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What Is the Difference Between an MD and a DO?
When you say that you are going to see a doctor, you may be referring to two types of medical professionals: MDs and DOs. Each title refers to the type of degree and licensing the doctor has. Both MDs and DOs have similar training and duties, but they differ in a few key areas.
What Is an MD?
MD stands for doctor of medicine. MDs are allopathic doctors. That means they treat and diagnose conditions using conventional medical tools like x-rays, prescription drugs, and surgery. Allopathic medicine is also called conventional or mainstream medicine.
MDs can choose to be broad practitioners and work as family medicine or primary care doctors. They can also specialize in several different areas requiring further education including:
- Specific body parts or organs
- Geriatric medicine
What Is a DO?
DO stands for doctor of osteopathic medicine. They use the same conventional medical techniques as MDs but with a few other methods. DOs tend to focus more on holistic health and prevention. In holistic health, all parts of a person, including their mind, body, and emotions, are considered during the treatment. They also use a system of physical manipulations and adjustments to diagnose and treat people.
Over half of DOs choose to work in primary care, but they can also choose to specialize in another area, just like MDs.
DOs have all the same responsibilities and rights as MDs, including the abilities to perform surgery with proper training and prescribe medicine.
How Are MDs and DOs Similar?
MDs and DOs follow similar educational routes. They must first earn a four-year undergraduate degree, and most will take pre-medicine courses during this time. After getting an undergraduate degree, they will attend either medical school or a college of osteopathic medicine.
After finishing four years of medical education, MDs and DOs must complete an internship and a residency. A residency is on-the-job training under the supervision of more experienced doctors. Some MDs and DOs will also go on to do fellowships to learn more about a specialty.
MDs and DOs often train side by side in residencies and internships, despite going to different types of schools.
Both MDs and DOs must also take a licensing exam in order to practice medicine professionally. The type of licensing exam taken depends on the state that the MD or DO resides in.
How Are MDs and DOs Different?
Education. Both allopathic medical schools and colleges of osteopathic medicine are competitive to get into. However, students attending colleges of osteopathic medicine have slightly lower average GPAs and MCAT scores compared to students attending medical schools.
These lower GPAs and MCAT scores do not necessarily reflect the quality of students in DO programs. There are fewer students in colleges of osteopathic medicine compared to allopathic medical schools. Only a quarter of medical students in the US attend a college of osteopathic medicine.
DOs have extra education, usually about 200 hours, to learn osteopathic manipulative medicine (OMM). It is also called osteopathic manipulative technique (OMT).
DOs learn about how the bones, nerves, and muscles work together and influence people’s health. OMT focuses on methods used to relieve back pain, neck pain, strained muscles, and other conditions.
Approach to Medicine. MDs focus on looking at your symptoms and making a diagnosis based on those symptoms. They tend to take a more targeted approach to treatment.
DOs, on the other hand, see the body as an integrated whole and treat health issues accordingly. Because of this holistic view, they usually focus more on prevention. They may also make more lifestyle recommendations compared to MDs.
Some MDs may also take a holistic approach to medicine, but not all of them will. Holistic health is the basis of osteopathic medicine, so all DOs will use this approach.
Patient visits. One study found that around 19% of doctor’s visits were to DOs, and 81% were to MDs. Depending on where you live or who you are, you may be more or less likely to see a DO or MD.
- More people living in the Northeast United States sought care from a DO.
- Children, African-American, and Hispanic people were less likely to see a DO than an MD.
- Women were more likely than men to see a DO.
Patient satisfaction. One survey showed that people who had seen osteopathic doctors were more satisfied with their treatment than those who had been to allopathic doctors, chiropractors, and other types of health care providers.
Differences Between DOs and Chiropractors
While the OMM techniques performed by DOs seem similar to those used by chiropractors, the two fields are different. Unlike DOs, chiropractors cannot practice medicine. Chiropractors focus more on the musculoskeletal system and spinal alignment. DOs can practice medicine like an MD, and they focus on holistic and preventative medicine.
DO vs. MD: How much does the medical school degree type matter?
As you ponder medical school, you may be wondering, “What is the difference between an MD and a DO?” In the U.S. there are two types of degrees in which physicians can practice medicine: MDs, a doctor of medicine, or a DO, a doctor of osteopathic medicine.
The two degrees reflect different types of medical school training. MDs attend allopathic medical schools, while DOs attend osteopathic medical schools.
Learn the six things they don’t tell you about life in medical school.
About a quarter of U.S. medical students train at osteopathic medical schools. That number has grown significantly in recent years, with the American Association of Colleges of Osteopathic Medicine reporting first year enrollment at osteopathic medical schools rising by more than 40% over the past decade. That spike is, at least, in part due to additional DO-granting medical schools opening.
In terms of the requirements to apply to MD and DO programs, the criteria are virtually the same, with both osteopathic and allopathic programs weighing grade-point average and Medical College Admission Test (MCAT) scores heavily. The curriculum is largely the same structure, with students in both types of programs typically spending much of their first 12-24 months in the classroom and the majority of their training beyond that in a clinical setting.
Find out what the rise in medical school applications means for premeds.
October 2020: Kaplan MCAT stumpers put premeds to the test
Single accreditation, residency training
Single accreditation, residency training
In the past, residency programs for trainees from osteopathic and allopathic medical schools have generally matched with residency programs through separate processes.
In an effort to simplify the graduate medical education (GME) accreditation system in the United States, the organizations that accredit GME—the Accreditation Council for Graduate Medical Education and the
American Osteopathic Association (AOA)—have changed how they do things.
The 2020 Main Residency Match marked the completion of the transition to a single accreditation system and the consolidation to one Match for U.S. DO seniors and graduates.
Those changes also affect licensing. Most residency programs will accept the Comprehensive Osteopathic Medical Licensing Examination taken by DO graduates, as well as the United States Medical Licensure Exam which is taken by MD graduates and can be taken by DO graduates.
Mind, body, spirit
Mind, body, spirit
Historically, DO programs have touted their methods as more holistic. One aspect of that is the osteopathic manipulative treatment, defined by the AOA as a “set of hands-on techniques used by osteopathic physicians . .. to diagnose, treat, and prevent illness or injury.”
Those skills typically mean that osteopathic medical students spend an additional 200-plus hours training on the musculoskeletal system in the curriculum.
“If a student is somebody who really enjoys that patient-centered approach and really is of the mindset that medicine is a mind-body-spirit relationship, a DO program will serve them well,” said John D. Schriner, PhD, associate dean for admissions and student affairs at Ohio University Heritage College of Osteopathic Medicine, one of 37 member schools of the AMA Accelerating Change in Medical Education Consortium.
Discover which undergraduate majors are best for medical school.
Most DOs choose primary care
Most DOs choose primary care
The first fully combined MD-DO Match in 2020 yielded positive results for graduates from both types of schools. An all-time high 6,581 U.S. DO seniors submitted rank order lists of programs, and the 90. 7 percent PGY-1 match rate was the highest ever. That percentage is just 3 points lower than the 93.7% Match percentage posted by graduates of US MD-grant medical schools.
According to AOA 2019 figures, nearly 57% of DOs practice in primary care specialties: 31.4% are family physicians, 18.1% are internists and 6.89% are pediatricians.
By comparison, less than 30% of active U.S. physicians with MD credentials practice in primary care specialties: 11.3% are family physicians or in general practice, 10.6% are internists, and 6.8% are pediatricians. That data comes from the Association of American Medical Colleges.
Which is right for you?
Which is right for you?
One admissions officer provides this tip: Don’t worry about the degree.
“People ask often: Should I apply to an allopathic or osteopathic school?” said Benjamin R. Chan, MD, associate dean for admissions at the University of Utah School of Medicine, also a member of the AMA Accelerating Change in Medical Education Consortium
“What I tell everyone is you should apply to both. Then if you get into both schools, just the same as if you got into two osteopathic schools or two allopathic schools, you need to do your research as a premed to figure out which is the best fit.”
Which undergrad majors are best for med school?
