Talk:Medicine/Archive 1

Hello!
Welcome to whoever wants to contribute to Medicine branch of wikipedia.

There is a wikipedia doctors's mess where topics related to medicine are discussed.

Phoniatrics
Hmm, strange, I see lot of branches of medicine have been deleted, Phoniatrics, for example (my addition). Why? Ok, it's not a major branch of medicine, more like a sub-branch of something, but still it *is* medicine and it should be mentioned somewhere. In addition, the organisation of this page is mess. Alas, I don't have the time to do anything to it. --Tbackstr
 * Checking on phoniatrics - You are talking about speech pathology. This is a field practiced by non-physicians, but of great importance in rehabilitation.  It is not medicine.  The training does not include a number of fileds, such as pharmacology, general anatomy, epidemiology, microbiology, and other courses that define practitioners of medicine.  Interesting issus is how to include this topic, as it is important to medicine to say what it is not and to include closely related fields as this is. Kd4ttc 18:04, 22 Feb 2004 (UTC)

Shamanism
The current medicine article should become a disambiguation page with links to Medicine (health science) and Medicine (shamanism).--NetEsq 4:19pm Sep 5, 2002 (PDT)

Nah. Medicine (shamanism) is misnamed. That article ought to be Shamanism. The discussion of medicine in shamanism should be a part of that article, and other aspects of shamanism need to be described there. Kd4ttc 20:48, 13 May 2004 (UTC)

More discussion
There is no page titled List of medical topics, with links to all Wikipedia articles on medical topics. If such a page existed, then one could click on "related changes" on that page and see all editing of pages on medical topics that appear on the list. This has been done for astronomy, physics, mathematics, religion (although that one is far from complete so far), music (I think) and some other topics.

BTW, would someone with expertise in medicine please fix the article titled diagnosis? Michael Hardy 01:42 Mar 16, 2003 (UTC)


 * I've started a page at that title; in an attempt to keep it relatively brief, I started it with a List of Other Medical Lists. :)  The list itself seems to be breaking down mainly into fields of study/practice (medical "ologies", which may merit their own list), and generic terms -- Drug, Symptom, Epidemic, etc.  I've tried to keep specific disorders, treatments, etc. to their own lists.  Are there any Wikiprojects focused on medicine?  I didn't see any in my (admittedly brief) survey, and many of these lists and articles seem pretty haphazard -- could definitely use some loving and consistent attention.  I'm only a reasonably well-educated laywoman, but I'll be happy to help.  Catherine 01:02 Apr 13, 2003 (UTC)


 * I'm currently trying to reorganise the medicine article a little, which means essentially to move out those endless link lists to individual articles (see below). Not done yet, but I think your list will help (thank you!). Generally, medical topics on Wikipedia seem to deserve a little more attention, and certainly some coherent structure. Specifically, I believe that there should be templates for pages on: diseases, medical procedures, drugs, and fields of medicine. I could think of some formats for these and will, hopefully, write some proposals soon. If you know of any other projects, please let me know, and I suggest that things could be discussed here for a while before moving on to a wikiproject page. Kosebamse 12:00 Apr 13, 2003 (UTC)

Article is still messy and too long, tried to reorganize it a little. Can anyone think of a reasonable place where to leave all the details about organs etc.?Kosebamse 09:34 Mar 23, 2003 (UTC)


 * I´ve started moving those long and unreadable link lists to specific articles and replaced some of these lists with short definitions. Will return later to this work, but there´s still much to do, help from others would be great. Kosebamse 13:56 Apr 10, 2003 (UTC)

Are we sure that "most countries" request diplomas and have a medical board? The majority of countries are 3rd world! 212.198.0.93 18:19, 2 Oct 2003 (UTC)
 * Well, as an encyclopedia article that issue should be dealt with in an article on medical licensing in a sub section there on medical practice licensing in the third world. Kd4ttc 18:23, 22 Feb 2004 (UTC)

Transfusion Medicine
We need to do something with Transfusion Medicine. It the US that field is practiced by pathologists. I noted the point in the short article on it that in the UK it is part of clinical immunology. In the US Transfusion medicine is not considered clinical medicine, it is thought of as a supporting laboratory function of the blood bank. Kd4ttc 18:23, 22 Feb 2004 (UTC)


