The practice of medicine is devoted to the maintenance of good health. This involves the detection and prevention of disease, the curing of those disorders for which treatment exists, and, in all cases, the amelioration of pain and minimizing of disabilities. Modern medicine has also assumed the task of improving \Tpublic health\t by promoting hygiene and advancing standards for nutrition and the environment. Medical science in the 20th century has experienced a rapid growth in its informational and technological resources. This growth has been accompanied by increasingly complex patterns of health-care delivery. The importance of health care in modern society is reflected in the fact that about 10 percent of the gross national product of technologically advanced societies is devoted to serving the health needs of their citizens. Society, in turn, has made increasing demands for greater access to health care and for greater accountability from the healing professions. Scarcely a century ago, health care was primarily the task of the family or neighborhood physician, who diagnosed and treated patients and prepared medications with no assistance other than unskilled help. In contrast, the modern physician has become only one--although an essential component--in an enterprise that numbers among the largest enterprises in developed countries, both in terms of money and in terms of the numbers of persons employed. HOSPITALs, which are among the largest employers, form the largest single component of health-care costs. Another large component is education, which in addition to medical schools and schools of nursing includes technical schools required for discrete fields of training (laboratory and radiology technicians, among others) and educational programs for health care administration (see \Tmedicine, education in\t). Modern medicine also requires ongoing research in various fields of science as well as the continuing development of clinical procedures and technologies. Such research and development is an international endeavor, running into tens of billions of dollars. Much of it is done in universities, medical schools, and governmental institutions, but the \Tpharmaceutical industry\t is also a major contributor. International in nature, the industry is dominated by a few giant U. S. and Swiss firms. In the United States alone, annual sales of drugs and other chemicals exceed $30 billion, and a vast distribution system is needed to bring the products to pharmacies and hospital dispensaries. THE BRANCHES OF MEDICINE Until the 20th century, most physicians were general practitioners. Of those who specialized, or confined their practice to a narrower field, the majority were surgeons. Specialists in other fields were found mainly on the faculties of medical schools. With the growth of science in the 20th century, however, medicine began to harvest results such as the ability to produce standardized drugs, to analyze the constituents of blood and body tissues, and to examine patients by means of X rays and electrocardiographs. This, in turn, stimulated the development of specialization. In the United States and Canada, medicine is currently divided into 23 distinct areas, each with its own rule-making and certifying body. The largest divisions, such as internal medicine, pediatrics, and surgery, are further divided into subspecialties that have additional requirements for training and certification. In the following description, these 23 divisions are grouped under the more general categories of nonsurgical, surgical, and hospital-based specialties, with family practice as a separate field. For a description of the fields of nursing, see \Tnursing\t. Nonsurgical Specialities The nonsurgical specialties that involve direct patient care include internal medicine, \Tpediatrics\t, allergy and \Timmunology\t, \Tdermatology\t, preventive medicine, and \Tpsychiatry\t and \Tneurology\t. Practitioners of internal medicine, or internists, are concerned with the diagnosis and treatment of adults with diseases of the internal organs. Those called general internists are primary-care physicians, in that they have a direct relationship with patients on a long-term basis and refer them to other specialists only for specific problems. Many internists, however, specialize in a specific area of the body. This had led to the formation of nine subspecialties of internal medicine, as follows: Cardiology is the care of patients with diseases of the heart and blood vessels. Endocrinology and metabolism is the care of patients who have problems related to glands of the body, and gastroenterology is the study of diseases of the gastrointestinal tract; it also deals with diseases of the liver and pancreas. \Thematology\t treats patients with diseases of the blood cells, bone marrow, and lymph nodes; hematologists also operate blood banks and manage patients with blood-clotting disorders. Infectious disease specialists are consulted chiefly in the treatment of severe or exotic infections, the selection and use of antibiotics, and the management of complications resulting from their use. Specialists in nephrology are experts in the diagnosis and treatment of kidney diseases, also managing blood-dialysis centers for patients who lack functioning kidneys. Oncology involves the treatment of cancer patients with chemotherapeutic agents; oncologists frequently act in the capacity of general internists for such patients. Pulmonary disease is concerned with disease of the lung and air passages. Finally, rheumatology specialists treat patients with joint diseases and joint-related systemic diseases such as rheumatoid arthritis and lupus erythematosus. Pediatrics is constituted much like internal