient relationship
   • Be socially accountable: address community health concerns
   • WHO definition of health:
     • State of complete physical, mental and social well being
     • Not merely absence of a disease
   • The role of the doctor is to:
     • Maintain medical education and training
     • Trust in the patient-doctor relationship
     • Make diagnosis and prognosis
     • Complete complex decision making
     • Adopt a multidisciplinary approach
     • Maintain professionalism
     • Ensure leadership in health services throughout the community
     • Train the current and next generation of doctors

3. Describe Evidence Based Medicine.

   • Integration of:

     • Best research evidence
     • Clinical expertise
     • Patient values

     

   • Evidence-synthesis: primary research to create individual research studies

     • Systematic Review:
       • Research paper that reviews research evidence on a particular question
       • Identifies, appraises, and synthesizes all the findings of relevant primary research studies on a particular topic
       • Uses systematic and explicit methods to achieve this
       • Intrudes rigour to a literature review to minimize bias

4. Define and describe the terms disease, illness and sickness.

   

   • Disease
   • Illness
   • Sickness

5. Analyse the differences between biomedical and social constructions of health.

6. Reflect on and describe the impact of different world views on the experience of health and illness.

7. Define paternalism and critique its impact on clinical care.

8. Describe the patient-centered clinical interview and cite the patient-centered clinical method.

9. Discuss the importance of the patient ‘in context’ in providing clinical care.