Medicine can be a career that is both challenging and highly rewarding, but figuring out a medical school’s prerequisites and navigating the application process can be a challenge into itself. The AMA premed glossary guide has the answers to frequently asked questions about medical school, the application process, the MCAT and more.
Have peace of mind and get everything you need to start med school off strong with the AMA.
What’s an MD, DO, NP, PA and MA?
The initials floating behind your healthcare provider’s name can be confusing. Here are some insights on what the letters mean:
MDs, medical doctors
Medical doctors practice the classical form of medicine called allopathic medicine. Making up 90 percent of today’s practicing physicians, MDs diagnose and treat disease. MDs practice independently.
- Four-year college degree
- Four years of medical school
- Three to seven years of residency training, depending on the specialty
- Fellowship training for one or more years in some specialties
What an MD does:
- Diagnoses and manages acute and chronic illnesses
- Orders, performs and interprets diagnostic tests such as lab work and X-rays. Refers to other specialists and healthcare providers as needed.
- Prescribes medications and other treatments
- Manages a patient’s care
- Surgeons perform operations
DOs, doctors of osteopathic medicine
DOs practice osteopathic medicine, a more holistic view of medicine. The focus is on seeing the patient as a whole person instead of treating just the symptoms. They practice independently.
DOs also receive training in osteopathic manipulative treatment — moving a patient’s muscles and joints with stretching, gentle pressure and resistance — to diagnose, treat and prevent illness. DOs make up 10 percent of practicing physicians in the U.S. today.
- Four-year college degree
- Four years of medical school
- Internship, residency and fellowship lasting three to eight years
Included in DO education is special training in the body’s musculoskeletal system of muscles, nerves and bones.
Medical licenses are governed at the state level by state boards of medicine. In addition, there are 24 medical specialty boards that certify physicians in specialties and subspecialties.
To become board-certified, a physician needs to spend several years after medical school receiving supervised in-practice training followed by written and sometimes oral exams.
What a DO does:
- Diagnoses and manages acute and chronic illnesses
- Orders, performs and interprets diagnostic tests such as lab work and X-rays. Refers to other specialists and healthcare providers as needed.
- Prescribes medications and other treatments
- Manages a patient’s care
- Surgeons perform operations
- Can do manipulative treatment of muscles and joints
NPs, nurse practitioners
Nurse practitioners practice in primary, acute and specialty healthcare services. They can be in primary or specialty care, treating the whole person and guiding each patient to make smart health and lifestyle choices. NPs practice independently.
- Bachelor’s and Master’s degrees in nursing
- Most graduate programs require more than five years’ experience in the medical field before a candidate can apply
- Ph.D. and/or doctorate in nursing (DNP) degree for some nurse practitioners
What an NP does:
- Diagnoses and manages acute and chronic illnesses
- Orders, performs and interprets diagnostic tests such as lab work and X-rays. Refers to specialists or other healthcare providers as needed.
- Prescribes medications and other treatments
- Manages a patient’s care
- Focuses on health promotion, disease prevention and health education and counseling
- Practices under the rules and regulations of the state in which they’re licensed and are nationally certified in the specialty areas
NPs do not need physician supervision to make clinical decisions.
PAs, physician assistants
The first PAs started training in 1967 at Duke University in North Carolina. The program began to help Vietnam vets who had served as medics.
PAs work in primary and specialty care under the direction and supervision of a licensed physician.
Physician assistants can:
- Diagnose and treat common illnesses and injuries
- Perform certain procedures and minor surgeries
- Prescribe medication
- Order and interpret diagnostic and lab tests
- Offer guidance about health and nutrition
- Refer patients to a specialist and other healthcare providers
- A master’s degree usually is required to be considered for a PA program although most programs require applicants to have work experience as an EMT, paramedic, medical assistant or ER technician. Prior healthcare experience is not always required.
- PA programs typically include at least 2,000 hours of clinical rotations
What a PA does:
- Tracking medical histories and symptoms
- Ordering lab tests and analyzing results with physicians
- Providing a limited number of prescriptions
- Advising patients about preventive healthcare
- Treating minor injuries or sicknesses
- Referring patients to specialists as needed
Licensing and certification: Although laws vary by state, all PAs need to complete an accredited education program and pass a national exam.
MA, a medical assistant
You might think the medical assistant in your doctor’s office is a registered nurse, but he or she is most likely a medical assistant. A medical assistant performs both clinical and administrative jobs at doctors’ offices, urgent cares and clinics.
Clinical duties may include:
- Taking a patient’s medical history
- Explaining treatments to patients
- Preparing a patient for examination
- Helping the physician during exams
- Collecting and preparing lab specimens
- Performing basic lab test
- Preparing and administering medications as directed by a physician
- Teaching patients about medications and special diets
- Drawing blood
- Doing electrocardiograms
- Removing sutures and changing dressings
- Transmitting prescription refills as directed
Administrative duties may include:
- Greeting patients
- Updating patient medical records
- Coding and filling out insurance forms
- Using computer applications
- Answering telephones
- Scheduling appointments
- Arranging for hospital admissions and lab services
- Handling correspondence, billing and bookkeeping
Many employers prefer that medical assistants be certified by the American Association of Medical Assistants.
M.D. Versus D.O.: Similarities and Differences
The difference between a physician who is a “M.D.” and a physician who is a “D.O.” is subtle and sometimes confusing. The initials “M.D.” are usually quite familiar for patients, but a “D.O.” behind a name might not be as familiar. Understanding the similarities and differences of each will help any patient find the type of physician that best suits their needs.
M.D. Versus D.O.
The initials “M.D.” stand for “Doctor of Medicine” and indicate that the physician has been awarded a degree from an allopathic medical school. The initials D.O. stand for “Doctor of Osteopathic Medicine.”
A D.O. is granted to physicians who graduate from an osteopathic medical school. Osteopathic medicine is an approach to the practice of medicine that focuses on the unity of all body systems.
What Does a M.D. and a D.O. Have in Common?
While the average person is probably more familiar with a “M.D. ” behind a physician’s name, they will find that a D.O. can have the same requirements and qualifications as an M.D.
The two are similar in important ways, including that both a M.D. and a D.O.:
- Attend medical school, a residency, where they learn the same things. Upon completion, they both leave medical school certified to see patients, diagnose conditions, prescribe medications, and perform surgeries.
- Meet the same requirements to practice medicine from their state’s licensing board.
- Practice in all 50 states.
- Perform in any specialty.
- Examine and treat patients with methods based on scientific conclusions.
How Does a M.D. Differ From a D.O.?
While a M.D. and a D.O. have the same amount of education and qualifications, there is one big difference between the two. A D.O. goes to medical school, but they differ from an M.D. in the focus of their training and their philosophy when it comes to patient care.
An M. D. is traditionally trained when it comes to diagnosing patients and treating conditions. An M.D. is trained with a focus on medicine where the physician observes the patient’s symptoms and treats them directly.
Meanwhile, a D.O. practices osteopathic medicine which means they view the patient more holistically beyond the symptoms that are being presented. A D.O. will consider a patient’s entire body system, their nutrition, and their everyday environment to appropriately diagnose and treat a patient.
A D.O. also receives an additional 200 hours of training in the skill of osteopathic manipulative medicine. This means that if a patient presents with muscle pain, a D.O. may choose to manipulate the musculoskeletal tissue to relieve pain.
A D.O.’s Approach to Pregnancy Planning and Care
According to an article in the Journal of the American Osteopathic Association, a woman’s entire body and system processes change and shift when trying to accommodate a growing fetus. Because of the stress on a woman’s body as pregnancy advances, it isn’t uncommon to experience musculoskeletal misalignment which causes pain and discomfort in expectant mothers.
A D.O. might be able to help alleviate this pain and discomfort through their use of osteopathic manipulation techniques from soft tissue general manipulations to full manipulations like a chiropractor would perform. A D.O. can help with natural relief from pain from expanding bellies and shifting pelvic bones.
A Collaborative Medical Care Team Is the Best Choice
Whether they are D.O.s or M.D.s, the providers at Moreland OB-GYN are all dedicated to working together and supporting one another to ensure that Moreland patients get the best possible care in a manner that best suits their needs. Our physicians are dedicated to providing excellence in women’s health.