 * In the absence of any advice I moved Trans. Med to clincal labs and added the term blood bank.Kd4ttc 03:26, 28 Feb 2004 (UTC)


 * The term Blood bank was expunged. I put it back in. In the US if you call a hospital and ask for the Transfusion Medicine department you will get a pretty confused response.  The lab that handles blood products in the US is called the Blood Bank.  Before we get in an edit war on this minor point, I'd like to have folks explain the Transfusion Medicine issue - I expect in international usage there is a difference from US standard usage.  S. Holland, M.D.  Kd4ttc 23:44, 21 Mar 2004 (UTC)


 * Gedday, sorry that was me. I didnt realise it had an 'owner' or i'd have asked! I don't think blood bank should be here because (a) 'blood bank' is not really a branch of medicine but one of the smaller branches of 'haematology' or 'immunology??' < >(b) there is not even a blood bank stub! < > (c) this page is going to get way too long without very tight discipline (d) there are many other places that will link to blood bank... including but not limited to hospital, medical laboratory, transfusion, haematologyand immunology... does that sound reasonable (i think (c) is my major reason) best wishes  Erich gasboy 02:54, 22 Mar 2004 (UTC)


 * Erich: Thanks for your comments.  Turns out there is not really a branch of medicine called transfusion medicine.  There are no transfusion specialists, no fellowships in transfusion, no departments in medical school.  However, transfusions are important.  Blood banking is more or less recognized as an important function in a hospital, and is one of the sections in any hospital. It is actually run by pathologists rather than hematologists. Perhaps Transfusion medicine really needs to be dropped.  I'm thinking is is such an inherent part of the lab of any hospital it serves |Erich gasboy]] 18:22, 22 Mar 2004 (UTC)well there just to link to something that explains the issue.  What do you think?  By the way, there is no ownership on Wikipedia, but people do watch areas they have special knowledge about.  The enterprise is advanced both by experts and novices, since the audience of the work is people of all levels.  Kd4ttc 18:06, 22 Mar 2004 (UTC)

Hi.. thanks you! my expertise really in anaesthesia. I've given a fair bit of blood (other peoples). I have heard the term 'transfusion medicine' used - i find it hard to believe there are not fellowships in 'tm' - are you sure?. I must so I'd be calling the haematologist before the pathologist if I had a choice when I need advice - both will do but this is really haematology.

I must say I think this page is tooo long and could be broken down into sections. But I still don't think blood bank belongs..

So I agree if you are saying deleting "Blood Bank or Transfusion medicine is concerned with the transfusion of blood and blood components. " would be a step forward. Is that what your saying? --User:Erich gasboy


 * I put in some headers. Well, I'm thinking keep Blood bank here because it is a part of medical practice in hospitals.  Legitimately the whole section could be outsourced, since the whole section of laboratory medicine is sort of it's own thing, but right now it is just  a subsection.  At every hospital in the US I've worked at (8 in Chicago, 2 in Moline, 4 in Peoria, and 1 in Birminham Alabama, the blood bank is run by a pathoologist.  Seems the pathology boys are most comfortable with laboratory techniques.  Now, when I have a patient who is anemic and I need a consult a hematologist is called, but to just get the crossmatch done and run the lab the techs in the blood bank are running the show, supervised by one of the pathologists.  Where do you know of there being a transfusion medicine fellowship or residency program?  Kd4ttc 21:47, 22 Mar 2004 (UTC)


 * gedday Kd4ttc!... (can't say I know any TM fellowships either... just surprised - not feeling strongly either ;-) -- Anyway my concern is really with the scope of this page. me thinks it must be extremely focussed or will expand to big. Every hospital I've ever worked (7 in Queensland, 6 in UK doing locums, 1 in US as student for a month) has had the following section - also generally containing or led by doctors of medicine of one sort
 * 1) admin section
 * 2) emergency departement
 * 3) endoscopy department (alright most for this one!)
 * 4) outpatients department
 * 5) operating theartre
 * 6) doctors carpark
 * 7) birth suite
 * 8) docotors common room etc etc

every hospital has also had a:
 * 1) medical records
 * 2) laundry
 * 3) security office
 * 4) IT support dept
 * 5) education dept
 * 6) also a good cluster of allied health depts

all of the above serve an important role! so that's why I think TM/bb should go - just because this is a list that is best in a section about hospitals not about medicine! what do you think?

