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MEDICAL COURSE -- Introduction and Overview HP Kedilaya Professor & Head, Dept. of Biochemistry, Contents 1. Why Introduction and Overview for the Newly Joined Students? 2. Introduction and Overview of the Medical Course Why Introduction and Overview for the Newly Joined Students? Teachers Often Observe – Students are Academically Disoriented Don’t Know What and Why Exactly they are Doing When They are Studying Not Focused While Studying Possible Reasons for Disorientation in Students Attitude Towards Academics -- cultural -- previous experience with academics Academic Quality of Students Quality of Teaching No Proper Introduction to the Course Importance of Introduction and Overview Everyone Knows it for a Topic in Textbooks in a Lecture Class Then Why not for an Entire Course Imagine a Task of A Trekking Expedition Take an Overview ……… ……………. A Helicopter View What is a Proper Introduction and Overview of the Medical Course? Introduction and Overview of the Medical Course Concerned With All the Teachers of a Medical College Irrespective of the Their Specialty. Opinion about What is Proper or Appropriate May Differ from Teacher to Teacher MEDICAL COURSE -- Introduction and Overview Medical science is one of the most interesting subjects. Medical profession is the noblest of all professions. Medical Science is One of the Most Interesting Subjects. Working of the Human Body -Sophisticated, Intriguing More and Exciting Than that of any Existing Machine Medical Profession is the Noblest of all Professions….. ……Because it Deals with – -- Pains and Pleasures of the Body -- The Comforts and Discomforts of the Body -- Life and Death of the Patients More Customer (patient) Satisfaction and No other Field of Science is Facing Real-life Challenges that are as Large and Formidable as those of Medical Science CONTENTS Meanings of Basic Concepts Study Of Medicine Meanings of Basic Concepts The Living Organism The Machine and the Body (A Mechanistic View) Health, Disease and the Doctor The Living Organism All Living Organisms are made up of Matter --- Just like the Non-living Matter. Therefore, the Living Organisms Obey all the Laws of Physics and Chemistry – -- Just like the Non-living Matter. The Ultimate Property of all Living Organisms – -- Reproduction Other Unique Properties are --- Growth and Self-maintenance. These Properties can also be Conceived as their --- Functions Thus, Reproduction is their Ultimate Function and All other Processes or Functions Sub-serve the Function of Reproduction. The Living Organism (Cont’d) Living Beings are Open Systems -- Exchanging Energy, Matter and Information with the Environment -- For Reproduction, Growth and Maintenance They Ingest Food (Nutrients) --- For Input of Energy and Matter They Interact with the Surrounding --- For Input of Information. The Machine and the Body (A Mechanistic View) The Machine Has certain FUNCTIONS and Requires a proper STRUCTURE (and/or Composition – composition in case of liquid state) for its proper Performance. Any Change in the Structure of the Machine, therefore, can Cause – -- Loss of its Functions. Therefore, all that a Mechanic Needs to do when a Machine is not Working is to – -- Repair the Machine in such a way that its Normal Structure is Restored. The Machine and the Body (A Mechanistic View) (Cont’d….. The Body The Body of an Organism, including Human, is like – -- a Machine The Body has Functions and to Perform these Functions it should have --- a Proper Structure (and/or Composition). A Normal or Healthy Body has a Proper or Normal Structure And Therefore, -- All its Functions are Intact Health, Disease and the Doctor What is Health? Health is a State of the Body – -- When all its Functions are Intact Since Function depends on Structure, to be Healthy a Body Should have – -- a Proper or Normal Structure. What is Disease? Disease or Disorder is a State of the Body – -- When there is Loss of One or More of its Functions. Since Function depends on Structure – -- Only a Change in the Structure of the Body can cause Disease. Health is Normal and Disease is Abnormal Who is a Doctor ? Ills Pills Kills Bills Health, Disease and the Doctor Who is a Doctor ? A Doctor is One Who Helps to – – Cure and Prevent Diseases. He is Like a Mechanic Who Helps to – Repair and Maintain a Machine. Health, Disease and the Doctor How Does a Doctor Cure a Disease? Since Disease is Caused by an Abnormality in the Structure of the Body – Only Helping to Restore the Normal Structure of the Body --- Can Cure a