The care providers at Moreland OB-GYN offer complete services for obstetrics, gynecology, preventative health, fertility, surgery, and ultrasound. With nine locations to conveniently serve you in Waukesha, Oconomowoc, Milwaukee, Mukwonago, and the surrounding communities, we pride ourselves on leading women to better health.
Learn more about our physicians and services, or contact us today to request an appointment.
Should You Choose an M.D. or D.O.
The American Association of Colleges of Osteopathic Medicine estimates that more than 20 percent of current medical students are studying to become a doctor of osteopathic medicine (D.O.). So what are the differences between an M.D. and a D.O., and what these differences mean for their patients? Read below to learn more.
1. What is a D.O.?
Licensed physicians in the U.S. must be either an M.D. or a D.O. The acronym M.D. stands for medical doctor, while D.O. is short for doctor of osteopathic medicine. The titles do not refer to a specialty. For example, I am a D.O. that works as an internal medicine physician, but there are D. O.s and M.D.s who specialize in pulmonary disease, neurosurgery, psychiatry, etc.
2. What are the differences between M.D.s and D.O.s?
The differences between D.O.s and M.D.s are the additional training that D.O.s receive, osteopathic manipulation and the integrative philosophy that we apply to medicine. D.O.s look at the “total person”—including their environment and its impact on the patient’s health—to promote preventive care instead of just treating symptoms.
3. How does osteopathic manipulative medicine work?
Osteopathic manipulative medicine is a hands-on approach to treatment which includes physically manipulating targeted areas of the body to improve circulation, release tension and balance muscles, providing the patient with a better foundation to begin healing. Osteopathic physicians use these tools in addition to what people typically view as modern medicine, which can include prescription drugs, surgery and technology. All D.O.s are trained in these techniques, but the degree to which they use them in their practice is up to the specific physician.
4. How common are D.O.s?
We are seeing recent growth in the number of D.O.’s in the United States, and one of the reasons is that the education and training programs for M.D.s and D.O.s are becoming increasingly aligned with one another. D.O.s are growing in popularity, and Swedish Hospital’s medical staff has osteopathic physicians in a wide variety of specialties, including family medicine, emergency medicine, obstetrics and gynecology, internal medicine and pediatrics.
5. How can patients tell which type of doctor is best for them?
Determining whether to see an M.D. or a D.O. is entirely personal. The most important thing is being comfortable with whomever you choose and trusting their ability to care for you. A good physician should be willing to take the time to educate you, listen to concerns and answer questions in addition to treating you for illness.
By David Modica | Published July 13, 2016
D.O. vs. M.D. Wages, Requirements and Responsibilities
Working as a physician can be a rewarding job with countless opportunities to help patients achieve better health. Depending on the medical degree you earn, you can expect to specialize in certain areas and make a specific salary range. Learning how Doctor of Osteopathic Medicine (D.O.) and Medical Doctor (M.D.) degrees differ can help you make the best possible choice for your career. In this article, we compare D.O. vs M.D. wages, requirements and responsibilities.
What is a D.O.?
A D.O. examines, diagnoses and treats patients’ illnesses and injuries using a combination of medications and surgery. These medical professionals tend to be primary care physicians rather than specialists. D.O. physicians are responsible for the following tasks:
- Taking medical histories and updating patients’ medical charts
- Ordering tests to check patients’ health status and diagnose problems
- Recommending treatment plans
- Prescribing medications
- Answering questions and discussing healthcare concerns
- Emphasizing preventive medicine, which is designed to take a proactive rather than reactive approach to medical issues
- Providing holistic care, which takes a whole-body approach and considers patients’ environments, nutrition and other factors
- Manipulating the musculoskeletal system to relieve pain and improve quality of life
Related: Learn About Being a Doctor
What is an M.D.?
Similar to a D.O., an M.D. examines, diagnoses and treats a variety of injuries and illnesses using surgery and medication. M.D. physicians also perform standard tasks like taking medical histories, ordering tests, prescribing medications and designing treatment plans. However, M.D. physicians focus less on preventive medicine and holistic care.
M.D. physicians often specialize in an area of medicine. These medical professionals can choose from hundreds of specialty areas, ranging from allergy and immunology to obstetrics and gynecology to psychiatry and neurology.
D.O. average salary
D.O. physicians make an average of $163,908 per year in the United States. Factors like experience level and geographic location often affect D.O. physicians’ earning potential.
M.D. average salary
M.D. physicians make an average of $201,918 per year in the U.S. Their area of specialty, experience level and geographic location can impact M.D. physicians’ earning potential.
D.O. vs. M.D. wages
D.O. and M.D. physicians make comparable salaries, but M.D. wages tend to be higher. On average, M.D. physicians earn more for the following reasons:
M.D.s usually specialize in an area of medicine, while D.O. physicians are usually considered general practitioners or family practitioners. Some fields of medicine have higher associated risks or require more complex training, which can lead to higher earnings.
M.D. physicians typically work in urban areas where compensation tends to be higher to allow for the cost of living. In contrast, many D.O. physicians work in rural areas where the cost of living and the average salary is lower.
Related: 12 Healthcare Jobs That Pay Well
D.O. vs. M.D. requirements
Although all D.O. and M.D. physicians have to complete several years of medical school and training, their educational paths and professional requirements are slightly different. Take a look at the requirements for each below.
To become a D.O., you need to complete the following steps:
1. Earn a bachelor’s degree
First, earn an undergraduate degree from an accredited university. Most medical schools will accept any major, but students who study sciences, such as biology, chemistry or physics, can better prepare themselves to work in medicine.
2. Take the MCAT
All prospective medical students have to take the Medical College Admissions Test (MCAT) to enter a graduate program. Most students complete the exam a year before applying to programs.
3. Pursue a D.O. program
Since there are only about 30 accredited D.O. programs in the U.S., these programs tend to be more competitive than M.D. programs. All D.O. programs take four years to complete and include both classroom lessons and clinical practice.
4. Pass the COMLEX-USA
All D.O. physicians have to pass the three-part Comprehensive Osteopathic Medical Licensing Examination (COMLEX-USA). Most students take the first part during their second year of medical school, the second part after the third year of medical school and the third part after graduation.
5. Complete an internship
After finishing medical school, D.O. physicians have to complete a year-long general internship, which is a requirement M.D. physicians typically do not have. This internship includes 200 hours of osteopathic manipulative medicine, or methods of relieving pain by manipulating musculoskeletal tissue.
6. Finish a D.O. residency
Following their internships, D.O. physicians have to complete a residency that gives them practical experience. D.O. residencies last from three to seven years. Family medicine residencies are generally the shortest and last for three years, while more specialized areas like radiology require four-year residencies.
7. Apply for a medical practice license
All D.O. physicians must have a license to work in their state, which requires passing the necessary medical practice exams and meeting all educational and training requirements previously listed.
8. Gain board certification
D.O. physicians can opt to become board certified by the American Osteopathic Association in more than a dozen specialty areas, ranging from anesthesiology to proctology.
Related: How to Choose a Specialty in Medicine
To become an M.D., you need to complete the qualifications below:
1. Earn a bachelor’s degree
Like D.O. physicians, M.D. physicians need an undergraduate degree, preferably with a science-focused major.
2. Take the MCAT
Prospective M.D. physicians also have to take the MCAT to apply to medical school.
3. Pursue an accredited M.D. program
Since there are over 140 accredited M.D. programs in the U.S., getting into one of these programs tends to be slightly less competitive. M.D. programs are just as rigorous as D.O. programs and require two years of classroom education and two years of practical experience.
4. Pass the USMLE
All prospective M.D. physicians have to pass the three-part United States Medical Licensing Examination (USMLE). Medical students usually take the first part before their third year of medical school, the second part during their fourth year and the third part after graduation.
5. Complete an M.D. residency
Like D.O. physicians, M.D. physicians also have to complete a residency program to gain practical experience. Residencies last for three to seven years and are usually focused on a specialty area, such as pediatrics or anesthesiology.
6. Apply for a medical practice license
All M.D. physicians need a license to practice medicine in their state, which requires passing the required medical practice exams and meeting all educational and training requirements listed above.
