Amy E. Thompson

Professionalism, Governance, and Self-regulation of Medicine

A revolution in medicine is occurring and is directly related to several major factors, including substantial changes in the health care system, largely due to the Affordable Care Act; remarkable scientific advances and an accelerated pace of discovery in biomedical science 1 ; increasing recognition of the need to practice restraint with respect to both diagnostic testing and therapeutic interventions; the promise of personalized medicine; more physicians being employed by large medical organizations; the increasing trend of consolidation and corporatization of health care delivery; and heightened public demands and expectations for transparency and accountability in health care. 2 At the same time, fundamental aspects affecting physician education and certification have come under intense scrutiny, with expansion of the number of medical schools, critical examination of government funding for residency training, and recent contentious debates regarding maintenance of board certification. 3 Considering these fundamental, dynamic, and rapid

Noninvasive Prenatal Testing

Most DNA is contained within cells, but a small amount circulates freely in the bloodstream. During pregnancy, a small percentage of cell-free DNA in a woman’s blood is from the placenta and usually matches the DNA of the fetus. With NIPT, cell-free fetal DNA can be examined for evidence of aneuploidy (an extra or missing chromosome). For example, NIPT can be used to look for Down syndrome, which is caused by an extra copy (trisomy) of chromosome 21.

A Physician’s Education

Medical School Medical school usually lasts for 4 years. In many schools, the first 2 years aremostlyinaclassroom.Studentsaretaughtabouthealthanddisease. They learn about topics such as the cardiovascular (heart and blood vessel), pulmonary (lung), and neurological (brain and nerve) systems. Medical schools are usually connected with teaching hospitals. During the last 2 years of medical school, students learn in a teaching hospital. They apply what they learned in the classroom to patients. They also learn about different specialties (areas of medicine). Some specialties are internal medicine, pediatrics, neurology, surgery, psychiatry, family medicine, and obstetrics/gynecology. Students decide what kind of physician they want to be during the last year of medical school. Students graduate from medical school with an MD (doctor of medicine) degree or a DO (doctor of osteopathic medicine) degree. Having either of these degrees means a person is a physician.

The Americans With Disabilities Act

The ADA protects the civil rights of more than 50 million Americans with disabilities. Its purpose is to make sure they have the same opportunities as everyone else to fully participate in public life. Under the ADA, a disability is defined as a physical or mental impairment that substantially limits 1 or more major life activities. Major life activities include things like speaking, walking, caring for oneself, and performing manual tasks. The law also protects people with a history of such an impairment and those who are regarded as having such an impairment. The ADA prohibits discrimination in all areas of public life, including • Employment • An employer cannot discriminate against a qualified person with a disability with regard to practices like hiring, firing, advancement, and training. • Employers must also make reasonable accommodations for an employee’s disability as long as the accommodations are not too difficult or expensive. An accommodation might be a modified work schedule or a special piece of equipment. • State and local governments: All public entity (state and local government) services, programs, and activities must be accessible to people with disabilities. This includes public transportation services like bus and rail systems. • Public accommodations: Public accommodations are places that are privately owned but open to the public. Examples are doctors’ offices, pharmacies, museums, restaurants, day care centers, educational institutions, hotels, libraries, and stores. They must be accessible to people with disabilities and they cannot discriminate based on disability. • Telecommunications: Emergency telephone services, such as 911, are now directly accessible by people with speech, hearing, and other disabilities. In addition, telephone and Internet companies must provide relay services so that people with disabilities can communicate by phone.

Diverticulosis and Diverticulitis.

Diverticulosis is common in older adults, occurring in about half of people between 60 and 80 years old. It affects men and women equally. Scientists do not know what causes diverticulosis. A lowfiber diet may play a role in developing the disease. Another cause might be abnormal contraction and spasm of the muscles in the colon wall. Obesity, lack of exercise, and some medications have been associated with diverticulosis.

Suntan and Sunburn

Melanin is the pigment that gives skin its color. People with light skin have less melanin than people with dark skin. When skin is damaged by UV rays, the body makes more melanin to try to protect against further damage. This extra melanin gives suntanned skin its darker appearance. But a suntan does not provide good protection against the harmful effects of UV rays. In fact, a suntan is a sign that skin has already been damaged, and tanned skin can continue to be damaged when exposed to UV rays. For people with light skin, exposure to UV rays can lead to sunburn in as little as 10 to 15 minutes. The redness of a sunburn is caused by increased blood flow to skin that has been damaged.

Deep Vein Thrombosis

Causes of DVT Causes of a thrombus (blood clot) include slow blood flow, an injury to the lining of a vein, or having blood with an increased tendency to clot. • Limited movement can cause slow blood flow, which increases the risk of DVT. Limited activity can occur with prolonged bed rest after surgery or because of illness. • Injury of a deep vein from fracture, surgery, or severe muscle injury can lead to DVT. • Estrogen in birth control pills or hormone therapy makes blood more likely to clot. Clotting risk is also higher during pregnancy and for up to 6 weeks after giving birth because of increased estrogen.