medicine, but it deals instead with infants and children. The new field of adolescent medicine, however, has extended these traditional age limits. Recognized pediatric subspecialties include pediatric cardiology, hematology/onocology, endocrinology, and nephrology. These subspecialties differ from their adult counterparts, because infants and children have distinctive diseases and disease patterns. One subspecialty unique to pediatrics is neonatal-perinatal medicine, dedicated to the management of premature infants and ill newborns. Specialists in this field also aid the obstetrician in caring for a child at risk before birth. Allergy and immunology, besides dealing with hypersensitivity disorders such as asthma and food allergies, also treats immune-related problems such as patients with organ transplants and patients incapable of manufacturing the various components of the immune system. A practitioner in this field has already completed training as an internist or pediatrician. Dermatology is the study of diseases of the skin. Since the majority of human diseases have at least some effect on the skin, this field of medicine intersects with many other specialties. The dermatologist must understand the systemic diseases likely to be responsible for the skin rash, just as the internist or pediatrician examines the skin as a first clue to underlying disease. Occupational dermatology is the study of skin manifestations resulting from some environmental factor in work areas. Preventive medicine studies involve improving the level of health in a community. Most work in the area of preventive medicine and public health is done under the aegis of a government, university, or institute, and many such specialists are found as public-health officers. Those interested in such a career customarily attend a School of Public Health and receive a master's degree, the MPH. Training encompasses a thorough grounding in statistics, epidemiology, microbiology, and immunology. Holders of an MPH are often not physicians, but physicians form a necessary element in public-health organizations. Two subspecialties exist: occupational medicine, devoted to detecting and measuring adverse effects of the workplace; and aerospace medicine (see \Tspace medicine\t). Psychiatry and neurology is divided into two obvious subspecialties. Psychiatry is concerned with those brain functions expressed as behavior, mood, and intelligence, whereas neurology is concerned with organic diseases of the central nervous system, including the brain. In general, psychiatrists treat patients with nonorganic diseases of the brain, whereas neurologists treat those with organic diseases. Organic diseases are those in which the immediate cause can be observed directly or under a microscope or can be identified chemically, while nonorganic diseases are those in which functional disturbances exist but no anatomical or chemical basis is identifiable. Psychiatrists also spend much of their professional time treating emotional responses to chronic disease. Surgical Specialities \Tsurgery\t and the surgical specialities include general, colon and rectal, orthopedic, plastic, and thoracic surgery, otolaryngology, \Tophthalmology\t, and urology. \Tobstetrics\t and \Tgynecology\t exhibit important elements both of surgery and of general medicine. General surgery deals with those conditions which require operative interventions not falling within the areas of the related disciplines listed above. If required, however, the general surgeon can deal with most surgical problems, having mastered the techniques basic to all the fields. The anatomical areas with which the general surgeon is most concerned are the abdomen and its contents; many surgeons specialize further, such as breast surgeons and thyroid surgeons. The subspecialties of general surgery are pediatric surgery, which deals with surgical problems of children, and hand surgery. In \Tplastic surgery\t the surgeon is called upon both to improve body function by dealing with disfigurements and to prevent such disfigurements following accidents or disease. Thus much of the surgery of the head and neck is performed by plastic surgeons, including that for congenital defects and that following surgery for cancer. The extensive skin grafting necessitated by severe burns is also performed by plastic surgeons. Some surgeons, however, deal primarily with cosmetic surgery performed solely to improve appearance. Colon and rectal surgery has developed because the colon and rectum are the site of a number of common diseases that routinely or occasionally require surgical therapy. General surgeons with a special interest in abdominal surgery also frequently treat malignant tumors at these sites. Neurological surgery is concerned with patients who have surgical problems of the brain and spinal column, the peripheral nervous system, or the tissues that support these systems, including the blood vessels. The neurosurgeon competes with the orthopedic surgeon (discussed below) for the care of patients with certain kinds of back pain. The field of otolaryngology is concerned with the ear, the nose and sinuses, and the throat, including the larynx, and pharynx, and related structures. Although the field is classified as a surgical specialty, the otolaryngologist also treats nonsurgical conditions of these structures. An important diagnostic technique in this field consists of passing a tube down a passage for the purpose of examination, or endoscopy; otolaryngology is one of several medical specialties in which physicians are trained and qualified in this technique. In treating the ear, the otolaryngologist not only attempts to correct ear problems but is also concerned with the prevention and