7. Gain relevant board certifications
M.D. physicians can also get certified in their area of specialization by one of two dozen specialty boards that offer certification in hundreds of areas.
Doctor of medicine profession (MD): MedlinePlus Medical Encyclopedia
The practice of medicine in the United States dates back to the early 1600s. At the beginning of the 17th century, medical practice in England was divided into three groups: the physicians, the surgeons, and the apothecaries.
Physicians were seen as elite. They most often held a university degree. Surgeons were typically hospital-trained and they did apprenticeships. They often served the dual role of barber-surgeon. Apothecaries also learned their roles (prescribing, making, and selling medicines) through apprenticeships, sometimes in hospitals.
This distinction between medicine, surgery, and pharmacy did not survive in colonial America. When university-prepared MDs from England arrived in America, they were expected to also perform surgery and prepare medicines.
The New Jersey Medical Society, chartered in 1766, was the first organization of medical professionals in the English colonies. It was developed to “form a program embracing all the matters of highest concern to the profession: regulation of practice; educational standards for apprentices; fee schedules; and a code of ethics.” Later this organization became the Medical Society of New Jersey.
Professional societies began regulating medical practice by examining and licensing practitioners as early as 1760. By the early 1800s, the medical societies were in charge of establishing regulations, standards of practice, and certification of doctors.
A natural next step was for such societies to develop their own training programs for doctors. These society-affiliated programs were called “proprietary” medical colleges.
The first of these proprietary programs was the medical college of the Medical Society of the County of New York, founded March 12, 1807. Proprietary programs began to spring up everywhere. They attracted a large number of students because they eliminated two features of university-affiliated medical schools: a long general education and a long lecture term.
To address the many abuses in medical education, a national convention was held in May 1846. Proposals from that convention included the following:
- A standard code of ethics for the profession
- The adoption of uniform higher educational standards for MDs, including courses of premedical education
- The creation of a national medical association
On May 5, 1847, nearly 200 delegates representing 40 medical societies and 28 colleges from 22 states and the District of Columbia met. They resolved themselves into the first session of the American Medical Association (AMA). Nathaniel Chapman (1780-1853) was elected as the first president of the association. The AMA has become an organization that has a great deal of influence over issues related to health care in the United States.
The AMA set educational standards for MDs, including the following:
- A liberal education in the arts and sciences
- A certificate of completion in an apprenticeship before entering the medical college
- An MD degree that covered 3 years of study, including two 6-month lecture sessions, 3 months devoted to dissection, and a minimum of one 6-month session of hospital attendance
In 1852, the standards were revised to add more requirements:
- Medical schools had to provide a 16-week course of instruction that included anatomy, medicine, surgery, midwifery, and chemistry
- Graduates had to be at least 21 years of age
- Students had to complete a minimum of 3 years of study, 2 years of which were under an acceptable practitioner
Between 1802 and 1876, 62 fairly stable medical schools were established. In 1810, there were 650 students enrolled and 100 graduates from medical schools in the United States. By 1900, these numbers had risen to 25,000 students and 5,200 graduates. Nearly all of these graduates were white males.
Daniel Hale Williams (1856-1931) was one of the first black MDs. After graduating from Northwestern University in 1883, Dr. Williams practiced surgery in Chicago and was later a main force in establishing Provident Hospital, which still serves Chicago’s South Side. Previously black physicians found it impossible to obtain privileges to practice medicine in hospitals.
Elizabeth Blackwell (1821-1920), after graduating from Geneva College of Medicine in upstate New York, became the first woman granted an MD degree in the United States.
The Johns Hopkins University School of Medicine opened in 1893. It is cited as being the first medical school in America of “genuine university-type, with adequate endowment, well-equipped laboratories, modern teachers devoted to medical investigation and instruction, and its own hospital in which the training of physicians and healing of sick persons combined to the optimal advantage of both.” It is considered the first, and the model for all later research universities. Johns Hopkins Medical School served as a model for the reorganization of medical education. After this, many sub-standard medical schools closed.
Medical schools had become mostly diploma mills, with the exception of a few schools in large cities. Two developments changed that. The first was the “Flexner Report,” published in 1910. Abraham Flexner was a leading educator who was asked to study American medical schools. His highly negative report and recommendations for improvement led to the closing of many substandard schools and the creation of standards of excellence for a real medical education.
The other development came from Sir William Osler, a Canadian who was one of the greatest professors of medicine in modern history. He worked at McGill University in Canada, and then at the University of Pennsylvania, before being recruited to be the first physician-in-chief and one of the founders of Johns Hopkins University School of Medicine. There he established the first residency training (after graduation from medical school) and was the first to bring students to the patient’s bedside. Before that time, medical students learned from textbooks only until they went out to practice, so they had little practical experience. Osler also wrote the first comprehensive, scientific textbook of medicine and later went to Oxford as Regent professor, where he was knighted. He established patient-oriented care and many ethical and scientific standards.
By 1930, nearly all medical schools required a liberal arts degree for admission and provided a 3- to 4-year graded curriculum in medicine and surgery. Many states also required candidates to complete a 1-year internship in a hospital setting after receiving a degree from a recognized medical school in order to license the practice of medicine.
American doctors did not begin to specialize until the middle of the 20th century. People objecting to specialization said that “specialties operated unfairly toward the general practitioner, implying that he is incompetent to properly treat certain classes of diseases.” They also said specialization tended “to degrade the general practitioner in the view of the public.” However, as medical knowledge and techniques expanded many doctors chose to concentrate on certain specific areas and recognize that their skill set could be more helpful in some situations.
Economics also played an important role, because specialists typically earned higher incomes than the generalist physicians. The debates between specialists and generalists continue and have recently been fueled by issues related to modern health care reform.
SCOPE OF PRACTICE
The practice of medicine includes the diagnosis, treatment, correction, advisement, or prescription for any human disease, ailment, injury, infirmity, deformity, pain, or other condition, physical or mental, real or imaginary.
REGULATION OF THE PROFESSION
Medicine was the first of the professions to require licensing. State laws on medical licensing outlined the “diagnosis” and “treatment” of human conditions in medicine. Any individual who wanted to diagnose or treat as part of the profession could be charged with “practicing medicine without a license.”
Today, medicine, like many other professions, is regulated at several different levels:
- Medical Schools must adhere to the standards of the American Association of Medical Colleges
- Licensure is a process that takes place at the state level in accordance with specific state laws
- Certification is established through national organizations with consistent national requirements for minimal professional practice standards
Licensure: All states require that applicants for MD licensure be graduates of an approved medical school and complete the United States Medical Licensing Exam (USMLE) Steps 1 to 3. Steps 1 and 2 are completed while in medical school and step 3 is completed after some medical training (usually between 12 to 18 months, depending on the state). People who earned their medical degrees in other countries also must satisfy these requirements before practicing medicine in the United States.
With the introduction of telemedicine, there has been concern as to how to handle state licensure issues when medicine is being shared between states through telecommunications. Laws and guidelines are being addressed. Some states have recently established procedures for recognizing the licenses of physicians practicing in other states in times of emergency, such as after hurricanes or earthquakes.
Certification: MDs who wish to specialize must complete an additional 3 to 9 years of postgraduate work in their specialty area, then pass board certification examinations. Family Medicine is the specialty with the broadest scope of training and practice. Doctors who claim to practice in a specialty should be board-certified in that specific area of practice. However, not all “certifications” come from recognized academic agencies. Most credible certifying agencies are part of the American Board of Medical Specialties. Many hospitals will not permit physicians or surgeons to practice on their staffs if they are not board-certified in an appropriate specialty.
90,000 Steve Wooding MD | Janssen
STEVE WOODING, DOC
HEAD OF THE GLOBAL COMMERCIAL STRATEGY ORGANIZATION
Since June 2015, Steve Wooding, M.D., has served as Head of the Global Commercial Strategy Organization (GCSO) and Market Access Organization. He is a member of the Pharmaceuticals Group Operating Committee (GOC).