sorry to harp on a bit - but I think this page needs more culling still so this is a bit of test case --Erich gasboy 23:34, 22 Mar 2004 (UTC)

I see what you mean. I think it is good to imagine who is coming to the article. A pointer to hospitals with some of these topics is useful. In the Medicine article a comment on where medicine is practiced such as ER, inpatient, outpatient, etc would be useful. Medical records would be reasonable to add. My sense would be to add to the article talking about settings of care where medicine is practiced. I am adding them to the article, and adding a new heading to talk. Kd4ttc 22:28, 25 Mar 2004 (UTC)

Delivery of Medical Care
New topic suggested by above discussion.

Oooh - i didn't explain my self properly!! my point is that this is bigger than medical care - this is about 'health care' - I think this section belongs in health care somewhere? what do you think? did you see my comments on allied health below (as well). best wishes e --Erich gasboy 16:40, 24 Mar 2004 (UTC)

Yeah. What I was thinking was that one useful thing about an encyclopedia is to discuss what a thing is not. I am imagining that there will be some poeple that think of nurses and other allied health care porviders are practicing medicine. Good to direct off to where they should want to go. Also, medicine is a very rich field due to the fact that there is a very complex of interactions that those that engage in medicine do. I am artguing for a rich trove of imformation here rather than a limited section. Kd4ttc 22:27, 25 Mar 2004 (UTC)

Pathology
Pathology needs to get into clinical medicine, or at least somewhere more than basic science. Pathology is interesting in that it is only branch of basic science that has a clinical science. The pathology societies understand this issue. Also, pathologists run the path lab, the autopsy service, the clinical labs, and bloodbank. Kd4ttc 18:23, 22 Feb 2004 (UTC)
 * I like how pathology was treated.Kd4ttc 03:26, 28 Feb 2004 (UTC)

Physiatry / Physical Medicine & Rehabilitation
I put physiatry back. Many PM&R practioners prefer to call themselves Physiatrists. The professional organizations of PM&R variously call themselves as being an organzation of people practicing Physiatry or Physical Medicine and Rehabilitation. The numbers are mostly the latter, but in talking about their field referring to themselves as Physiatrists is common. As an example, here is an article reference:
 * DeLisa, J.A., Foye, P.M., Jain, S.S., Kirshblum, S., & Christodoulou, C. (2001) Measuring professionalism in a physiatry residency training program. American Journal of Physical Medicine and Rehabilitation, 80, 225-229.

Here you have a referral to the field of PM&R as physiatry in the journal PM&R. Kd4ttc 18:23, 22 Feb 2004 (UTC)
 * I hereby submit the Google searches: "rehabilitation medicine" and "physiatry". All the rehabilitation doctors I know do not call themselves Physiatrists. I think to remove the term "Rehabilitation medicine" and instead put in "Physiatry" is misleading as "Rehabilitation medicine" is by far the more used term. Alex.tan 15:18, 23 Feb 2004 (UTC)


 * Hi, Alex! Yeah, I did the same two searches and there are hits in both places.  I see both terms used.  Physiatrist is what some rehab docs call themselves.  It is a more formal term, much like I'll say I am a Gastroenterologist, but when asked what I practice I may say GI.  Note in the reference above in the Journal Am. J PM&R that the article title refers to "physiatry training program" which I think is a good example on how the name of the field is in contrast to the name of what they do.  Initially, the term physiatry was placed here myself, and on that edit it was listed as "Physiatry, also known as Rehabilitation Medicine", so I think I'm not a compleat idiot in regard to usage.  I agreed with you rehab medicine is in more common use, both in the US and in Australia, as you point out.  When I looked up a number of the sites on Google I saw the term Physical Medicine and Rehabilitation in the text of the sites I went to, so I edited that to the primary term for the field.   I set it up so there is a link to Physical Medicine and Rehabilitation with the physiatry linked to the same thing with the verticle line thing used to rename the link.  Steve Holland, M.D.  Kd4ttc 22:55, 24 Feb 2004 (UTC)

