For medical education, the impact of changes in hospital function may be considerable. For the last half century, medical education has been almost exclusively in-patient education-the emphasis has been upon care of the patient who is in the hospital and not outside it. But as the hospital reaches outside its walls, so will medical education.
There is another point about medical education, not often considered in formal discussions. It is a problem, a fact of medical life, which can be dated quite precisely in terms of origin: it began in 1923, with Banting and Best. The discovery of insulin by these workers led directly to the first chronic therapy of complexity and seriousness, where administration lay in the hands of the patient. Prior to that time, there were indeed chronic medications-such as digitalis for heart failure or colchicine for gout-but a patient taking such medications did not need to be terribly careful about it or terribly knowledgeable about his disease process. That is to say, if he took his medicines irregularly, he developed medical difficulties fairly slowly, or else he developed difficulties that were not life-threatening.
Insulin was different. A patient had to be careful or he might die in a matter of hours. And since insulin there has come a whole range of chronic therapies that are equally complex and serious, and that require a knowledgeable, responsible patient.
Partly in response to these demands, partly as a consequence of better education, patients are more knowledgeable about medicine than ever before. Only the most insecure and unintelligent physicians wish to keep patients from becoming even more knowledgeable.
And when one considers a medical institution, such as the hospital, the importance of a knowledgeable public becomes still clearer. Hospitals are now changing. They will change more, and faster, in the future. Much of that change will be a response to social pressure, a demand for services and facilities. It is vital that this demand be intelligent, and informed.
Glossary
Abrasions - Scrapes.
Acidosis - Excessive acidity in the blood.
Acute - In medical reference, meaning of short duration. There is no connotation of severity. The opposite of an acute illness is a chronic illness.
Ampoule - A drug container, usually made of glass. amylase An enzyme produced in the pancreas and found in elevated blood concentration when the pancreas is diseased. amyloidosis A disease characterized by deposits of amyloid in various tissues. Amyloid is a protein substance.
Angiogram - An X-ray study of blood vessels. arrhythmia Irregular heartbeat.
Barium - A metallic element. Barium sulfate, a salt, is opaque to X rays and is not absorbed by the gastrointestinal tract. When a liquid suspension of barium sulfate is swallowed by the patient, the stomach and intestine are outlined in white on X rays and can be better studied.
Bilirubin - A golden pigment formed when the hemoglobin in red blood cells is broken down. Bilirubin is normally excreted by the body; in various disease states it can accumulate, causing jaundice (q.v.).
Biopsy - Removal of a sample of living tissue for examination.
Blood pressure - Expressed in millimeters of mercury, this is generally the pressure within the brachial artery of the arm. Blood pressure is expressed as a fraction, such as 120/80. The first figure is known as systolic blood pressure, and represents the peak pressure inside the artery corresponding to each contraction of the heart. The smaller figure is known as diastolic blood pressure, and represents the pressure inside the artery between contractions.
Blood sugar - Blood normally contains a certain amount of sugar, but the amount can be increased in disease states such as diabetes.
Bone marrow aspiration - Removal of some bone marrow by suction through a needle.
Catheter - A hollow cylinder of metal, rubber, or plastic designed to be passed through any of several body channels, such as the arteries, veins, or the urinary system.
Catheterize - To pass a catheter through a body channel.
Celiac angiogram - An X-ray study of blood vessels which supply abdominal organs, that is, of the so-called celiac arteries.
Cerebrospinal fluid - The fluid which bathes the brain and spinal chord.
Cirrhosis - From the Greek for "tawny," and the early observation that scarred organs became yellowish in appearance. The term refers to destruction of parts of an organ and replacement of the damaged areas by fibrous scar tissue. One can speak of cirrhosis of breasts, kidney, or lung, but the term usually refers to scarring of the liver, following damage from alcohol or other causes.
CPK - Creatinine phosphokinase, an enzyme. When the concentration of this enzyme in the blood is increased, it suggests tissue damage, particularly heart muscle damage.
CSF - Cerebrospinal fluid (q.v.).
Digitalis - A drug to improve the strength of heart muscle.
Disseminated cancer - Widespread or metastatic (q.v.).
Diuretic - A drug that promotes excretion of urine.
Diverticulitis - Inflammation of a diverticulum, generally the tiny diverticula of the lower intestine.
Diverticulum - Literally a pouch opening out from some hollow organ, such as the gut or bladder.
Edema - Accumulation of excessive fluid in tissues; dropsy. It can be observed in a wide range of disease states.
Electrocardiogram - A graphic record of the electrical activity of the heart, revealing information about the rhythm, the electrical conduction within the heart, the health and thickness of heart muscle, and so on.
Encephalitis - Inflammation of the brain.
Glomerulonephritis - Inflammation of the kidney; specifically, of a part of the kidney known as the glomerulus.
Guarding - In medical reference, it refers to a patient's tensing his muscles in a painful area when he is touched there.
Hematocrit - A centrifuge for separating cells from the liquid portion of the blood. In medica-lese, the volume percentage of red cells to fluid in blood. Normally 40 to 45 per cent.
Hepatitis - Inflammation of the liver, usually caused by a virus.
Idiopathic - Of unknown origin.
IVP - Intravenous pyelogram, an X-ray study of kidneys made while they excrete a special dye.
Jaundice - A yellow staining of skin and eyes, from accumulation of bilirubin (g.v.) in the body.
Lacerations - Cuts.
LDH - Lactic dehydrogenase, an enzyme. Blood levels are increased with tissue destruction in various organs.
Lumbar puncture - Passage of a needle between lumbar vertebrae in the lower spine, in order to enter the spinal canal and remove for analysis some of the fluid that bathes the brain and spinal cord.
Metastatic cancer - Cancer that has spread throughout the body to distant sites. myocardial infarction Heart attack. morphology Physical appearance.
Obtunded - Literally blunted, in medical reference to demonstrate decreased mental alertness and acuity.
Pancreatitis - Inflammation of the pancreas. pathological Diseased, abnormal.
Platelet A small, flat, plate-like cell in the blood that aids in clotting.
Platelet count - A count of such cells. prognosis Foretelling of the outcome of a disease.
Reticulocyte - An immature blood cell.
Reticulocyte count - A counting of the number of immature red cells in circulation. Normally only a small percentage of red cells are immature; if the bone marrow is making more blood, the number of reticulocytes in circulation will increase.
Tap - As in thoracic or abdominal tap, medicalese for passage of a needle into the chest or abdomen to drain off ("tap") fluid inside; centesis.
Toxin - Poison.
Triage officer - An emergency-ward physician who decides which patient requires treatment first.
Ventricles - The paired lower chambers of the heart.
Sequestered - Hidden.
SCOT - Serum glutamic oxaloacetic transaminase, an enzyme. When present in elevated concentrations in blood, it implies tissue damage.