treatment of deafness. Ophthalmology deals with another major sense organ, the eye. The ophthalmologist treats medical and surgical eye conditions and is concerned with the prevention and treatment of blindness. Eye conditions include refractive problems such as myopia (nearsightedness), hypermetropia (farsightedness), and presbyopia (a form of farsightedness that develops in middle-aged to elderly persons). Fitting such patients with corrective lenses is done not only by the ophthalmologist but also by the optometrist, a nonphysician devoted exclusively to the correction of refractive errors. Members of both professions have strong opinions as to why their profession is preferable in treating such patients. Orthopedic surgery derives its name from its beginnings in correcting childhood deformities (orthopedics literally means "straight child"), but it is now concerned with diseases of the bone, joints, and muscles. Orthopedic specialists are also called in when an arm or leg must be amputated, and they are involved with the fitting of artificial body parts (prostheses) and in the training of amputees to operate the prosthetic devices. Thoracic surgery first emerged as a separate discipline for treating pulmonary diseases, such as abscesses or cancer of the lung or complications resulting from tuberculosis. The field developed rapidly following development of the heart-lung machine, which enable physicians to make direct attack on congenital and acquired diseases of the heart. The thoracic surgeon must also be skilled in endoscopy, a necessary adjunct in both pulmonary and cardiovasular surgery. In addition to the otolaryngologist and the plastic surgeon, the thoracic surgeon may be called upon for cases involving surgery of the neck. Urology treats surgical diseases of the kidneys and both medical and surgical conditions of the remainder of the urinary tract and the male genital system. As is true of several of the surgical specialties, training begins with two years in general surgery. Nonsurgical conditions of the kidney are cared for by internists or pediatricians. Physicians in the field of obstetrics and gynecology have increasingly come to regard themselves as providing primary care for woman. That is, their patients come to them directly, rather than by referral from other physicians. Some of these specialists primarily practice obstetrics, or the care of women before, during, and after childbirth; others primarily practice gynecology, or the treatment of female patients with diseases or disorders of the genital tract. Hospital-Based Specialties The hospital-based specialist conducts highly technical but usually limited care in association with the physician of record. Specialties include anesthesiology, emergency medicine, \Tnuclear medicine\t, \Tpathology\t, physical medicine and rehabilitation (see \Trehabilitation medicine\t) and \Tradiology\t. In anesthesiology, the physician is responsible for much more than simply rendering a patient unconscious during surgery. Responsibilities also include general care of the patient from some hours before the operation until the patient has fully recovered from the effects of anesthesia. In recent decades, with the advances made in surgical procedures, the functions of the anesthesiologist have become correspondingly complex. The emergency medicine specialist must be able to care for a desperately ill patient brought into the emergency room of a hospital. Situations to be faced include the diagnosis and treatment of poisoning, illicit drug use, overmedication, attempted suicide, injury from accidents or assault, internal bleeding, and heart attacks. The physician must then also be prepared to marshall the resources of the hospital for more definitive therapy, as needed. Medical technicians trained to provide on-site emergency aid or otherwise assist specialists in emergency medicine are known as \Lparamedic\ls. Nuclear medicine is a fairly recent field that involves placing radioactive materials inside the body and determining their location by means of appropriate detectors. In this way a physician practicing nuclear medicine can establish such situations as the integrity of the heart muscle, thyroid-gland function, and the existence of tumors at such sites as the liver or bone marrow. Practitioners of nuclear medicine must have a good knowledge of internal medicine or pediatrics as well as a technical knowledge of radiation physics. In fact, most physicians in the field are also internists, radiologists, or pathologists. Pathology is the study of tissues or body fluids for the presence of abnormal conditions or disease. The clinical pathologist examines blood and other body fluids in a search for abnormal levels of substances such as blood sugar, urea, hormones, and drugs, and may also supervise the microbiology laboratory, where microorganisms causing a patient's illness are identified and their sensitivity to available antibiotics determined. Some clinical pathologists are in charge of blood banking (see \Tblood bank\t) or may direct hematology laboratories, where the numbers and types of blood cells is a sample are determined and the blood factors for clotting are measured. The forensic pathologist makes use of all the procedures and skills of pathology in an effect to aid the administration of justice. The anatomic pathologist examines tissues obtained during surgery or at an autopsy and also examines cells from body secretions. Certain fields of anatomic pathology are so complex that subspecialties have been established. The object of the area of specialization known as physical medicine and rehabilitation is to rehabilitate a patient who has had an injury or illness, using such physical modalities as