Allied health field section and movement to its own page
The section on the allied health field stating how many groups come together was well stated. Medicine is not just doctors, it is the way of putting care to patients. This depends on the allied professions. The section was well written and provided direction to other articles for the interested reader. It needs to go back. Kd4ttc 22:22, 22 Mar 2004 (UTC)

Well thank you... I felt sad about culling this myself as I thought I'd had a brief eloquent momment when I had edited it to that form! Concerns still as overall page length but it is good prose. Most concerned about ongoing uncontrolled growth on the tail of this paragraph. I don't suppose I could convince you about the merits of culling after nurses and just leaving a 'and others' ie:

The modern health care team also depdends on all health care professions, including nurses and many others.

did you have a look at health profession? best wishes --Erich gasboy 23:47, 22 Mar 2004 (UTC)

I don't like it. While the term seems reasonable, I don't think that it is legitimate to make a subject out of it. I don't know that 1) the term has actually been accepted in common usage; 2) the definition given is unsatisfying; 3) it seems to invite content that would better be in other places. Sort of like the problem with an overnormalized database. Kd4ttc 22:38, 25 Mar 2004 (UTC)

Hi. I agree it's not a fantastic page, and in reply: 1) I've seen it as a pretty common enough term in any interdisciplinary forum or effort. 2) aggree completely!! 3) yes it will invite content - which is exactly why I think it is best to move it off page - otherwise all these issues get re-debated on multiple pages do you see what I mean? I actually dont think this is 'over' normalised at all. I see this is moving a debate that would be repeated at least 5 times elsewhere to a single page (for examples, have a look at how poorly health and Health science handle this!) hey and thanks for fixing my broken link!! e --Erich gasboy 04:11, 26 Mar 2004 (UTC)
 * 1) what is a profesional?
 * 2) who are they?
 * 3) what is the hierarchy? (or how are they classified?).

Oh! I get it. Yes, that is a reasonable page. The sections listed are a nice start for it. I'd drop the definition part of it and go right to the article, letting the definition emerge operationally. Also, I'd make it incluseive, rather than only related to allied health professionals. I think in complements the medicine page nicely. The medicine page seems to be shaping up as a discussion of disciplins. My comment on overnormalization was regarding the medicine article being too split up. Health profession looks like it can stand on it's own. Kd4ttc 16:25, 26 Mar 2004 (UTC)

So, now tell me, who thou that art so wise in the ways of computer and medical science? Kd4ttc 16:25, 26 Mar 2004 (UTC)

THE BLUE BOX
Finally, there is a "blue box" that unites medical topics on Wikipedia. Please send comments to me about inclusion/exclusion (which was a tad arbitrary) and the design, as well as implementation. This has been long overdue. Please see the WIKIDOC page, a medical Wikipedia clique in formation, dedicated to raising the level of the medical side of Wikipedia. JFW | T@lk  02:14, 9 Apr 2004 (UTC)


 * Does this really reflect common usuage amongst doctors? Surely it is not medicine which divides into physcians and surgeons but healthcare which divides into medicine and surgery? BozMo

Thanks for your comments, BozMo. Having worked in hospitals as a doctor for a few years, it has become absolutely clear to me that there is a strong distinction between both the way of working and the way of thinking of internists and surgeons. All the other fields occupy their own niches and often have to defend themselves against intrusions by both "mega" specialisms (e.g. ophthalmologists needing theatre time in a general hospital). Could you be more specific about your objections? JFW | T@lk  11:10, 16 Apr 2004 (UTC)

Well I am not a doctor but have several in my immediate family, and also several surgeons all in the UK. Here the distinction is sharp: once you become a surgeon you actually drop the title "Dr" and have the right to use "Mr" "Mrs" etc again. Hospitals are divided sharply into medical servies and surgical services, consultants are either medics or surgeons. Perhaps for an encyclopedia the internal working of UK hospitals isn't so relevant and what is written is ok or perhaps it is a small "m" big "M" think but I don't think surgeons regard themselves as medics any more than a bus conductor regards himself as a type of bus driver. BozMo

I agree with jdwolff on the above distinctions between medicine and healthcare and physicians and surgeons.