In this role, Steve leads the GCSO and his primary responsibility is to develop the Janssen One vision, which is the company’s overall vision and global strategy to drive medical innovation and position Janssen as a global leader in the pharmaceutical industry.Steve and his team help identify and adapt to market changes and develop new growth strategies. Together with their research and development colleagues, they are realizing the accumulated potential to improve the quality of life for patients around the world.
Most recently, Steve was the Managing Director of Emerging Markets for Janssen EMEA (Europe, Middle East, Africa). His area of responsibility includes commercial operations in Central and Eastern Europe, the Middle East, North and West Africa, Turkey, South Africa and sub-Saharan Africa.Previously, as Vice President and Chief Executive Officer of Market Access EMEA, he created a comprehensive functional division, bringing together the teams in Commercial Strategy, Medical, Health Economics and Market Access, New Business Area Development, and Business Intelligence to provide patients with an ongoing prompt access to innovative medicines. Prior to that, Steve served as Vice President of Medical Affairs at Janssen EMEA. His confident outlook has helped to effectively streamline the operations of the medical division and create a more cohesive and coordinated functional division.
Previously, Steve served as Regional Managing Director for Janssen in the UK, Ireland and South Africa and Managing Director for Australia and New Zealand. He started his career at Johnson & Johnson with Janssen UK in 1992. Steve has held a number of high-profile positions in R&D, Healthcare, Commerce in the UK, Ireland, South Africa and Canada.
Steve earned his BS in Pharmacology, BS in Medicine and BS in Surgery from St. Bartholomew’s Hospital in London.He is a Research Fellow in the Department of Pharmaceutical Medicine and holds an MBA from Henley College of Management (Oxfordshire, UK).
Director John C. Cois M.D.
Director of the Kois Center
Received a D.M.D. from the University of Pennsylvania School of Dental Medicine and M.S.D. at the University of Washington School of Dentistry.He has a private practice limited to Prosthetic Dentistry in Tacoma and Seattle and is an Assistant Professor in Restoration Program at the University of Washington. Dr. Kois continues to lecture nationally and internationally, is a multi-journal reviewer and editor-in-chief of The Compendium of Continuing Education in Dentistry. Dr. Kois is the recipient of the 2002 Saul Schluger Memorial Award for Clinical Achievement in Diagnosis and Treatment Planning and has received the Lifetime Achievement Award from the World Congress of Minimally Invasive Dentistry and the American Academy of Cosmetic Dentistry.In addition, he is the recipient of the 2014 Dr. Thaddeus V. Veckl Prize, which is awarded annually to a dedicated educator who embodies the spirit of holistic dental care. In the past, he was President of the American Academy of Restorative Dentistry and the American Academy of Aesthetic Dentistry, as well as a member of many other professional organizations. In addition, he continues to work with restorative dentists at the Kois Center, a didactic and clinical training program.
When considering a postgraduate program to develop your skills as a medical practitioner, it is important to understand what vision the program has for you and your success. Dr. John Cois, director of the Kois Center, wants to “empower aspiring dentists to reach extraordinary levels of knowledge and skills in restorative dentistry.”It is an admirable goal that will only be achieved if learning enables you to succeed in both assimilating the information and applying the knowledge gained. The message must first “reach you” and then be followed by a realistic process that you can easily follow so that you can immediately bring about a change in your practice when you return. John’s first passion is seeing your success. One of the basic tenets of his philosophy is “honesty”. This permeates all aspects of his teaching.First, all information provided is based on independent scientific evidence reviewed at the highest level. This ensures that its application will give predictable results. He also loves relevance very much, so the material is updated as new research emerges and is introduced into his teaching. He does not accept sponsorship and is not guided by the plans of the companies. He has developed “systems” to put clinical protocols in “your hands.” It keeps class sizes small to be able to communicate with you and support you in your questions.John is non-judgmental and encourages you to voice your opinions and views on concepts. He insists that you approach him as an equal colleague and be open and receptive to your questions and concerns. He wants you to have every opportunity to “get it and then do it.” He has created an extensive support system with colleagues (“The Tribe”) who have taken the courses and can be used by you to develop your practice.
He is passionate about teaching. He takes pride in the fact that you learn and succeed.He cares deeply about the evolution of dentistry. He understands that you, as dedicated doctors, play a critical role in this success. His passion becomes your passion.
Dr. John K. Cois Around the World
Dr. John Cois is honored to be invited to speak to many organizations around the world.Please note that these events are not sponsored or organized by the Kois Center. Any questions related to these meetings, including registration, should be directed to the sponsoring organization.
Private dental practice
Practice website: www.drjohnkois.com
Contact: Office Manager ~ Judy Nordstrom-Tilton
5615 Valley Ave E.
Tacoma, WA 98424
90,000 To: Dr. Curry, M.D., Fellow: Handwritten Document, Liverpool, 12 July 1800
Robert Burns (1759-1796) is best known for his poems and songs reflecting the cultural heritage of Scotland.He was born in Alloway, Ayrshire, Scotland; he was the eldest of seven children of the peasant William Burns and his wife Agnes Brown. Burns did not receive a full formal education, but he read English literature and absorbed with keen interest the traditional Scottish folk songs and tales of his native rural region, which were transmitted mainly through oral tradition. He began composing songs in 1774 and published his first book, Poems, Primarily in Scottish Dialect, in 1786.The book was a great success, and thanks to the poems collected in it on various topics – in Scottish and English – Burns gained wide fame. While working in the literary field, Burns maintained a farm, and in 1788 he was appointed to the position of excise officer in Ellisland. He devoted the last 12 years of his life to collecting and processing traditional Scottish folk songs for collections of songs, including The Scottish Museum of Music and A Collection of Selected Scottish [sic!] Arias to Perform.Burns included hundreds of Scottish folk songs in these compilations, and in some cases he rewrote the original lyrics and transposed them into new or revised music.
This poem was written by William Shepherd, an unorthodox priest, school director and active politician based in Liverpool. He was intimately acquainted with William Roscoe, who was genuinely and deeply interested in Burns’s work and his writings. Shepherd wrote a 39-line poem in the style of Robert Burns, praising the 1800 edition of Dr. James Curry’s The Works of Robert Burns.
90,000 Captain Newman, M.D. (1963) – All about the film, reviews, reviews
The film draws a curve on the film’s graphics, alternating scenes of immense dramatic power with something like understated and cleverly inserted comedic elements with heart-warming variety.
Leo Rosten wrote a novel based on which they made a script with hot and cold water. The hero of the story is Captain Newman (Peck), the head of the neuropsychiatric department of an army hospital during the war (1944), who puts his medical obligations above his military duty. Three case histories are considered. This is a distinguished corporal with many awards (Bobby Darin), who considers himself a coward because he left a friend in a burning plane. The other is Colonel (Eddie Albert), who became violently insane with guilt for sending so many of his men to their deaths in dogfight.The third (Robert Duvall) is ashamed of hiding alone in a cellar for over a year in the territory occupied by the Germans.
Along the way, Newman gets involved with a nurse (Angie Dickinson) and his old-fashioned courtship is overseen by an orderly (Tony Curtis), an imaginative cameraman from Jesy City with a touch of Bergen County.
Peck’s portrait of the title character is mostly characterized by restraint and intelligence. Curtis has his good points, but he is essentially a central figure among the film’s supporting actors.Dickinson is cute, sometimes damn cute, as a nurse.
1963: Oscar nominations for Best Supporting Actor (Bobby Darin), adapted script and sound. (M. Ivanov)
90,000 Interview with the chief physician of the hospital No. 67, doctor of medical sciences, professor Andrey Shkoda and the head of the cardiac resuscitation department of the hospital No. 67, candidate of medical sciences, doctor of the highest qualification category Ekaterina Koshkina
Metropolitan medicine is on the mend
What will happen to the metropolitan healthcare after the reform? Will medical services become more accessible or will you have to pay for everything? Are Moscow doctors waiting for layoffs? The hosts of Vesti FM Natalya Mamedova and Vladimir Averin talked about all this with the chief physician of hospital 67, doctor of medical sciences, professor Andrei Shkoda and head of the cardiac intensive care unit of hospital 67, candidate of medical sciences, doctor of the highest qualification category Ekaterina Koshkina.