exercise, baths, electrical stimulation, and heat. While such modalities are useful in a broad range of cases, they are essential after a stroke that has left a patient with some degree of paralysis. Departments of physical medicine and rehabilitation headed by physicians trained in such procedures are standard in all major hospitals. Physicians trained in this way may also be found in institutions serving specialized needs, such as rehabilitation of patients with paraplegia, cerebral palsy, and other major neurological diseases. Specialists in this field work in cooperation with orthopedic surgeons to fit patients with prostheses and teach them how to lead useful lives thereafter. Nonphysicians who are trained to work in the field of physical rehabilitation, whether inside hospitals or in other settings, are discussed in \Toccupational therapy\t and \Tphysical therapy\t. The speciality of radiology began within months after the discovery of X rays in 1895. Although its first practitioners were orthopedic surgeons interested in setting fractures of bones, the more general usefulness of X-ray techniques in diagnosing many diseases was soon established. It was also soon realized that X rays could cause damage to living tissue, a fact made use of in the treatment of malignant tumors. In this way the field came to be divided into the areas of therapeutic radiology and diagnostic radiology. In recent years new methods have been developed for obtaining images of internal tissues, such as \TMagnetic Resonance Imaging\t and ultrasound (see \Tultrasonics\t), so that the term diagnostic radiology is in the process of being replaced by that of diagnostic imaging. Many radiologists have become exceedingly skillful at manipulating catheters through veins, arteries, and heart chambers for injecting contrast media--that is, materials that block the imaging rays for the purpose of observing internal structures. In therapeutic radiology, X rays, gamma rays, and particles from radioactive materials such as radium are used to cause the destruction of selected tissues. Family Medicine The explosive growth of medical specialties, as described above, has come to be perceived by many persons concerned with health care as a loss of the continuing relationship between patient and physician. A movement in reaction to this perceived trend began shortly after the end of World War II, eventually culminating in the development of the specialty called family practice. This specialty is intended to restore the patient-physician relationship and, simultaneously, to equip the practitioner with the knowledge and skills expected of a contemporary physician. A family-practice physician is expected to be able to care for most of the nonsurgical illnesses of adults and children, to use the continuing relationship with the patient and the patient's family to teach preventive medicine, and to have the wit to refer the minority of patients with illnesses too complex for the family physician to an appropriate specialist. Accreditation as a specialist in family practice, after suitable training, is by examination. Such accreditation must be renewed periodically by reexamination and can be maintained only if the specialist continues with his or her medical education by attending and participating in the appropriate continuing medical-education programs. HEALTH-CARE FACILITIES The largest and most complex form of health-care facility is the hospital, which deals with the critically ill and with patients who need complex diagnostic procedures or must undergo major surgery. Care given to patients not confined to a hospital, called out-patient or ambulatory care, is ordinarily dispensed in a clinic or office. A clinic may either be free-standing or attached to a hospital; in either case, clinic practice includes the availability at the same location of specialists in most of the major medical fields. The Hospital Team Treatment in a hospital necessarily is a team effort, led by the physician or physicians directly responsible for a patient's welfare. Other physicians who may be involved in the care of a patient include anesthesiologists, pathologists, and radiologists, and, in teaching hospitals, the resident physicians. All of the hospital personnel support the work of the physicians in charge. Of these personnel, the nursing staff is the largest component. The most skilled of this staff are the registered nurses (RNs), who undergo two to four years of general college-level education in addition to their nursing education, frequently obtaining a college degree; they are licensed by examination. The licensed practical nurse (LPN) practices at a somewhat less sophisticated level, having taken formal training for one academic year and having been examined for licensure. Nurse's aids carry out the least skilled components of nursing care. In order to provide for a patient as much as possible, the size of a hospital's nursing staff, in numbers, is approximately equal to the average number of patients in the hospital. As new machinery and new procedures are introduced into a hospital, members of the technical staff must also be increased in order to operate the equipment. Besides this, a hospital operates like a small village and must have cooks, cleaners, laundry personnel, carpenters, plumbers, bookkeepers, and a police staff. Managing this assemblage is a cadre of administrators, as well. Kinds of Hospitals Hospital in-patient care devolves into either acute or chronic care. Acute-care hospitals are classified as primary, secondary, or tertiary institutions. The low-technology primary hospitals are usually located in rural areas and generally deal with emergencies and therapies that do not involve complex procedures. The