The Physician in the @

20 Century
th

• No greater opportunity, responsibility or obligatiion can fall to the

lot of a human being than to become a physician.
• In the care of the suffering, (the physician) needs technical skill,
scientific knowledge, and human understanding….
• Tact, sympathy, and understanding are the expected of the
physician, for the patient is no mere collection of symptoms, signs,
disordered functions, damaged organs, and distrurbed emotions.
• (The patient) is human, fearful, and hopeful, seeking relief, help,
and reassuarance
• - Harrison’s Principles of Internal Medicine, 1950
 The Patient-Physician
Relationship
• The significance of the intimate personal
relationship between the physician and patient
cannot be strongly emphasized, for an
extraordinarily large number of cases both the
diagnosis and treatment are directly dependent on
it.
One of the essential qualities of the clinician is
interest in humanity, for the secret of the care of
the patient is in caring for the patient .
• -Francis W. Peabody, Lecture at Harvard School
Principles of Patient Care
• 1. Evidence-Based Medicine

• 2. Practice Guidelines

• 3. Medical Decision Making

• 4. Electronics Medical Records

• 5. Evualtions and Outcomes

 Clinical Medicine :
Traditional vs. EBM
• Clinical Medicine is defined as:

• Traditionally as a practice combining medical

knowledge (including scientific evidence), intuition,
and judgment in the care of patients
• EBM updates this construct by placing much greater
emphasis on the processes by which cliicians gain
knowledge of most up-to date and relevant clinical
research to determine for themselves whether medical
interventions aletr the disease course and improve the
length or quality of life ( Sources: RCT)
 EBM Key Steps
• 4 Key Steps in Practice of EBM

• 1. Formulating the management question to be answered

• 2. Searching the literature and online databases for

applicable research data
• 3. Appraising the evidence gathered with regard to its
validity and evidence
• 4. Integrating the appraisal with knowledge about
unique aspects of the patient (including the patient’s
preferences about the possible outcomes.
 Practice Guidelines
• Developed to aid physicians and other
caregivers in making diagnostic and
therapeutic decisions that are evidence-based,
cost-effective, and most appropriate to a
particular patients and clinical situation.
 Case Scenario:
Hemoptysis
• Case 1. A 40 year man The presentation pattern
presents with a chief suggests that the small
complaint of amount of blood-streaked
hemoptysis, sputum is due to Acute
Bronchitis.
• An otherwise healthy
non-smoker, he is Plan:
recovering from an
apparent viral A Chest X-ray
bronchitis .
 Case Scenario:
Hemoptysis
• Case 2: A 46-years old • Presentation fits for a
man who has the same pattern of Carcinoma
chief complaint but of the Lung
with a 100 pack year
smokin history, a • Plan:
productive morning
• A Chest X-ray
cough, and epidoes of
blood –streaked • Sputum cytology xam
sputum fits the pattern
of carcinoma of the • Chest Computed
lung. Tomography ( Ctscan)
 Electronic Medical
Records
• Offer rapid access to information that is
invaluable in enhancing health care quality
and patients safety, including relevant data,
historical and clinical information, imaging
studies , laboratory results, and medication
records.
 Evaluation & Outcome
• The practice of medicine requires
consideration and integration of both
objective and subjective outcomes
• Use objective and readily measurable
parameters to judge the outcome of
therapeutic intervention ( eg. Mortality, length
of hospital stay or readmission rates )
 Expanding Frontiers in
the Practice of Medicine
• Womens’ Health and Diseases

• Care for the Elderly

• Errors in the Delivery of Health Care

• Physician’s Role in the Informed Consent

• The Approach to Grave Prognosis and Death

• Honesty is the absolute essential in the face of

terminal illness.
 Expanding Frontiers in
Medical Practice
The ERA of “OMICS”

Genomics
Epigenomics
Proteonomics
Microbiomics
Metagenomics
Metabolomics
Expos0mics

The task of physicians is complicated by the fact that

phenotypes generally are not determined not by genes with
interplay of genetic and environmental factors.
 Molecular Medicine
• Epigenomics – study of alterations in chromatin and
histone proteins and methlation of DNA sequences
that influence gene expression (eg. Cancer)
• Proteonomics - the study of of the entire library of
proteins made in a cell organ and its complex
relationship to a disease through alternate slicing,
posttranslational processing, and posttranslational
modifications that often have unique functional
consequences (eg. Diagnostic and disease-
screening applications)
 Molecular Disease
• Microbiomics – the study of the resident
microbes in humans and mammals (eg. Health
status on maturation of the immunse system,
metabolic balance and disease susceptibilty)
• Metagenomics – a part of microbiomics that is
a genomic study of of environmental species
that have potential toinfluence human biology
directly or indirectly (eg. farm microbes that
influence lower incidence of children asthma)
 Molecular Medicine
• Metabolomics -the study of the range of
metabolites in cells or organs and the way they
are altered in disease states (eg. Aging
process).
• Exposomics – refers to efforts to catalogue
and capture environmental exposures (eg.
Smoking,sunlight, diet. Exercise, education,
and violence)
 Expanding Frontiers of
Medical Practice
• The Globalization of Medicine

• Medicine in the Internet

• Medical Ethics and New Technologies

• The Physician as Perpetual Student

• The Physician as a Citizen

• Learning Medicine

• Public expectations and Accountability

• Research, Teaching and the Practice of Medicine