Let’s start with what, probably, a lot of people don’t understand at all:
health care reform is in order to save money, or to
to change something within the medical industry itself?
Of course, there is no talk of any savings. I must also say that
first of all, all the reforms that are taking place are aimed at improving
quality of life and quality of patient care.
Mamedova: Well, we are
really thought. Volodya, if you have a number of critical
comments, then I am ready to support doctors today.
Averin: I have a row
stories of some acquaintances, acquaintances of my acquaintances who work
doctors in clinics and hospitals and tell horrors. Are occurring
layoffs, specialists are thrown into the street, the number of
beds. In the end, a meeting of doctors was held in Moscow.And I do not know in
this situation, who to believe. Pretty streamlined wording that everything
aimed at making life easier for me – the patient. Or is it
to believe some of these figures about the reduction of people, beds?
Mamedova: Let’s just
with specific examples. Andrey Sergeevich, hospital number 67, I think
Muscovites know her, she is very old, has been working for a long time, a great medical
company. Have you had a reduction in the medical staff?
Skoda: You know this, I would
said the evolutionary process.And the process of reduction, optimization
our staff is held almost annually. And part of us is leaving
doctors are being retrained. But the changes that took place in Moscow
health care, I can talk about our hospital, they happened
drastically. I mean, over 300 units of medical equipment
was admitted to our hospital. And probably, if you let me, I
I will give just some examples that allowed to change the appearance
hospitals, to change the internal state of doctors and patients as well.
Averin: Ekaterina Vilenovna,
tell me, please, if we take one department in hospital No. 67, in
as a result of the reform that has begun and continues, you have decreased
or has the number of patient beds increased? Have changed some
technologies that are applied? Because here I am nothing at all
I understand medicine, I always honestly admit it, I am therapists
get scared because they say, “Well, you know how to heal.” No I do not
I know! I really don’t understand anything about medicine.That is, the doctor is for me
such a god, and no apparatus can replace him. So when I
they say that there were 20 doctors, and now there are 15 (I’m not talking about a laboratory, but,
for example, about the separation), I think: “So, 5 gods have gone somewhere, they
they won’t save me. “Maybe I’m wrong? How is it in your department?
Koshkina : Currently in
the cardiac intensive care unit, we both had two daily doctors, and
work. That is, in fact, our patients are in no way
deprived of the amount of attention.A patient who arrives at the hospital
within a short time he receives a highly qualified
consultation of specialists and further a decision is made. Usually,
patients who come to us are people with acute myocardial infarction.
That is, at present, our hospital has all the possibilities
help patients in the most acute stage of a heart attack. That is, modernization
brought great technical capabilities to the hospital. What we have? We
we have an angiograph, we are able to make a diagnosis within an hour.AND
if the reason for admission to the hospital was chest pain
cell and we saw acute coronary syndrome with elevation of the CT segment, then
have a myocardial infarction, we are a patient for half an hour, having already received
analyzes, we send to the operating room. And within an hour, the patient is
operation. Also in the program:
Skoda: – Availability and
the quality of medical services has increased significantly. – The hospital is not
a sanatorium is a place where a patient is helped.- If earlier
the patient was on average in the hospital for 20 – 25 days, but now – 7 and even
Koshkina: – Exists
the belief that if the hospital is paid, it means good. This is not true. –
Polyclinics today have every opportunity to make a diagnosis. –
The therapist is the backbone of the basics. This is a person who knows everything about the patient.
Listen completely in the audio version.
90,000 “Do you believe that Russian surgeons are wonderful?” American doctor on how our medicine differs from Western medicine: Society: Russia: Lenta.ru
Summing up the results of the outgoing year, Lenta.ru has compiled a list of the best publications of 2016. This text is one of them. A Russian patient organization is conducting a survey on whether a fatal diagnosis should be reported to a patient. In social networks, discussions have flared up around this topic. Many believe that the doctor should first of all notify close relatives, and they will already decide whether to disclose information to the patient. However, the same people admit that in such a case they themselves would like to know the whole truth from a doctor.Many Russian doctors also do not have an unambiguous opinion on this issue. How ethical issues are resolved in other countries, why medicine is a service, and how Russian doctors differ from foreign colleagues – Lenta.ru spoke with Vadim Gushchin, director of the surgical oncology department at Mercy Medical Center in Baltimore, USA. He left for America in the late 1990s, graduating from the Medical University. N.I. Pirogov.
“Lenta.ru”: Should a doctor tell a patient that he has several months left to live?
Vadim Gushchin : In America, by law, all information about a patient’s life and health belongs to the patient himself.And the doctor is an ordinary consultant who finds out what is happening to a person. Among patients who have learned a poor prognosis, there is no surge in suicides or depression – studies have been conducted on this topic. Of course, a person’s behavior changes at first, but as soon as he experiences this fact, life goes on.
Probably, a lot depends on how to say about it.
I personally heard doctors in Russia announce: “You have cancer. Fourth stage ”. Or: “You have cancer, but don’t be afraid.We will treat everything. ” This leaves a depressing impression.
How do you need it?
Most patients really do not like being held for fools. I do not like it when the doctor avoids eye contact, mentioning the name of the disease and making predictions. But when you say to a person: “You know, you have the fourth stage of oncology. What do you think about this? ”, Most often he will answer that the remaining time with him is not the most important at the moment. It turns out that the vast majority of the patient’s fears are very well solvable.Do you know what worries seriously ill Russians?
Personally, I would be worried about the possible lack of money for treatment. And the fact that the family because of this can get into unaffordable debts.
Many feel the same way. According to surveys that I conducted among my relatives and friends, two points are leading on the list of fears: the first is talking with doctors and visiting hospitals, and the second is that treatment costs a lot of money and you will have to sell an apartment to pay for it. But if you talk to the patient normally, the general stress is relieved and you become the best doctor for him.Our clinic deals with especially severe tumors. We are often visited by goners with a dull look, but you should have seen how they leave the clinic! Almost everyone is smiling. Nobody is lying to them that everything will be fine for them now – on the contrary, we tell them what complicated operations are coming up, what complications are possible. They value sincerity.
Photo: Adam Berry / Getty Images
You are currently teaching ethics seminars for young resident doctors. What are you teaching?
Including how to deliver bad news.We analyze specific practical skills: into what time intervals it is worth breaking up the conversation, how to enter the patient’s room, how to introduce yourself, how to examine – and not from a medical point of view. Reception should be structured. It is easier for the doctor, and patients are satisfied with this approach. Communication skills are very important. When I studied at the medical institute in Moscow, we were always told that we had to be a good doctor, but they didn’t explain how to do it in practice. Personally, I thought that being a good doctor meant reading a lot of books and passing exams well.
In Russia, many patients believe that a good doctor is one who heals well. And the fact that he is rude or silent – each has its own shortcomings.
It is impossible for an ordinary person to distinguish a good doctor from a layman. Now metrics are being developed on how this can be done in terms of treatment indicators. But if you show the comparison tables of surgeons, you will not understand anything. Even I can hardly figure it out. The patient pays attention precisely to the behavior of the doctor, as a specialist he is simply not able to evaluate him.You don’t know what the doctor sees and hears when he examines you. You look at his gestures, whether he is fussing or not, friendly or rude, whether he makes eye contact. And in fact, 90 percent of what the doctor says is forgotten. Only a small amount of information and general impression is absorbed. How to make it good – that’s what I’m talking about.
In Russia, doctors complain that due to the lack of medical staff, the appointment time is now decreasing: 10-15 minutes are allotted per visitor. How can you manage to structure something during this time?
I also sometimes have no more than five minutes per patient.The problems with time are exactly the same. But a lot can be done in any time frame. There is such a thing – empathy. At first it was difficult for me to understand what it is, in Russia I was never taught this. This is not sympathy at all, you do not need to be friends with a person. Empathy is an attempt to understand what the patient is thinking now and with what he came to you. It is necessary to take the place of the patient. A very difficult skill, but very useful.
Our doctors often look down on patients as if they were unreasonable children. And what is the model in America?