Disease. An Important Difference between the Body and the Machine is that – The Body has the Property of Self-repair, which the Machine has not Study of Medicine What Knowledge and Skill should one Acquire to be a Doctor and How to Acquire it ? Practical Knowledge of – How to Cure and Prevent Diseases Theoretical Knowledge of – All Aspects of Diseases Theoretical Knowledge of – All Aspects of the Normal /Healthy Body OR Normal Structure and Function. The Order for Study of Medicine From the Above Argument, it Follows that– The Order of the Study of Subjects of the Medical Course Will be as Follows: The Order for Study of Medicine I. Theoretical Study of the Normal Body – The Pre-Clinical Phase of the Medical Course II. Theoretical Study of Diseases – The Para-Clinical Phase of the Medical Course III. Practical, Hospital-based, Patient Centered Learning of Diagnosis, Treatment or Management and Prevention of Diseases – The Clinical Phase of the Medical Course I. Study of the Normal Body (Pre-Clinical Phase) Study of any Organism involves nothing but – -- The Study of the Function And -- The Study of the Structure (Because the Function depends on the Structure) I. Study of the Normal Body (Pre-Clinical Phase) The Structure and Function of the Human Body, like those of other Organisms, are Hierarchical. Structural and Functional Hierarchy of the Body The Body Organs and Organs- Systems Tissues Cells and Intercellular Substances Sub-cellular Organelles Molecules I. Study of the Normal Body (Pre-Clinical Phase) (Cont’d….. Scales/Levels of Size in the Study For the Convenience of Distributing the Subject Matter of Study of the Normal Body among the Disciplines – -- Two Scales of Size are adopted 1) The Lower, Molecular Level And 2) The Higher, Micro and the Macro Levels (Or the Supra-molecular Level) I. Study of the Normal Body (Pre-clinical Phase) (Cont’d….. Distribution of Subject Matter among the Disciplines Studying the Normal Body -- Based on whether the study is of – 1) Structure or Function and whether it is at the 2) Molecular level or Micro & Macro level Subject Matter is Distributed among Three Disciplines — Biochemistry Anatomy and Physiology I. Study of the Normal Body (Pre-Clinical Phase) (Cont’d….. Subject Matter of Biochemistry, Anatomy and Physiology STUDY OF THE NORMAL BODY I. Study of the Normal Body (Pre-Clinical Phase) (Cont’d….. Subject Matter of Biochemistry, Anatomy and Physiology STUDY OF THE NORMAL BODY Study of Structure I. Study of the Normal Body (Pre-Clinical Phase) (Cont’d….. Subject Matter of Biochemistry, Anatomy and Physiology STUDY OF THE NORMAL BODY Study of Structure Study of Function I. Study of the Normal Body (Pre-Clinical Phase) (Cont’d….. Subject Matter of Biochemistry, Anatomy and Physiology STUDY OF THE NORMAL BODY At the Molecular level Study of Structure Study of Function I. Study of the Normal Body (Pre-Clinical Phase) (Cont’d Subject Matter of Biochemistry, Anatomy and Physiology STUDY OF THE NORMAL BODY At the Molecular level At the Micro & Macro level Study of Structure Study of Function I. Study of the Normal Body (Pre-Clinical Phase) (Cont’d….. Subject Matter of Biochemistry, Anatomy and Physiology STUDY OF THE NORMAL BODY Study of Structure At the Molecular level At the Micro & Macro level Anatomy Study of Function I. Study of the Normal Body (Pre-Clinical Phase) (Cont’d….. Subject Matter of Biochemistry, Anatomy and Physiology STUDY OF THE NORMAL BODY Study of Structure Study of Function Anatomy Physiology At the Molecular level At the Micro & Macro level I. Study of the Normal Body (Pre-Clinical Phase) (Cont’d….. Subject Matter of Biochemistry, Anatomy and Physiology STUDY OF THE NORMAL BODY At the Molecular level At the Micro & Macro level Study of Structure Study of Function Biochemistry Anatomy Physiology I. Study of the Normal Body: (Pre-clinical Phase) (Cont’d….. Energy and Matter (Food/Nutrients) Nutrition INPUTS (Biochemistry) Behavior Science (Physiology) Information II. Study of Diseases: (Para-Clinical Phase) Disease or Disorder is a State of the Body when there is Loss of One or More of its Functions. Since Function Depends on Structure --- Only a Change in the Structure of the Body can Cause Disease. II. Study of Diseases: (Para-Clinical Phase) ASPECTS OF DISEASE Cause (Etiology), Mechanism of Disease (Pathogenesis), Disease Manifestations (Clinical Manifestations) Detection/Identification and Assessment (Diagnosis) Treatment/Management And Prevention II. Study of Diseases: (Para-clinical Phase) (Cont’d……. Cause of Diseases ( Etiology) • There