The word 'Doctor' is derived fro the Latin word "doccre" which means 'to teach' since the doctor has the function of instructing the patient and his relatives regarding treatment. Medicine, moreover, is a technique (an art or a craft of a special kind) with a broad philosophy.
The medical profession is supported by a plethora of scientific knowledge which is continuously growing. It is also guided by the norm of conduct termed "ethics". Ethics deal with the principles of morality., of right and wrong. Over the centuries, the Hippocratic Oath has been handed down from one to the next generation of practitioners of medical science. Though generally, the code of ethics has been attributed to Hippocrates, it is quite likely that in its present form it came into existence much later. The ethics have been laid down to be followed by the students and practitioners so as to command veneration from the public and to prevent misuse of the medical knowledge and exploitation of the society.
The nations of the world jointly pledged on September 12, 1979 at Alma-Ata that primary health care would be provided to everyone on this globe, wherever he may be, by 2000 AD. The eight important tasks identified on this occasion for achieving this objective were health education, food supply and nutrition, water and sanitation, maternity care, child-health and family planning, immunization, control and prevention of communicable diseases, basic curative are and provision of essential drugs. Some Asian and African countries such as India and Nigeria have already set up on this task of fulfilling the objectives of the Alma-Ata declaration.
The final diagnosis: The physician approaches the patient with the total picture of the patient in mind, and with the determination and skill of a detective to unravel the disease and its cause. While ascertaining the history and conducting the physical examination, an experienced observer forms an impression about the probable diagnosis and the immediate differential diagnosis. The clinical diagnosis should always be supported by by investigations. The purpose of investigations may be summarized as:
1. Confirmation of the clinical diagnosis, e.g, sputum for acid fast bacilli in tuberculosis or blood culture in typhoid fever.
2. assessment of the severity of affection or damage to organs (e.g, Liver function, renal function etc)
3. Assessment of prognosis (e.g, biopsy in malignancy)
4. Differentiation of the condition from closely resembling diseases (e.g, Liver biopsy in hematomegaly of rheumatoid factor in subacute arthritis e.t.c)
5. Planning the therapeutic modality; (e.g, determination of acetylator status to decide on the dose of INH therapy); and
6. Follow up of the treatment an to detect early recurrence.
While appropriate investigations are essential to establish the diagnosis and to institute therapy and follow up, the availability of different types of investigative procedures and the pver-dependence on them have led to unnecessary and sometimes even invasive, investigations which may jeopardize the patient's health and life.
In general, invasive procedures include biopsies of vital organs, catheterization of vital structures, angiography, contrast radiography, and endoscopies. These may cause temporary or permanent morbidity and even mortality in a smaller number. Hence the decision to employ them should be taken after evaluating the non-invasive methods and only if the risks involved are justifiable. Over-investigation should be avoided and this is possible only if the interrogation and physical examination are properly done. Moreover, results of the investigations should be interpreted in the light of the clinical findings, otherwise they may be misleading and may result in administering inappropriate therapy.
Recording of data is important and the method of recording has been considerably improved in recent years. The problem oriented medical record (POMR) is a generally accepted form which greatly helps data retrieval and also helps the physician to make decisions on the spot. Flow charts giving the design of management have been constructed for many of the common ailments. These help the physician to plan investigations and institute sequential therapy.
Computers are being increasingly used to help the physician in storing, coding and retrieving data and even to suggest therapeutic approaches in problem cases. Use of the computers is invaluable in organizations such as transplant associations, cancer registries, etc. Large volumes of properly prepared data can be fed into the computers which can be easily retrieved when required without the disadvantages of "human error" and "fatigue". Feeding and retrieval of the data using the computer are specialized processes and the reliability and efficiency of the computer depend to a large extent on the technical perfection achieved in its programming and operation.
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