In oncology, for example, the relationship between doctor and patient is built on a long-term basis.Both financially and professionally, we are interested in the patient coming to us further. Numerous studies show that the only good long-term communication model in this case is to be on the same level with the patient. Imagine that a patient comes to a doctor, especially an oncologist. The situation is not tantamount, the imbalance of power is very large. I am so important and he is so small. The patient cannot “grow up” to me. So I have to “go down.” Look, I’m hosting a reception today, but am I wearing a white robe?
Photo: David Gray / Reuters
Are medical uniforms intimidating to patients?
White coat is a confirmation of the doctor’s status.When I have a difficult conversation or when I need to go down hard, I shoot it. For the same reason, our pediatricians go without gowns. There are other tricks as well. For example, I try to never talk to a patient from the table so that there is no obstacle between us. I sit on the same level as the visitor’s eyes or below. The toes of the boots should point towards the patient.
You are now talking about common techniques. It turns out that any, even an illiterate doctor, if he masters them, will be successful with patients.Is this okay?
This is bad, but this is a completely different topic. I’m talking about how to show a good doctor that he is really good. In America, much attention is paid to communication between patients and doctors. A separate subject in universities is devoted to this, everyone takes an exam with actors. It is assessed how you greeted, looked in the eyes, how you smiled, how you responded to criticism – and so on.
Have you passed such an exam?
Yes. But if for the first time all this goes through, especially for a person with a Russian mentality, you can experience irritation: “What bastards are the Americans, they came up with another exam to rip off money.Who cares if I smile or not? But look what stitches I put on the stomach: stitch to stitch. ” And I thought so, until I was personally convinced of the opposite and until I felt the difference on my own wallet. In America, medicine is a service. We do not save lives, we do not make people happier, we serve them.
If a Russian doctor is told that medicine is a service sector, he will most likely be offended.
For me, too, at one time it was a knife through the heart. We were taught that a doctor is a high humanistic title.But above all, it is a profession. And I get very great pleasure at the expense of, sorry, patients. Nothing hurts me, I have no tragedy in my life, but they do. And in general, thanks to them, I satisfy my intellectual needs. It is thanks to the patients that they come to me, and not vice versa. If I have no patients, I have no money. Every member of the medical business in America understands that patients are the only reason doctors exist at all.
00:01 – September 14, 2015
We have a popular myth that in the USA the quantity and quality of care depends on the patient’s ability to pay.Is it so?
The situation varies from state to state. Therefore, I can only say about what I myself see and what I face. I live in Baltimore, one of the poorest cities in America, with big social problems: there are a lot of unemployed people, drug addicts, and former prisoners. But no one is denied treatment in our hospital, even if the person does not have insurance. We almost always find some kind of funds to pay for, or they are treated for free. I don’t remember a single case when someone died because there was no money.Moreover, first aid is provided, and then the financial component looks. Personally, I very rarely base my medical decisions on whether a person can afford it or not. The main thing is that it suits him.
Is everything available to the poor?
Not right on a silver platter, but practically everything. And it is wrong to say that the quality of treatment depends on ability to pay. At least not to the extent that it is described in Russia.
Another myth: in America, if something goes wrong, patients immediately run to court.
In America, according to statistics, 90 percent of all doctors during their careers face a lawsuit at least once. This is very unpleasant, this is a very bad situation and a lot of money. In Baltimore – from a million dollars and more. I don’t have that kind of money, so we have a lot of research on what is the cause of the lawsuits.
Probably medical errors?
This is the most insignificant reason for judging. Although, as statistics show, there are a lot of mistakes.But the lawsuits are mainly due to a bad relationship between patient and doctor. There is a good experiment when they record a conversation between doctors and patients, then the words are “covered” with audio and just observe the dynamics of the conversation. By the manner of communication, you can immediately understand who is being sued and who is not. The former dominate the conversation, communicate in a team style and do not allow the patient to finish.
When you left for America, did you have to retrain a lot to confirm your Russian medical diploma?
Although I had a red diploma and a Lenin scholarship, there was nothing to retrain.I learned everything anew. The volumes of knowledge are incomparable. In America, they are taught to extract information according to certain principles. You may not know something about the patient – he forgot to say, but you know exactly how to get information and how to interpret it. It’s a big shock when you read foreign textbooks. They do not say that stomach cancer should be treated this way and that, as it was said in Soviet textbooks. Here they write: such and such studies were carried out, which showed that if you do this, you will get one result, if that way – another.And you yourself are already conjecturing which situation is preferable to you. Very strange at first, uncomfortable. But then, when you master the ability to make critical decisions, everything falls into place.
Photo: Vladimir Smirnov / TASS
Many people in our country are sure that abroad, on the contrary, everything is clear by standards. Not a step to the side.
Standards exist. But the main thing that every doctor should know is why, on what grounds they were written. I have seen many translations of European standards in Russia, but this is useless: in order to understand them, doctors must read scientific literature.This is a very big job. Everyone in America and Europe does it.
Because competitors are breathing in the back?
This too. But the main reason is because it was taught that way. Talk to any American district doctor for the latest research findings on the causes of high cholesterol. They know. This is professionalism. And with colleagues who invent something according to their own creative principles, because it seemed to them that it was better that way, it is very difficult to work. Therefore, it is difficult for me to follow the thought of my Russian colleagues, but it seems to them that “imported” doctors have a blinkered mind.As a scientist, I don’t know which is better.
Russians have been taught that there are a lot of problems in the domestic health care, but our surgeons are one of the best in the world.
This is a very common idea: they operate well, but they do not take care of them well. I have my own point of view. I know how doctors were taught in Russia 20 years ago. In my opinion, this has not changed much. After graduation, you come to residency and spend some time there. Sometimes you manage to assist. No one has ever taught doctors how to perform an operation.The system is simple: watch and do as I do. This technique is possible, but it still doesn’t work very well. After five years of American residency, I had 1200 independent operations on almost all organs except the heart, brain and eyes. In Russia – no more than a dozen. Do you believe now that all Russian surgeons are wonderful?
Nobody talks about everyone, but we have stars.
Stars are everywhere. Their presence is not the merit of the system. It is the middle level that makes the weather, and not the personal qualities of one or the other.And it all depends on education.
Do the solvent Russians right when they leave to treat serious illnesses abroad?
I don’t think so. It’s one thing to replace a knee. Oncology, for example, is not a disease that can be treated in isolation from the place where you live. The risks are big. It is not enough to do the operation, you need to maintain the state after. Sometimes I have patients from Russia. It is very difficult to organize further adequate therapy for them at home – you need to find some Russian doctor who would be on the same wavelength with you.I cannot advise on this issue, although I understand such patients very well.
Dmitry Egorovich Gorokhov, Doctor of Medicine, assistant professor of the Moscow Imperial University, our famous fellow countryman.
Talents of the Yelets land
Dmitry was born on February 2, 1863 in the village of Nikolskoye, Krasnopolyanskaya volost, Eletsk district, Oryol province in the family of an archpriest.
Father Dmitry Yegorovich, after graduating from the Oryol Theological Seminary, served as a village priest.He strove to educate children. Dmitry received his secondary education at the Yeletsk men’s gymnasium. “Education in it was paid. According to the results of entrance exams, they accepted both children of the nobility and representatives of the unprivileged estates. ”
Like the classical gymnasiums in Moscow and St. Petersburg, the Elets gymnasium at the end of the 19th century met the traditions of classicism, i.e. the content of education was based on the study of ancient languages and classical literature, prepared children for admission to the university.“The disciplines taught at that time in the gymnasiums of Russia were as follows: Russian, arithmetic, history, God’s Law, calligraphy, drawing, German, French, Greek, Latin, geography, gymnastics.
The Charter of Russian gymnasiums dated November 12, 1864 emphasizes the strengthening of humanitarian and linguistic trends in Russian pre-revolutionary primary education. According to this charter, two ancient languages at once were included in the number of the main subjects of teaching – Latin (34 lessons per week) and Greek (24 lessons per week), they were taught daily, several lessons a day.In addition to the ancient Greek language and Latin, pupils of classical grammar schools studied European languages, namely: German, French and English. ”
The composition of the Yelets gymnasium students in the 1874-75 academic year was as follows. Of the 252 high school students admitted to exams, children of nobles and officials were 78, clergy – 23, urban estates – 136, rural estates – 12, and foreigners – 14. By religion, the overwhelming majority (244 students) were Orthodox, Roman the Catholic faith was represented by 4 pupils, the Evangelical Lutheran – by 3, and the Jewish – by one high school student.
