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Wikipedia talk:WikiProject Clinical medicine/Archive 2

< Wikipedia talk:WikiProject Clinical medicine
Latest comment: 20 years ago by Ww
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Parentage

If your WikiProject aims primarily to replace the more-or-less defunct "WikiProject Medical Conditions" than that should be your parent project. At least that old project is physically in existence. How can you reference a project as your parent, that does not even exist? -- John Gohde 20:04, 5 May 2004 (UTC)

Are you saying our project is illegitimate? at this stage probably better illigitimate than an orphan. --Erich gasboy 21:11, 5 May 2004 (UTC)
I am suggesting that you try clicking on WikiProject Health Science and Wikipedia:WikiProject Medical Conditions. Which site provides the most information? -- John Gohde 21:32, 5 May 2004 (UTC)
a good point! I agree with JFW's original placement of this project as a subproject of health. I think you'll find the valuable stuff will be pulled of the old dead page inshallah. --e

I think Clinical medicine replaces Medical conditions, and it probably better described as a heir than a bastard or an orphan. Medical conditions also has a much more limited scope, as it would—for example—not span seperate pages about diagnostic testing.
WikiProject Health Science is not very active; the whole use of "Health science" as a parent for all these medical issues might benefit from a serious review.
As stated on John's talk page, this project is certainly not meant to clash with the new CAM WikiProject. If anything, I think cross-pollination is more to everyone's benefit than continuous bickering.
JFW | T@lk 21:45, 5 May 2004 (UTC)

Help the page assume shape

The Project page is rather boring and still lacks the stuff we discussed when WikiDoc had just appeared on the scene. Is anybody willing to adapt that material for the project? I've reshaped this page to resemble our old doctors' mess.
JFW | T@lk 12:48, 9 May 2004 (UTC)

PS: WHERE ARE THE SURGEONS! The surgical side is atrophying! Can you imagine me writing cardiothoracic surgery and vascular surgery!

funny you should say that, I was just thinking about mate (ex cardiac surgeon) in the Midlands who i was going to email... mind you i spend enough time in the company of surgeons! ;-) --e 21:06, 9 May 2004 (UTC)

We should be pleased to have your surgical Midlander. What do you mean: ex-cardiac surgeon? Is he marketing artifical heart valves now? JFW | T@lk 09:05, 11 May 2004 (UTC)

not as far as I know... e 06:50, 18 May 2004 (UTC)

Boxes

for those of all of us interested in boxes, worth watching User:AlexR/Article_series_boxes e --Erich gasboy 17:16, 6 May 2004 (UTC)

Thanks.
JFW | T@lk 13:11, 9 May 2004 (UTC)

Situs inversus

Hey guys - especially (you ksheka) - this is article of the week. should we put in an effort? --Erich gasboy 23:12, 7 May 2004 (UTC)

Sure. Why not. :-) Ksheka 13:27, May 8, 2004 (UTC)
Is there an article on Kartagener syndrome?
JFW | T@lk 13:11, 9 May 2004 (UTC)

Acetaminophen - Featured article candidate

FYI, I've nominated the article on acetaminophen for featured article. I did a heavy edit on the article a couple weeks or so ago, and it's held up, and I think the resulting article's good enough for a feature. So those of you interested, the discussion is here, but more importantly, make edits to the article if you think it needs some cleaning up! Ksheka 00:01, May 9, 2004 (UTC) I looked at it; nice job Alteripse 04:02, 9 May 2004 (UTC)

looking good! I made some minor changes (hopefully improvements but i'm never sure!!). I commend you for working on a core topic. I'll try to add some stuff on indications and combination with NSAIDS. erich --e 21:18, 9 May 2004 (UTC)
As of today, Acetaminophen is now a featured article. Ksheka 20:08, May 16, 2004 (UTC)

Pregnancy Category (Pharmaceutical)

I added a link to the pregnancy category, and mentioned that it's pregnancy category B. My problem is that it's United States pregnancy category B. I wouldn't be surprised if it's a different category in Europe. Should I put in something like Pregnancy Category B ( AE)? Or is there some other terminology that's more appropriate? Ksheka 12:06, May 11, 2004 (UTC)

My understanding is that this classification is international - yayyy! I think a single article on Pharmaceutical pregnancy category would be an excellent idea... by the way has anyone looked at the pages drug, medication and pharmaceutical lately? urg e 03:19, 12 May 2004 (UTC)

Actually, I am trying to make pregnancy category (pharmaceutical) into an international-sort of page, and will add a compare-and-contrast section soon. I'm going to list a set of common medications and what pregnancy class they fall in in different countries. My problem is actually getting those classifications for anywhere but the U.S. Any input would be appreciated. Ksheka 10:32, May 15, 2004 (UTC)
Aussie Mims will give you our classification... (in most things aus follow uk, but every now and then goes american... sometimes we even make things up for ourselves) e 12:28, 15 May 2004 (UTC)

