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[edit] Etymology
The word physician shares a common etymology with words such as physics and
metaphysics, physical, physique, and physiognomy. There are many other words that
have a meaning similar to, but not exactly the same as physician. The word physician
φύσις (physis) and its derived adjective physikos, meaning "nature" and "natural." From
this, among other derivatives came the Vulgar Latin physicus, which meant a medical
practitioner. After the Norman Conquest, the word entered Middle English via Old
French fisicien, as early as 1100. Originally, physician meant a practitioner of physic
(pronounced with a hard C). This archaic noun had entered Middle English by 1300 (via
Old French fisique). Physic meant the art or science of treatment with drugs or
medications (as opposed to surgery), and was later used both as a verb and also to
describe the medications themselves.[1][2][3]
In English, there have been many synonyms for physician, both old and new, with some
semantic variation. The noun phrase medical practitioner is perhaps the most widely
understood and neutral synonym. Medical practitioner is lengthy but inclusive: it covers
both medical specialists and general practitioners (family physician, family practitioner),
and historically would include physicians (in the narrow sense), surgeons or apothecaries.
In England, apothecaries historically included those who now would be called general
practitioners and pharmacists.
The term doctor (medical doctor) is older and shorter (see doctor of medicine), but can be
confused with holders of other academic doctorates. Doctor (gen.: doctoris) means
teacher in Latin and is an agentive noun derived from the verb docere ('teach').[4] In
French, médecin (doctor, physician) is a contraction of docteur médecin, a direct
equivalent of doctor of medicine. In current French idiom, the term toubib, is now a
synonym, derived from Arabic ( طبيبtabīb, physician).
The Greek word ἰατρός (iatrós, doctor or healer) is often translated as physician. Ἱατρός
is not preserved directly in English, but occurs in such formations as psychiatrist
(translates from Greek as healer of the soul), podiatrist (foot healer), and iatrogenic
disease (a disease caused by medical treatment). In Latin, medicus meant much what
physician or doctor does now. Compare these translations of a well-known proverb (the
nouns are in vocative case):
1
The ancient Romans also had the word archiater, for court physician. Archiater derives
from the ancient Greek ἀρχιατρός (from ἄρχω + ἰατρός, chief healer). By contraction,
this title has given modern German its word for physician: arzt.
Leech and leechcraft are archaic English words respectively for doctor and medicine.[1]
The Old English word for "physician", læċe, which is related to Old High German lāhhi
and Old Irish liaig, lives on as the modern English word leech, as these particular
creatures were formerly much used by the medical profession. Cognate forms for leech
exist in modern Swedish as läkare, in Danish as læge, in modern Norwegian as lege
(bokmål) or lækjar (nynorsk) and in Finnish as lääkäri; these Scandinavian words still
translate as doctor or physician rather than as a blood-sucking parasite.
A doctor performing a typhoid vaccination, 1943.In modern English, the term physician
is used in two main ways, with relatively broad and narrow meanings respectively. This is
the result of history and is often confusing. These meanings and variations are explained
below.
This older usage is at least six hundred years old in English: physicians and surgeons
were once members of separate professions, and traditionally were rivals. The Shorter
Oxford English Dictionary, third edition, gives a Middle English quotation making this
contrast, from as early as 1400:
2
Henry VIII granted a charter to the London Royal College of Physicians in 1518. It
wasn't until 1540 that he granted the Company of Barber/Surgeons (ancestor of the Royal
College of Surgeons) its separate charter. In the same year, the English monarch
established the Regius Professorship of Physic at the University of Cambridge.[6] Newer
universities would probably describe such an academic as a professor of internal
medicine. Hence, in the 16th century, physic meant roughly what internal medicine does
now.
These days, a specialist physician in this older, narrower sense would probably be
described in the United States as an internist. Another term, hospitalist, was introduced in
1996,[7] to describe US specialists in internal medicine who work largely or exclusively
in hospitals. Such 'hospitalists' now make up about 19% of all US general internists;[8]
such doctors are often called general physicians in Commonwealth countries.