secondary hospitals are more typical of hospitals in general, providing a greater range of physician skills and modern technology than the primary hospitals. Tertiary institutions are typified by the teaching hospitals of the major medical schools and are also called referral centers. Usually they are large, often with more than a thousand beds, and they provide most or all of the latest medical equipment available. Even more important, they have physicians and technicians on their staffs who are highly trained in all types of investigation and treatment. Most of the patients found in tertiary-care hospitals are similar to those in secondary centers, but the rest have been referred to such hospitals for special care such as therapy for severe burns, open-heart surgery, premature births, and hip replacement. In terms of average cost per patient per day, tertiary-care hospitals are quite expensive, partly because of the advanced technology being employed but even more because of the size of the staff required. The ratio of employees to patients in a tertiary-care hospital may exceed five to one. Other types of hospitals, called specialty hospitals, admit only those patients who fit a restricted group of diagnoses and, usually, who are due for a medium to long stay. Psychiatric hospitals are the most numerous specialty hospitals and the ones with the largest patient population. Others include hospitals for the severely mentally retarded and rehabilitation hospitals that treat severe injury involving loss of function. Chronic-disease hospitals form another category of health-care facility. Also called long-term-care facilities, they are typically the hospitals of last resort for persons who are too ill for any other alternative but for whom no known therapy exists that could justify their presence in the much more expensive acute-care hospitals. Finally, the \Thospice\t movement, devoted to caring for the terminally ill, generally makes use of the home environment but sometimes involves so-called hospice dwellings, which are commonly located within a hospital. STANDARDS OF PRACTICE In the United States, medical licensure is controlled by each state, territory, and commonwealth. Licensure depends on furnishing evidence of satisfactory completion of the standard medical curriculum in an American or Canadian medical school, clinical experience, and satisfactory performance on an examination. In theory, possession of a valid medical license entitles a physician to practice all branches of medicine and surgery within that jurisdiction, In actuality, further training is needed beyond receipt of the MD degree. Such training, called graduate medical education, is controlled by a quasi-autonomous nongovernmental body called the American Council on Graduate Medical Education. This body is made up of representatives from each specialty board and from hospitals, medical schools, specialty societies, and the \TAmerican Medical Association\t (\TAMA\t), with one member appointed by the federal government. Working through committees and its constituent organizations, the council approves each hospital training program and endorses an examination given by the appropriate specialty board. This laborious method of specialty certification sets a standard of practice. As noted, when the family-practice specialty was established, certification was for the first time granted only for a defined interval, after which the practitioner must be reexamined. The specialist must also take part in a certain number of hours of continuing medical education each year in order to maintain accreditation. Both of these new departures may in time become standard for all of the other specialty boards. Most physicians in active practice have hospital privileges. That is, they are members of the medical staff of a hospital and are allowed to admit patients to that hospital. To practice at a hospital, however, requirements in addition to a license are mandated by the governing body of the institution. Hospitals are divided into clinical services that reflect the various medical specialties, and staff privileges are valid only for a specific service. Increasingly, certification by the appropriate board as well as participation in the educational meetings of the service are being required for such validation. In most nations other than the United States, licensure is a national rather than a provincial matter. Graduation from one of the schools within a country often entitles a physician to a license without further examination. In most countries, however, physicians are required to complete further examinations in order to be accredited as specialists. THE ECONOMICS OF HEALTH CARE Unlike Great Britain and the Scandinavian countries, the United States does not have a national health program that provides physician services, medications, and a hospital bed when required. A multiplicity of insurance plans exists instead, including voluntary nonprofit plans such as Blue Cross, commercial plans of the major insurance corporations, the national \TMedicare\t plan (primarily for those over 65), and \TMedicaid\t, a federal-state scheme for those needing financial aid. In all of these insurance schemes a limit exists to coverage of physician services. Thus in all of these plans 30% to 40% of health costs, on the average, turn out to be the responsibility of the patient (see \Thealth-care systems\t). One growing trend in this area is the development of health maintenance organizations, or HMOs. Enrollees in an HMO select a primary-care physician from the plan's panel. For a set fee, the enrollee is provided with primary physician services, specialist services as needed, drugs, and hospital coverage. There is less