In some contexts "medicine" is used loosely to refer to all aspects of healthcare: science, institutions, and both physicians and all other health care providers. But most people think the more precise usage of medicine is as defined in the article: the knowledge system of basic and applied science, the arts and traditions and social structures of the profession of physicians.

Jfdwolff is correct that the division between physicians and surgeons is the oldest and broadest historically. In England in the 19th century, a physician did not practice surgery and was considered more accomplished in terms of training and intellect, and was addressed as doctor, while a surgeon had less educational training, did not necessarily earn an MD, and was addressed as mister. In North America you can find the semantic distinction preserved in the formal title of older US and Canadian medical schools, like Columbia University School of Physicians and Surgeons. Now in North America, the term physician is applied to anyone, surgeon or nonsurgeon, who has graduated with an MD or equivalent, and the many specialties of medicine are divided into "medical specialities" and "surgical specialties". Internal medicine (and the internists who do it) is simply the biggest of medical specialties. Within the medical profession the oldest general distinction is between the surgeons and the nonsurgeons, but "physician" is used less and less to mean "nonsurgeon" no other English word has replaced it. {aside: Actually BozMo thinks it has been replaced by the word "medic") Surgeons generally are better paid and often command more power within a medical center because they bring in more money. Nonsurgeons tell jokes such as "Why do surgeons stop elevator doors with their heads? Because they can't risk damaging their hands." (Aside: good... hadn;t heard that one BozMo) That If you fully understand the joke, you understand the distinction between physician and surgeon in the traditional sense. alteripse 16 apr 04

I don't know if this needs to be in Medicine in general, but the Mr. vs Dr. in England is something that a lot of physicians in the US do not know about. I think it ought to be described in some article, somewhere. Geographic Patterns of Medical Care, Social conventions regarding medical care worldwide, or something like that. That there is a Mr./Dr. dichotomy is not really relelvant to the medical article, but a link in the medicine article to such an article would be nice. Kd4ttc 20:40, 20 Apr 2004 (UTC)

Pediatric subspecialities
One of the contibutors {Not to mention names...} added a number of Peds subspecialities. I agree those exist. ''{I didn't know our existence was in question, but thanks for the reassurance.}. '' I suspect there is not enough interest in making all those stand alone. {Stand alone where?}  In GI the peds diseases are very similar to the adult, but differences exist that make a section in the GI article needed. My proposal is to not have separate peds subspeciality articles,{Sorry I already wrote one} but to put sections in the appropriate adult medicine articles. {See, that's the problem--- they should be just "medicine" articles, not "adult medicine" articles.}  Of course, Neonatology probably needs its own section. {Those guys always think they're special.} Kd4ttc 23:03, 23 Apr 2004 (UTC)


 * Italics mine obviously. Before I saw your opinion, I wrote a brief article covering a random pediatric subspecialty-- pediatric endocrinology --in which I have a casual interest. Look at the article and tell me if you think it is either (a) an unnecessary article that "there is not enought interest in" to warrant writing, or (b) would be better put into the endocrinology article. Finally I am not (a) suggesting we write two duplicative articles on diseases that occur in both children and adults, or (b) really being hostile, just reminding you that wiki doesn't have to be limited the way you suggest. Alteripse 12:23, 9 May 2004 (UTC)

C'mon docs. Alter ipse amicus (means: "a friend is another self") has every right to flesh out all those pediatrics things. It would probably be the best thing to make all these pages hierarchically inferior to pediatrics but to provide ample links on the "adult" specialisms (i.e. pediatric hematology linked properly from hematology). I also suggest we think about a nice pediatric navigational element... JFW | T@lk  12:44, 9 May 2004 (UTC)

Let's not hose'em down too soon. Debate is healthy and from what I've seen of those two they are robust enough to take it on the chin. The ability to resolve, rather than avoid the disagreements is a mark of groups' maturity (and i love watching a good stoush ;-). Anyway I think that paeds is 'different' (thinking about paediatric anaesthesia, a well established sub-discipline - personally, I like my customers between 20-100kg!). --e 01:45, 10 May 2004 (UTC)