Rare diseases

I just looked at the rare diseases article which the Medicine article links to. Something is wrong with the definition: "An orphan or rare disease is generally considered to have a prevalence of less than 5% affected individuals in the society." A disease that affects even 1% of the people in a population is a very common disease, likely to be dealt with every week by a general practitioner. But what does "less than 5% affected individuals in the society" mean? I've never heard a formal definition of a "rare disease", but I would reserve the term rare for something seen once or twice or less in an average career of general practice. A disease like that would probably have a prevalence of 1 in 100,000 individuals but that definition still includes thousands of reported diseases. Any suggestions? Alteripse 04:02, 9 May 2004 (UTC)

guday, i just discovered the - 'non-rare' list hence added to medicine page. agree that that definition or rare needs a re-write - your 1 in 100000 sounds good. The working definition actually seems to be anything that 'people' don't want to put on common (aka List of diseases ) disease list - List of diseases also seemed to need some tlc (mind you, so does medicine which reads like a phone book, doesn't state modern (or post-modern) medical philosophy and overlaps with physician) --e 04:42, 9 May 2004 (UTC)
In my humble opinion: having two disease list articles is stupid. Its like having a list of common animals and rare animals. Who wants to look in two lists if you want to look up an animal? The criterion of rare or non rare is either ridiculously subjective or if based on an arbitrary prevalence or incidence, fairly difficult and culture specific. How hard would it be to combine the two articles? Howe do we even know that all the disease articles written are even listed in either article? (And I in the middle of my own 3 big ones am not volunteering.) Alteripse 11:53, 9 May 2004 (UTC)
Seconded. A disease may be rare in one country, but relatively less rare in another. One I just worked on, ARVD has an incidence of 1:10,000 in the U.S., and is considered rare (by cardiologists). However, in Italy, the incidence is 40 times as high, and is screened for before joining competitive sports. How about just having one list of diseases, and maybe highlight ones that are commonly known about in the general population. Not that I'm volunteering for the merger... Ksheka 12:01, May 9, 2004 (UTC)
Just redid definition for rare disease. Sounds better, imho, than the previous one of 5% of possible population. Don't know if what I wrote qualifies as "rare" or just "very uncommon" but I'll leave it as it is for now. Also, I think the list of rare diseases should be axed and the list moved to list of diseases while the current list of diseases should be moved to list of common diseases. Only the common ones deserve a separate listing, not the rare ones (the rare ones outnumber the common ones by a fair margin). The stupid thing is that there are common diseases (such as asthma) in the list of rare diseases! Alex.tan 19:09, 9 May 2004 (UTC)
mmm... perhaps rare should be 'comprehensive', btw I think at least until someone has a serious burst of mania I think we should keep two lists and focus on getting the small one (i just added diabetes!) looking fantastic. we could then gradually expand it bringing in stuff from the large list. IMHO, we are much better off with the status quo than a half hearted attempt at a merger. erich --e 20:56, 9 May 2004 (UTC)
  • I agree with Alex that the two lists ought to be combined in a single article. Since gasboy has a good point, I would suggest that the disease article keep two separate lists: the first would be a list of diseases treated as more than a stub in wikipedia, and the second would be everything else. As we finish or buff an article we move it from the bottom list to the top. It saves looking in 2 different articles for a particular disease and avoids imposing upon the reader the (IMO) fairly useless distinction of common/uncommon. I think "good article" vs stub or no article is a more useful distinction.Alteripse 22:45, 9 May 2004 (UTC)

Naming conventions for medicine

Discussion about the issue of naming conventions for medical topics is scattered throughout Wikipedia:

Because arguments for and against the use of medical terminology in article titles are not presented in a centralized fashion, it is difficult for those unfamiliar with the issue to make useful contributions to our cause. I suspect this decentralization is in part responsible for the lack of response JFW has received following his posts on the subject, and IMHO this is slowing our progress in assigning proper names to medical articles.

Wikipedia:Naming conventions has a list of conventions under consideration that we might want to make use of. I suggest we add Wikipedia:Naming conventions (medicine) to the list and carry out discussion on Wikipedia talk:Naming conventions (medicine). --Diberri | Talk 22:11, May 10, 2004 (UTC)

err... sorry I'm having trouble finding the bit where anybody says 'no you can't move heart attack to MI and put a redirect at heart atttack to point to MI. The only concern people have is if the heart attack page were deleted rather than redirected... sorry what have I missed? (thanks for above list Diberri) --e 23:21, 10 May 2004 (UTC)

Well, in order to move the article, the "myocardial infarction" page needs to be empty. When I'm a sysop (in a few hours he he) I might be able to speed it up. So far responses have been minimal, and consensus is not forming in any form.
PS Diberri, to make a special "naming conventions" page for medicine is probably just a tiny bit over the top. I've raised it on the Village pump, where I've had some minimal response. JFW | T@lk 23:41, 10 May 2004 (UTC)

