The Medical Updating

Looking back over the last decade or century, it is easy to see that the scientific bases of medical practice, the organization of hospitals and clinics have changed dramatically.

The future promises even more changes. Population growth, environmental pollution, the emergence of infectious diseases and global warming, for example, are global problems that have immense medical implications. Medical, legal and social values are not static, therefore it is necessary to re-examine the ethical principles of the practice of medicine and its application in new circumstances. Certain aspects of medicine are fundamental and eternal, whereas the practice of medicine is always changing. Physicians must be prepared to face changes and to reaffirm those that are fundamental. The law does not always establish positive duties (i.e. what one should do) to the extent that professional ethics, especially medical ethics, do. Today ethical issues attract widespread public attention, through legislation, administrative measures or legal decisions, the government increasingly participates in medical ethics. Today the convergence of diverse forces, scientific advances, public education, civil rights, consumer movements, the effects of law, economics on medicine, and the heterogeneity of our society demands that physicians clearly express the ethical, scientific-technical principles that guide their conduct, and their professional work.

However, other aspects of medicine have not changed as rapidly. In the community and within the physician-patient relationship, physicians are still considered skilled in the art of healing and in teaching others about health and disease. Physicians are still those who receive extensive training, state authorization, and societal approval to provide all levels of care: advising on healthy living, researching and diagnosing disease, prescribing medications to alleviate suffering, and caring for critically ill patients. Although physicians currently share many responsibilities related to patient care and work closely with other health care professionals, it is still the physician who is primarily responsible for the patient's care. Being a patient's physician carries many responsibilities and requires at least three attributes. The first is the knowledge of biomedical science and clinical medicine to understand the patient's problem. There are no precise amounts of knowledge required, but it is important to be able to correctly answer the patient's questions such as Why did this happen to me and will I get better soon? The physician needs to know the disease process well enough to quickly identify and classify the patient's problem. It is important, and sometimes critical, to know if the problem will be resolved spontaneously or if detailed investigations, inter consultations or hospitalization are required. It is essential to have a comprehensive and up-to-date knowledge of physiopathology, diagnosis and treatment. . In addition to having the specific skills necessary to diagnose and treat a patient, a good doctor must recognize the limits of his or her own skills. The physical examination remains a fundamental skill, it is crucial the ability to recognize the difference between normal and abnormal data, according to age, gender, ethnicity and other factors.

The second attribute is to have a good record of the data (both written and mental), so that the circumstances of each visit and changes in the patient's appearance or other characteristics that may not have been noted are remembered. With practice and attention, these skills (history taking, physical examination, and data recording) can grow during professional life. Other skills, such as selecting and performing diagnostic tests, procedures, and treatments, are constantly changing. All physicians need to practice medicine as well as study regularly to maintain and improve essential skills. The third, but no less important, attribute is the physician's responsibility to the patient and the medical community for appropriate professional and ethical conduct. The first principle in the physician-patient relationship is that the most important aspect is the well-being of the patient. To put the patient first, it is necessary to understand the patient and to know the patient's values. Usually, explaining the patient's illness, determining the best method of treatment or treating emergencies, consumes precious time, place the doctor at the patient's service. Ethical behavior includes clearly recognizing situations in which the physician's interest may conflict with the patient's interest. Finally, the privacy and primacy of the physician-patient relationship should never be abused in a personal manner. Therefore, the physician's work (recognizing illness, providing advice and comfort, relieving pain and suffering, and dealing with illness and death) has not changed much since antiquity. Better recording of medical data, quantitative observation, meticulous experimentation and careful clinical studies have contributed to the rapid evolution of medical practice in the past century and at the dawn of the present. This makes continuing medical education at the undergraduate, graduate and postgraduate levels imperative, which should be imparted with knowledge that has a true scientific basis and intellectually cohesive approaches for understanding diseases.

Extraordinary advances in the biological sciences, the development of medical and surgical specialties and the explosion of medical information have brought great benefits. The weight of all these responsibilities may suggest that it is impossible, or almost impossible, to be a good physician. On the contrary, people with very different personalities, interests and intellects are or are becoming good physicians, and are deeply satisfied with this work. The information needed to practice medicine is now more accessible than ever before. The skills the physician needs can be learned through experience, improved through practice, and focused to achieve excellent medical practice. Physicians' ethical requirements are not burdensome. In fact, they are the expectation for all good citizens, regardless of their profession. Being a physician is both exciting and satisfying, providing a unique opportunity to combine modern scientific knowledge with the traditions of an ancient profession recognized for its service and help to human beings.

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