The clinical medicine logic

The physician works in a large frame of 3 pillars: the preventive medicine, the diagnostic medicine and the curative medicine. From a broad practical view the physician’s job is mainly in the curative medicine pillar.

The clinical (curative) medicine logics may be thought of as:
1- Adjunctive medicine
– analgesic, sedative, anxiolytic
– Mood modifiers
– Psychoactive agents
2- Casual medicine
– surgery
– invasive diagnostic and therapeutic interventions
3- Regular medicine
– nutrition
– common nonspecific agents: laxative, purgative, emollient, carminative
– specific medical agents
– antibiotics and antimicrobials
– anticancer agents


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Medical qualification consensus

I have been concerned for some time by the appropriate time lapse needed for the formation and qualification of physicians. It is always quite long but how long should it be? In parallel to this question another not less important view arises about a standard “medical qualification consensus”. The latter view proposes that there should not be a difference in the medical knowledge and training skills among all doctors. I remember the “difficult” time I had in my medical courses when there were a lot of things to understand, memorize, and interpret and to fear from.

I did not by that time know that there could be a problem in the learning process and what it could be except that I was always tired and life could just lose its delight; I am a future doctor! The door is thus open for each one, medical student, to build and adopt personal idea and trace an “emergency exit” for such apparent medical career crisis. Some sought a solution in simply memorize to preserve a respected position as a university staff member as best thing among all bad options. Some others diverted to international certificates for both recognition and enhancement. The third group made every possible effort to escape the GP label to a specialist or assistant specialist title. In many of those examples the solution was almost superficial and cosmetic. The outcomes of the medical service provided by many medical colleagues are, therefore, almost random and the learning curves are quite flat too. The typical query: doctors are guilty or victims?

The proposal for an efficient and working medical formation may find its success in a well designed medical qualification consensus. There could be no more need to read whole books or to sprain your mind to memorize “a line” within the covers of several hundred pages book just because it may come in a question. The consensus should be laid down and agreed upon by notable and experienced scholars and practicing physicians such that a whole subject, e.g. physiology, may not exceed 50 pages in its neatest and leanest form. A subject like anatomy, e.g., should not be such frustrating for a green student mind with all details in one menu, but rather served in pieces that are totally clinically and research-wise relevant. In this regards building models and simulations and encouraging learning maps and subjective imagination should be also very helpful.

Must know facts in medicine

Are there any facts in medicine? This question may come to medical students because of the many situations where a certain finding or outcome cannot be stated clearly or absolutely and not to forget the usual gap between academic study and the real daily practice. In this essay I would like to try to give a reasonable answer to this question if there could be any solid basis (evidence-based facts) for medical practice.
On one extreme of the scale, the human body should be regarded as a mere machine, a living machine, only in order to objectify and modularize the medical facts that we are looking for.
I. Generalities:
1- Doctor’s collegial conduct.
2- A well defined and openly made medical service fee (physician and other costs) is the only most effective statement to guarantee a responsible conduct of service giver and taker.
3- A substantial number of people’s morbidity or death is caused directly by medical staff dehiscence and faults.
4- Human body function and health is amenable to study and predict by mathematical methods such as probability estimation.
5- Patient’s misery for doctor but doctor’s ‘revelation’ for patient.
II. Functionalities:
1- Spatiotemporal connection.
2- No price for an absent goat. No single organ can replace or cover the absence of another organ.
3- Once born is done. The new born is completely made person that will change almost only in shape and size (genetic and social constitution).
4- Consolidation rule.
5- Life is neither gifted nor robbed.
III. System operation:
1- A human is an open system organo-heterotroph.
2- Self and nonself (immune system).
3- Flow and stagnation (in- and outflow).
4- True- and malposition (body positioning).
5- Juvenility and aging.
IV. Pathognomonic criteria:
1- Vital data (temperature, blood pressure, heart rate).
2- Inspection and light transmission.
3- Palpation, percussion and auscultation.
4- Reflex arches.
5- Biochemical and radiologic tests.
V. Remedies:
1- Social manipulation.
2- Life style.
3- Antibiotics.
4- Medical remedies.
5- Anesthesia and surgery.

Hippocrates of Cos


As it seems to be a pressing need by humans to credit somebody with the emergence of some discipline or art, we have got many fathers: Geber of chemistry, Socrates of philosophy, Lavoisier of modern chemistry, Mendel of genetics, Alhazen of optics, Einstein of modern physics, and so on.