In 1881, at the age of eighteen, Gorokhov graduated with honors from the Yelets gymnasium and entered the medical faculty of Moscow University. A large number of students of the Imperial University were former pupils of the Yelets gymnasium.
In the personal file of student Gorokhov, there is a note from his older brother, also a zemstvo doctor, with a request to provide the newly-made student with a place of orderly in the city hospital “to support the family.” It was not only a financial need, but also a moral attitude and conviction.
The two Gorokhov brothers were separated by a 20-year age difference, political views and position in society, but united by morality and “the acute feeling of condolences for the suffering and burdened, laid down by Christian upbringing.” By the way, as a student, the elder brother Nikolai married not so much out of love as out of complicity, to the widow of a church artist who crashed while falling from the woods. In the dowry he took five children, to whom he later added three of his own, and no one in the family considered it something bad or wrong.
Fourteen years after graduating from university, Dmitry Yegorovich gave zemstvo medicine, without staying for a long time in one place, now they would say, he changed 5 medical institutions in different provinces.
The first year after graduating from the university in 1886 with a doctor’s degree and the title of district doctor Gorokhov was in charge of a private hospital in the village of Netbezh of the Maloarkhangelsk district of the Oryol province and for six months he worked in a hospital in his native village of Nikolskoye, Yeletsk district.
Further in 1888 and 1889 he headed the Tesovskaya rural hospital in the Sychevsky district of the Smolensk province.
From 1889 to 1896 for about 7 years, he was in charge of the Dmitrovsky zemstvo city hospital in the Moscow province and all this time was the secretary of the Dmitrovsky district zemstvo sanitary council.
In 1896-1897, he worked as a senior physician at the Smolensk provincial zemstvo hospital.
In 1897, Gorokhov returned to the Moscow province, where he worked until October 15, 1900 as a senior physician at the Bogorodsk zemstvo hospital and at the same time was in charge of the medical nursery of the Elisabeth charitable society in the city of Bogorodsk.
During his service in the Bogorodsky district, he was the secretary of the district zemstvo sanitary council and a member of the construction commission for the arrangement of hospitals in the district.
Life was not easy. The working day lasted at least 12 hours, not counting emergency calls and preparation of medicines. In the 1890s, the approximate size of the plot that was served by one doctor was at least 10 versts, which is about 200 villages and the population was 6-7 thousand people. Every day, at least 60 patients had to be admitted, and on holidays up to 100 patients.
It was like this everywhere: work from morning until night, travel by horse-drawn transport to the house, and living in an apartment at the “workplace”, that is, the life of doctors was modest, in most cases they lived where patients were received.
At the end of the 19th century, epidemics of cholera and typhus raged. About 60% of zemstvo doctors died of typhus, but the rest continued to fight for the lives of the peasants, possessing high morality and dedication to their cause. This was also our fellow countryman Dmitry Yegorovich Gorokhov.
In 1895, at the Imperial Military Medical Academy in St. Petersburg, Dmitry Yegorovich passed the exam for the degree of Doctor of Medicine, three years later he defended his thesis and received the degree of Doctor of Medicine.
In October 1900 D.E. Gorokhov was appointed senior physician of the surgical department of the Moscow Sofia Children’s Hospital.
So they began to call her in honor of Princess Sophia Shcherbatova.
Three-storey building with spacious wards, one hundred beds, power supply, sewerage, mechanical laundry, dissection room, morgue, outpatient clinic, church, now Children’s City Hospital No. 13 named afterN.F. Filatov of the city of Moscow. From December 24, 1905, he was its director and chief physician, while he received the rank of a full state councilor.
According to the table of ranks of the Russian Empire, a valid state councilor (an official of the 4th class) corresponded to the head of a ministerial department, and in the army hierarchy – to a major general. Since 1856, it was from these ranks that hereditary nobility was given.
During the First World War, a hospital was opened in the hospital headed by Dmitry Yegorovich, and Dmitry operated on the wounded there around the clock.In general, Gorokhov gave 21 years of his life to the Sofia hospital.
From the end of 1901, Gorokhov was elected assistant professor of Moscow University in the department of obstetrics and women’s diseases, and from the end of 1902 – assistant professor of the department of clinical surgery.
Privat-docent – academic title of a freelance teacher at universities and some other institutions of higher education in pre-revolutionary Russia and in a number of foreign countries. In Russia, it was introduced on the initiative of N.I.
In addition, Gorokhov gave a course in pediatric surgery and lectures on the so-called “refresher” courses for doctors.
In 1906, under the Society of Russian Doctors in Moscow, a commission was created to combat infant mortality. D.E. Gorokhov. The commission existed for two years, during which time its members made a number of speeches on the fight against child mortality, on the proper care of infants. The commission was the nucleus of the Moscow Society for the Fight against Child Mortality, and developed its charter.The society was organized in 1909. D.Ye. Gorokhov. The Moscow Society for the Fight against Child Mortality was the most active among such societies in Russia. The Moscow society has created several small children’s health care institutions. By 1912, the society had three free consultations for infants, in which, in addition to a medical council, milk and nutritional formulas were given, one inpatient department for infants, three summer climate stations for school-age children, and a summer playground in Moscow.D.E. Gorokhov was chairman of the Moscow Society for the Fight against Child Mortality from 1909 to 1911.
An obvious achievement of zemstvo medicine is the organization of scientific medical and sanitary statistics in Russia. And in particular D.E. Gorokhov, one of the first stood at its origins. In 1905, he began to publish medical reports of the Moscow Sofia Children’s Hospital, mainly of a statistical nature, about which he himself wrote in the newspaper Prakticheskiy Doctor in 1907: data on morbidity according to a monotonous program, for example, according to the nomenclature of diseases developed by the Pirogov Congress, detailing these data by classes and groups of diseases, with the designation of at least the most important diseases, which could be determined by a specially elected commission from the society of pediatric doctors.The study of mortality, especially child mortality, attracted the attention of many representatives of zemstvo sanitary statistics. But the studies of D.E. Gorokhov ”[10, p. 96-97].
The activity of zemstvo sanitary statisticians was multifaceted. They studied the issues of general morbidity of the population, occupational morbidity, morbidity with temporary disability, social and occupational mortality, etc. … The summary results of medical institutions were published in the works of all zemstvos.After the general population census in 1897, it became possible to calculate the intensive indicators of the incidence of the population. …
In addition to his main professional duties, Dmitry Yegorovich conducted intensive social activities. On December 15, 1908, he was elected a vowel of the Moscow City Duma for 1909-1912, and then re-elected for a second term. From the beginning of 1909 he was a member of the Medical Council at the Moscow City Duma. Since the same time, at the Moscow City Duma, a member and then chairman of the Public Health Commission and since the spring of 1917, chairman of the Commission on the Benefits and Needs of Public.
Dmitry Egorovich was a full member of nine Moscow medical societies: surgical, obstetric and gynecological, hygienic, societies of Russian doctors, and pediatric doctors and others, was the founder of a physical therapy society, a member of more than 20 commissions.
D.E. Gorokhov is the author of 215 works, of which 60 are devoted to pediatric surgery, the rest of the problems of zemstvo medicine, gynecology, general surgery and the fight against infant mortality, cerebral hernias, osteoarticular tuberculosis, osteomyelitis, infantile paralysis and a number of others.The main work of Dmitry Egorovich: “Pediatric Surgery” (1910-16) is the first attempt in Russian medical literature to single out the clinic for pediatric surgery as a separate branch of knowledge. He also insisted on the creation of the Department of Pediatric Surgery, made an estimate for its content and a detailed course program, put forward a plan for the widespread fight against tuberculosis.
Gorokhov died on December 29, 1921, he was 58 years old.