choice of physician and hospital in an HMO than in an insurance plan, but the financial advantage both to the employer and to the employee are powerful motivating forces. That is, healthcare costs in the United States are continuing to increase, and these costs are paid for either from the tax dollar (Medicare and Medicaid) or by health insurance, which as part of the wage package directly reduces the take-home pay of an employee. Consequently, although provision for health care is recognized as important, there is also a great appeal in the notion of reducing costs without diminishing the amount of care. Because the largest single item in the total health-care bill is hospital care, increasing emphasis has been placed both on decreasing lengths of hospital stay and on restricting the ease of admission into a hospital. In fact, medical economists have been aware for some time that the major cost reduction in HMOs has resulted from reducing the number of hospital days per thousand enrollees. The pressure exerted on all hospitals by the various insurance plans has resulted in a shorter length of stay for the average admission and in a heightened competition for admissions among hospitals. The result is that a patient currently admitted into a hospital is more acutely ill, on the average, than a patient in years past, thereby requiring more complex and advanced and, inevitably, more expensive therapy. Those hospitals that cannot compete have a decreased percentage of bed occupancy, which can swiftly lead to financial pressure to close the hospital. Some 10% of the hospitals currently functioning in the United States are expected to close within the 1990s; many of them will be small, inefficient, ill-equipped rural hospitals. At the same time, since patients can no longer be admitted to hospitals solely for testing (insurers no longer pay the costs for such admissions), the trend has been established to do testing on an ambulatory basis. Ambulatory surgical centers have been developed in which procedures that once required days of hospitalization are done within an hour of the patient's entrance in the early morning, so that the patient may return home by the end of the working day. Worldwide, as many systems of health-care financing exist as there are countries. They range from the comprehensive schemes of Great Britain and the Scandinavian countries to nations that can or do provide little or no care. TRENDS IN MEDICINE The rapid changes just described as taking place in the U.S. medical-care system are likely to continue. Establishment of a national health plan is considered less probable than the expansion of insurance coverage to selected groups; the imminent establishment of federal catastrophe insurance is an example of such targeted expansion. Such processes, however, take on the character of a never-ending quest, because rapid increases in technology are at the same time defining new groups eligible for coverage. Medicine and the law are currently maintaining an uneasy relationship, as seen in the rising number of \Tmalpractice\t suits. Of equal moment are new medical dilemmas with strong ethical and legal overtones that have been brought about by the introduction of new therapies and techniques. These include the definition of death for purposes of organ transplantation or for cessation of care to the terminally ill (see \Tdeath and dying\t), \Tsurrogate motherhood\t, and decisions as to who shall benefit from treatment modalities or new drugs when needs exceed what is available (see \Tmedical ethics\t). In the United States these legal problems are exacerbated by the fact that most of them fall under state law, so that similar cases must be tried in several jurisdictions before legal precedents are firmly established. On the whole, medical care in the United States, at its best, is unequaled anywhere else in the world. Such care, however, is not uniformly available. For example, much has been made of the fact that infant mortality in the nation exceeds that of other technologically advanced countries. Studies revealed that a two-phase rate is involved. Much of the population enjoys an infant mortality rate comparable to the rates observed in Scandinavian countries, but at the lowest socioeconomic status the infant mortality rate is comparable to those in Third World countries. Thus the United States simultaneously enjoys the best and--in terms of developed countries--the worst of medical care. Aaron D. Freedman, M.D. Bibliography: Aiken, L.H., ed., Applications of Social Science to Clinical Medicine and Health Policy (1986); Arnheim, Louise, and Webb, Lee, eds., A Health Care Agenda for the States (1985); Black, Douglas, Invitation to Medicine (1987); Bleich, Alan, Exploring Careers in Medicine, rev. ed. (1986); Callahan, Daniel, What Kind of Life: The Limits of Medical Practice (1989); Fein, Rashi, Medical Care, Medical Costs (1986); Fishman, M.C., et al., Medicine, 2d ed. (1985); Gray, Bradford H., The Profit Motive and Patient Care: The Changing Accountability of Doctors and Hospitals (1991); Harvey, A.M., et al., ed., The Principles and Practice of Medicine, 21st ed. (1984); Langsley, D.G., and Darragh, J.M., eds., Trends in Specialization: Tomorrow's Medicine (1985); Lanza, Robert, ed., Medical Science and the Advancement of World Health (1985); McKinlay, J.B., ed., Technology and the Future of Health Care (1982); Miller, B.F., and Keane, C.B., Encyclopedia and Dictionary of Medicine, Nursing, and Allied Health, 3d ed. (1983); Parrillo, J.E., and Ayres, S.M., Major Issues in Critical Care Medicine (198l); Todd, J.W., The State of Medicine (198l). See also: \Tchiropractic\t; \Tdentistry\t; \Tgeriatrics\t; \Tosteopathic medicine\t; \Tsports medicine\t.