For medical students and practitioners, Hippocrates deserves special interest, because he is credited with the founding of the western school of medicine. Very interesting is that the father of modern medicine lived in the fifth century before Christ (460- 370 BC). The medical genius was born in the Greek island of Cos. Though the well appreciated medical texts found by that time were not only those written by Hippocrates, the honor gave to Hippocrates was not almost certainly a matter of chance. Accordingly, there could be other important physicians that helped in the establishment of a fine medical intuition as can be shown by good observation and cause-effect rationale, among which Hippocrates should have been the most eminent.

Before we go on to the astonishments of Hippocrates as the credited father of medicine, I wish to throw some light on his name that should be an old Greek word. As the name means horse power; ιππος (hippos) “horse” and κρατος (kratos) “power”, this would present an interesting proof about how one could be blessed by the meaning of the name he/she bears.

Hippocratic face, clubbing of fingers and Hippocratic bench are a few of the impressing medical contributions that are attributed to Hippocrates. The amazement seen in Hippocratic medical genius originates in the school he followed that regarded disease as a mere bodily phenomenon that is totally amenable to observation, interpretation, forecasting and treatment apart from magic or spirits (superstition). Such a medical school may have been several centuries ahead of its time as that myth-imparted picture of disease was not almost completely debunked until the 19th century (the urea synthesis by Wӧhler, the vaccination by Jenner and the germ theory of disease by Koch) and the 20th century (the discovery of antibiotics by Fleming).

Hippocrates’ fine medical intuition caused him to largely dispense with “the specific diagnosis”, when basic medical knowledge and research tools were lacking in that time and to adopt gentle and general rules in the medical care (a prognosis-oriented generalized therapy relying on the healing power of nature – “vis medicatrix naturae” in Latin) that suit a generalized diagnosis. For example, he generally avoided using drugs and specialized treatment except in certain occasions and gave great attention to patients’ hygiene, nourishment, exercise, rest and positioning.

Francis Adams describes Hippocrates as “strictly the physician of experience and common sense.” While Fielding Garrison says “He is, above all, the exemplar of that flexible, critical, well-poised attitude of mind, ever on the lookout for sources of error, which is the very essence of the scientific spirit.”

* This essay was written based on internet searches.

The word cures

the word cures

Has anyone thought ever what the best and cheapest cure could be? I might have got an answer: the word. It is the word that conveys love and respect; the word that spreads hope, light and warmth. Nothing in the world can do all this other than the good word. Should it have to do with pain or with some shortage and stress? Does the situation concern confidence and competence? Or were it a sweeping fear and unbearable doubt? I never wonder when one single word turns all this misery to delight and existence.

As a physician one might ask; what could a word do for an acute appendicitis or a heart attack? The answer, and hence the role of the word, will depend largely on the way one thinks. If one thinks of the blessings of the good word, the urgency of the situation would lessen quite enough so that a typical medical care would be optional or even superfluous. Because such extreme belief and sensitivity are always the exception, in the general practice the role of good word would be confined only to fulfill ethical and moral aspects of the cure art.

What could the word do, on the other hand, when used badly? A bad word might obscure light, steal hope and threaten talent. A bad word might impair and impede the mind, mislead the aims and spoil the potentials. Even, renal colic, stroke or lost temperance, for example, might be precipitated by one bad word said with or without intention. In other words, the cost of word misuse in our life might far exceed the inevitable losses caused by labor, thoughtfulness and care we invest to achieve our existence and satisfaction. That’s why we should train ourselves to best use our word treasure as much as we are keen on taking courses to improve our work and professional skills.

Who believes in the beneficence of word, might look a bit different, because in an increasingly materialized life a brilliantly good word might be overlooked. But when every kind of medicine and manipulation may be insufficient for cure and relief, then one may reconsider the good word as the best and cheapest cure.

“Are you going to be a specialist? Or just a GP?”

Nomadic GP

“Are you going to be a specialist? Or just a GP?”

As a medical student and junior doctor in my hospital training years, I was often asked this question by friends, senior doctors and well meaning patients.  It really grated on me, that one little word: “just”.

I always thought I’d become a GP. As a teenager, I was inspired to study medicine by my own GP who had always looked after my family with such care and compassion.  As I went through my training I dabbled with the idea of other specialties; I was fascinating by the life stories of my geriatric patients, I loved the cute-factor of paediatrics, I was hooked on the emotional highs and lows of obstetrics, I enjoyed the team atmosphere of the emergency department. But I think, deep down, that I always knew I liked ALL of medicine too much and that above all I…

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