My turn: But do we really need full articles on the peds and adult and geriatric subspeciality on everything? I recognize a wiki doesn't have size constraints like a paper version would. The issue I want to consider is usability for a non-medical professional coming onto the site. The peds subspecialities are usually identical to the adult versions. While the training path is different I think there is more to be learned from one article for a subspeciality with subsections on pediatric issues and geriatric issues in the main articles. (BTW, the comment on acknowledgement of the existance of the peds subspecialities was meant to get past the anticipated comment that we ought to have them just 'cus they exist). The pediatric patients are truly not small adults, but full articles on EVERY speciality? For example - peds gas - you still have airway management. The pharmacology of the drugs is the same. Yeah, you pressure ventilate rather than set up for AC on the vent, and the doses are different - but as a rule aren't the similarities more important than the differences? As Erich says, it is a subdiscipline of anesthesia, not another thing altogether. Adding peds and geriatric sections/content would improve the articles and generalize them appropriately for an encyclopedia audience. (Now, as a physician I am going to exercise my perogative to stomp around wave my arms and pout) Kd4ttc 19:40, 10 May 2004 (UTC)
 * Recognize that this is just idle lounge chitchat, with amusement rather than rancor the dominant tone, but you actually didn't respond to my questions and suggestions.

Please: 1. Reread my reply above. 2. Did you look at the pediatric endocrinology article? Do you think it a totally pointless waste of time and electrons? I have actually had people ask me what the specialty was when they showed up for an appointment or when they asked me what I did. And before you answer, keep in mind that it is half the size of an article detailing the use of umlauts in the names of heavy metal bands that was nominated for a feature article--- it's not like the bar is real high here... 3. I didn't simply stick it into the general endocrinology article because it seemed like it would be a disproportionately big subsection, but it doesn't seem like that big a deal to me. Is that what you want? 4. I agreed 100% with you that we should cover childhood and adult aspects of diseases in the same article. 5. And as far as gasboy's complaint about the length of the list, it is no longer than the list of internal medicine specialties, so why one and not the other? OK, because I rarely pick fights in the doctor's lounge, here's my proposal: list the organ specialties with a mention of both child and adult versions as a separate list (not two lists) outside of internal medicine and pediatrics. See what an irenic kinda person I can be? Alteripse 21:14, 10 May 2004 (UTC)
 * Alteripse - um... that was a rather long list you had added! perhaps until the articles are actually created the list would be best on the paeds page. I could add red links to the subbranches of anaesthesia (cardiac, neuro, paeds probably biggest) but it wouldn't add much value a this stage.
 * However I disagree completely with The peds subspecialities are usually identical to the adult versions. They are completely different. A GP friend of mine compared paeds with vet. 'check all orifices and talk to the owner' ;-) (and before you reply alteripse... JFW wants us to behave) but seriously paeds = different diseases, approach and philosophy. (And if you ever anaethetise a kid like you would an adult, you'll end up with an extremely unhappy child at best and dead one at worst)...
 * The benefit a telephone book has over this list of specialties, of course, is that people don't waste as much time on a telphone book! Another good reason for splitting the list off. - see my rational for health profession in discussion of allied health above :-)--e 20:44, 10 May 2004 (UTC)

I practice both adult and pediatric GI. The differences are not as great as the GP reverenced here imples. For that matter, the description fits with dementia and the spouse, respectively. You typically do get a history from a child. They do talk. Just listen, though as with any patient there is a need for interpretation. Yeah, abdominal pain is not well locallized under 10 years of age, yeah there are glycogen storage diseases, atresias of this and that, and you tend to treat a little before pulling out the scope, but in the main the diseases are really quite similar. And the anesthesiologists who put the kids under for endoscopy are all adult anesthesiologists, they dial the gas up slowly to 3% (for enflurane?), and versed and ketamine do a nice job too, with adjustments for weight, and avoid the nitrous so it doesnt' puff up the gut. Just use an ET tube about the size of the 5th digit. Alterlipase's article is more about the history of pediatric endocrine, rather than a talk on pediatric endocrine. An article with more focus on Peds Endocrine history and a section of the endocrinology of peds patients might read better overall. It is interesting that the articles on medical specialities tend to address the diseases. I trained with Hirshowitz, so thought I'd put in an article about him separate from GI, cross ref it, and put in some photos of his first scope. I still say limit the separate articles on each Peds speciality with comments above still standing. Stephen Holland, M.D., Wikidoc, Kd4ttc 01:47, 11 May 2004 (UTC)