Physician

 

 

“The Doctor” by Luke Fildes

A physician or medical practitioner is a person who 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.

Etymology

The word physician shares a common etymology with words such as physics & 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 comes from an ancient Greek noun ????? (physis) and its derived adjective physikos, meaning “nature” and “natural”. From this, amongst other derivatives came the Vulgar Latin physicus, which meant a doctor of medicine. After the Norman Conquest, the word entered Middle English via Old French fisicien, as early as 1200. 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.

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 a contraction of the Greek ???????? (didakt?r, teacher), from the verb ????????? (didaskein, to teach). 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 ???? (tab?b, physician).

The Greek word ?????? (iatros, doctor or healer) is often translated as physician. ?????? 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):

?????, ?????????? ??????? (Greek New Testament: Luke, 4:23)

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

Physician, heal thyself (from the Authorized King James Version, 1611)

The ancient Romans also had the word archiater, for court physician. Archiater derives from the ancient Greek ????????? (from ???? + ??????, 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. The Old English word for “physician”, læ?e, which is related to Old High German l?hhi and Old Irish liaig, has survived 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, and in modern Norwegian as lege; these Scandinavian words still translate as doctor or physician rather than as a blood-sucking parasite.

Meanings of the word physician

In modern English, the term “physician” is used in two main ways, with relatively broad and narrow meanings respectively. This is often confusing, especially to non-physicians. These meanings and variations are listed below.

As a medical practitioner

Physician in the broad sense, usually in North America, now applies to any legally qualified and licensed practitioner of medicine. In the United States, the term physician is now commonly used to describe any medical doctor holding the degrees of Doctor of Medicine (M.D.) or Doctor of Osteopathic Medicine. The American Medical Association, established 1847, uses physician in this broad sense to describe all its members.

As a specialist in internal medicine

Physician is still widely used in an older, 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 still conveys a sense of expertise in treatment by drugs or medications, rather than by the procedures of surgeons.

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 OED, third edition, gives a Middle English quotation making this contrast, from as early as 1400:

“

O Lord, whi is it so greet difference betwixe a cirugian and a physician.

”

Henry VIII granted a charter to the London Royal College of Physicians in 1518, and granted the Company of Barber/Surgeons (ancestor of the Royal College of Surgeons) its separate charter in 1540. In the same year, the same English monarch established the Regius Professorship of Physic at the University of Cambridge. 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, narrow sense would probably be described in the United States as a internist. The older, narrow usage of physician as an internist is common in Britain, Ireland, Canada, Australia, Brazil, New Zealand, Japan, South Africa, India, Indonesia, Republic of China, Pakistan, Bangladesh, Sri Lanka, Zimbabwe and Hong Kong. In such places, the terms doctor or medical practitioner are prevalent, to describe any practitioner of medicine (whom an American would likely call a physician, in the newer, broad sense). In Commonwealth countries, specialist paediatricians and geriatricians are also described as specialist physicians who have subspecialized by age of patient rather than by organ system.

Physician and Surgeon

On both sides of the Atlantic, the combined term “Physician and Surgeon” is a venerable way to describe either a general practitioner, or else any medical practitioner irrespective of specialty. This usage still shows the older, narrow 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 USA, and by equivalent bodies in provinces of Canada, to describe any medical practitioner.

Other designations

Within the United States, the term physician may also describe holders of the Doctor of Osteopathic Medicine (D.O.) degree; the D.O. and the M.D. are the only two degrees permitting U.S. licensure. Outside the USA, such status for osteopaths is less common and osteopaths are recognized as complete physicians in only 48 countries. This is due to the fact that in many countries outside of the United States, the D.O. degree does not signify a Doctor of Osteopathy but usually a practitioner who just focuses on osteopathic treatment.

Within the United States, some practitioners of primary care hold degrees such as Doctor of Chiropractic (D.C.), Doctor of Naturopathic Medicine (N.D.), or Doctors of Podiatric Medicine (D.P.M.). Chiropractors, naturopaths and podiatrists maintain a relatively narrow scope of practice compared to medical doctors and osteopaths.

Nurse practitioners (NPs) are not generally described as physicians, though they may perform work similar to that of some physicians, especially in primary care.

Social role of physicians

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.

The practice of medicine has ancient associations with religion and magic; see article on History of medicine.

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.

Education and training

Medical education and career pathways for doctors vary considerably across the world.

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, these may be either undergraduate-entry or graduate-entry courses. The former commonly take five or six years. Entrants to graduate-entry courses, usually four or five years, have previously completed a three- or four-year university degree, commonly but by no means always in sciences. Hence, gaining a basic medical degree may take from five to eight or even nine 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”.

Medical practitioners hold a medical degree specific to the country and university in and from which they graduated. This degree qualifies that medical practitioner to become licensed or registered under the laws of that particular country, and sometimes of several countries, subject to requirements for internship or conditional registration.

Specialists in internal medicine

After graduation, any medical practitioner may undertake further training in any particular field, to become a medical specialist. This may take from three to six or more years, depending on speciality and jurisdiction. A medical practitioner who completes such training in internal medicine (or in one of its subspecialties) is an internist, or a physician in the older, narrow sense.

In some jurisdictions, speciality training is begun immediately following completion of entry-level training, or even before. In other jurisdictions, junior medical doctors must undertake generalist (unstreamed) training for a number of years before commencing specialization. Hence, depending on jurisdiction, a specialist physician (internist) often does not achieve recognition as a specialist until twelve or even more years after commencing basic medical training.

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 subsidised by national governments.

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, Commonwealth and Ireland. Synonyms in use elsewhere include colegiación in Spain, ishi menkyo in Japan, autorisasjon in Norway, Approbation in Germany, and “????? ????????” in Greece. In France, Italy and Portugal, civilian physicians must be a member of the Order of Physicians to practice 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 USA, 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 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. After graduating from medical school, physicians who wish to practice in the USA usually take standardized exams, such as the USMLE for allopathic physicians or COMLEX-USA for osteopathic physicians, which enable them to obtain a certificate to practice from the appropriate state agency.

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.