This older, more narrow usage of physician as an internist is common in the United
Kingdom and other Commonwealth countries (such as Australia, Bangladesh, India, New
Zealand, Pakistan, South Africa, Sri Lanka, Zimbabwe), as well as in places as diverse as
Brazil, Hong Kong, Indonesia, Japan, Ireland, and Taiwan. In such places, the more
general English terms doctor or medical practitioner are prevalent, describing any
practitioner of medicine (whom an American would likely call a physician, in the newer,
broad sense).[9] In Commonwealth countries, specialist pediatricians and geriatricians
are also described as specialist physicians who have sub-specialized by age of patient
rather than by organ system.
3
Nurse practitioners (NPs) are not described as physicians; the American College of Nurse
Practitioners do not describe themselves this way. They are classified as advance practice
registered nurses/clinicians, also known as mid level healthcare providers [15]. Nurse
practitioners may perform work similar to that of physicians, especially within the realm
of primary care, but utilize advanced nursing models instead of medical models. The
scope of practice for a Nurse Practitioner in the United States is defined by individual
state boards of registration in nursing, as opposed to state boards of registration in
medicine. Physician Assistants are also classified as midlevel advance practice clinicians,
have a similar scope of practice as nurse practitoners, and are regulated by state boards of
registration in medicine.
Physicians commonly enjoy high social status, often combined with expectations of a
high and stable income and job security. However, medical practitioners often work long
and inflexible hours, with shifts at unsociable times, and may earn less than other
professionals whose education is of comparable length or shorter [16] [17] [18].
Some commentators have argued that physicians have duties to serve as role models for
the general public in matters of health, for example by not smoking cigarettes. [19]
Medical practitioners hold a medical degree specific to the university from which they
graduated. This degree qualifies the medical practitioner to become licensed or registered
4
under the laws of that particular country, and sometimes of several countries, subject to
requirements for internship or conditional registration.
This further training typically takes from three to six years, but can be longer depending
on specialty and jurisdiction. Primary care is increasingly recognized as a specialty, and
residency programmes in this field are becoming common. A medical practitioner who
completes specialist training in internal medicine (or in one of its sub-specialties) is an
internist, or a physician in the older, narrower sense.
[edit] Regulation
In most jurisdictions, physicians (in either sense of the word) need government
permission to practice. Such permission is intended to promote public safety, and often to
protect the public purse, as medical care is commonly subsidized by national
governments.
In some countries, including the United Kingdom and Ireland, the profession largely
regulates itself, with the government affirming the regulating body's authority. The best
known example of this is probably the General Medical Council of Britain. In all
countries, the regulating authorities will revoke permission to practice in cases of
malpractice or serious misconduct.
In the large English-speaking federations (United States, Canada, Australia), the licensing
or registration of medical practitioners is done at a state or provincial level. Australian
states usually have a "Medical Board," while Canadian provinces usually have a "College
5
of Physicians and Surgeons." All American states have an agency which is usually called
the "Medical Board", although there are alternate names such as "Board of Medicine,"
"Board of Medical Examiners", "Board of Medical Licensure", "Board of Healing Arts"
or some other variation.[20] After graduating from medical school, physicians who wish
to practice in the U.S. usually take standardized exams, such as the USMLE for MDs,
COMLEX-USA for DOs, the NBDE exams for dentists, the NBPME exams for
podiatrists, or the NPLEX for naturopaths which enable them to obtain a certificate to
practice from the appropriate state agency.
The following causes are less likely than in the general population:[21]
• Traffic accidents
• Drug-related causes
• Accidental poisonings
• Hepatitis (exclusive chronic non-viral)
• Suicide/self-inflicted injury
• Malignant melanoma of the skin
• Alzheimer's disease
• Pancreatic cancer
• Cerebrovascular disease
• Ischemic heart disease