is always a Cause for the Process of Disease i.e.. Causes that can Create an Abnormality in the Structure of the Body • Sometimes a Disease may have More than One Cause -- Multifactor Etiology 2 Types of Causes 1. Genetic and 2. Acquired/Environmental II. Study of Diseases: (Para-Clinical Phase) (Cont’d……. Cause of Diseases ( Etiology) Genetic (Cont’d…. Diseases -- Due to Inborn Errors in the Genetic Make-up of the Body -- Inherited from One or Both the Parents -- Like Manufactural Defects in II. Study of Diseases: (Para-Clinical Phase) (Cont’d……. Cause of Diseases ( Etiology) (Cont’d………. Acquired Diseases --Due to Several Kinds of Agents – Physical Agents, Chemical Agents and Biological Agents -- Even Lack or Excess Intake of Food or Nutrients – Nutritional Disorders -- And Lack of Proper Social Environment (Abnormal Informational Input) --Behavioral or Psychological Disorders Subjects : Clinical Biochemistry, Pathology, Microbiology and Psychiatry II. Study of Diseases: (Para-Clinical Phase) (Cont’d……. Mechanism of the Disease Process (Pathogenesis) Tracing the Cause and Effect Sequence --- From Etiology to Manifestation (loss of function) Subjects: Clinical Biochemistry, Pathology and Psychiatry II. Study of Diseases: (Para-Clinical Phase) (Cont’d……. Clinical Manifestation Clinical Manifestation includes Signs and Symptoms. Symptoms – What the Patients Complain or Report to the Doctor about the Abnormal Sensations they Feel (e.g. Pain). Signs – What the Doctor Makes out on Physically Examining the Patient. Subjects: Clinical Biochemistry, Pathology, and all Clinical Subjects II. Study of Diseases: (Para-Clinical Phase) (Cont’d……. Diagnosis Identification and Assessment of a Disease and also its Outcome (Prognosis). It is Done by Undertaking Tasks in the Order Given Below. History Taking Physical Examination Special Investigation Diagnosis History Taking Collecting Information from the Patient regarding his Complaint or Symptoms Physical Examination: Visual Examination, Examination by Hands (Palpation) and Examination of Sound and Smell. Diagnosis Investigation: -- Investigations or Tests Using Special Instruments Determination of Levels of Certain Substances in Blood, Imaging Techniques (Like X-ray, Ultrasound, Etc), Microscopic Examination of Body Fluids and Tissues, Etc] Special Diagnosis Subjects: All Clinical Subjects Para-clinical Subjects – Clinical Biochemistry, Pathology and Microbiology – Radiology, is Involved in the Actual Performance of Imaging Techniques. II. Study of Diseases: (Para-Clinical Phase) (Cont’d……. Treatment and Management Aim is to Cure Prevent Manage Decrease the Suffering Rehabilitate Many Diseases are Self-limiting The First Line of Strategy – -- Remove the Cause whenever Possible. II. Study of Diseases: (Para-Clinical Phase) (Cont’d……. Types of Treatment (Therapy) and Management Options Reassurance and Patient Education: Physical Rest: Diet: Pharmacotherapy (Use of Drugs for Treatment): – To Reduce Unpleasant Symptoms Like Pain, Fever, etc – To Act Against Disease Causing Bacteria (Antibiotics), Virus, Worms, etc; – Replacement of Essential Molecules, Such as Hormones, in the Body. Surgery – Removal of Unwanted Parts of the Body – Correction/Replacement of Defective or Lost Parts II. Study of Diseases: (Para-Clinical Phase) (Cont’d……. Types of Treatment (Therapy) and Management Options (Cont’d.... Physiotherapy: Special Exercises, Application of Pressure, Massage, Heat, etc Rehabilitation Counseling -- For Behavioral or Psychiatric Disorders Other Types of Treatments – Radiotherapy, Heat Therapy, Phototherapy, etc. Subjects: All Clinical Subjects and Pharmacology, Dietics and Nutrition (Under Clinical Biochemistry) II. Study of Diseases: (Para-Clinical Phase) Prevention of Disease (Cont’d……. Prevention is Better than Cure. Done by --- Identifying and Removing the Cause -- Improving the Bodily Defense Done at the – -- Individual Level (e.g. Vaccination) -- Community Level (e.g. Sanitation) Subject: Community Medicine Medico Legal Aspects --To Solve Crimes -- Ascertaining the Cause of Death, etc. Subject: Forensic Medicine III. Learning Clinical Skills (Clinical Phase) The Clinical Phase Involves – --Practical, Hospital-Based, Community-Based and Patient-Oriented Learning of – – Diagnosis – Treatment/Management – and Prevention of Diseases During this Phase Students Apply the Knowledge and Skills Learnt during the Pre- and Para-Clinical Phase SUBJECTS – Medicine, Surgery, Obstetrics & Gynecology, Pediatrics, Ophthalmology, Otolaryngology (E.N.T), Orthopedics, Psychiatry, etc.