After reading the relevant materials and note at Wikipedia:WikiProject Clinical medicine#The naming issue, I was under the impression that a consensus to the naming issue had not yet been reached—in which case it would have been nice to consolidate the ongoing discussion to a single talk page. However, if the convention is already more or less fleshed out, I retract my original suggestion (since I was apparently unaware that the community had reached a consensus opinion :-)
In any case, we should definitely make a note of our decision at Wikipedia:Naming conventions (in lieu of my proposed Wikipedia:Naming conventions (medicine) page), and not simply relegate discussion to that article's talk page or (even worse) rely on folks to glean the convention by following a discussion which spans several distinct articles. For those who do check with the naming conventions page prior to creating an article, it will be useful to see that the community has a convention for naming medically-oriented articles whose topics are known by several different names. Plus, when we encounter a contributor who's using common names for medical articles, we can say "The community has agreed that medical articles should be named using medically-correct terminology. Please see Wikipedia:Naming conventions for more information." I'm probably over-arguing my point, but hopefully you can see the value in this approach. --Diberri | Talk 00:22, May 11, 2004 (UTC)
I think we can sign off this as one the first project achievements then. JFW, do you wanna do the honors on the Wikipedia:Naming conventions page? how about something like (as a start):
Medical condtions are placed under the name currently used by the professional community. Common names should redirect to the technically correct name.
(if you're allergic to passive voice.... Contributors should place medical condtions under the ... or Wikipedia places medial..... The currently is because i don't know much latin!!!)--e 03:31, 12 May 2004 (UTC)

fictional doctors

Hey Nunh-huh! err well that surgeon from MASH played by Alan Alda is one of my role models... as is the hologram from Star Trek, but er not sure if this is the right project.... --e 23:29, 10 May 2004 (UTC)

They sound fictional enough to me<G>. You gotta admire a series that lasts longer than the war it's based on... - Nunh-huh 01:52, 11 May 2004 (UTC)

who is our audience?

(cut and paste from erich's list)

  • how do we accomodate multiple audiences?... just thinking...--e
  • Considering recent opposition to featured article nominations of medical topics it seems to be worthwhile to think about creating mutually linked and parallel versions like Diabetes mellitus and Patient information on diabetes mellitus. IMO Editorial approaches in articles aimed at patients and scientific articles are disparate. Kpjas 07:58, 15 May 2004 (UTC)
  • Separate templates for medical coverage and patient information sounds like a wise idea. The language in corresponding sections can be modified appropriately, and some sections may be appropriate to one but not the other. --Nunh-huh 08:47, 15 May 2004 (UTC)
  • mmm having started to actually contemplate this in practice it certainly seems easier to have separate articles... but I think this is something we all need to stew on and not rush. me still thinks a wiki-medical textbook could be cleaner... but must think more e 12:41, 15 May 2004 (UTC)
    • I've an itch to start a clinical medicine wiki where all (?) could share their practical knowledge with younger colleagues (?). Online medical textbooks are rather common, but this wiki might be something novel. Kpjas 07:19, 16 May 2004 (UTC)
    • Well also a patient info wiki would have a role - I bet many docs have already got pt info brochures that they'd be willing to share. all sound's like a lot of work but doable if greater audience clarity invited greater participation. all very easy in theory! e 13:45, 16 May 2004 (UTC)

clinical death (quickie)

cardiac arrest which is also called clinical death is an absence of systole

is the above statement utter rubbish or is it just me?

Nah, I think the phrase "clinical death" is even stupider than "clinical depression" and would predict 99.9% of the use of the phrase is by nonphysicians. What does the word "clinical" add to "death"? Heck I don't even think gasboy is "utter rubbish"-- he's being a bit too hard on hisself. Alteripse 02:40, 16 May 2004 (UTC)
such kindness. I don't think you're utter rubbish either Alteripse! I'll zap 'clinical death' if no one has heard of it then. interesting the death page mentions it as well... mmmm... e 13:39, 16 May 2004 (UTC)

i can't recall reading any death definitions recently but its that little point about irreversibility that is pivotal... isn't it? e 01:50, 16 May 2004 (UTC) Unless you've been playing too many video games. Alteripse 16:39, 16 May 2004 (UTC)

I guess cardiac arrest can be defined as the absense of systole. (effective systole better?) I'm not sure how they got clinical death in there... The page on death has a nice definition of death, by the way. :-) Ksheka 02:08, May 16, 2004 (UTC)

thanks! e 02:15, 16 May 2004 (UTC)

Cardiopulmonary resuscitation

mmmm while i'm at it... this is a page i'm planning to review carefully ( input most welcome of course). since it gives the kind of first aid advice that could be life (or neurone) saving i wonder if it should be given some prominince in the other pages* paniced wikipedians may go to when mum carks it in the living room and dad is calling the ambulance. flys in the face of the "wikipedia don't give medical advice yadda yadda" but hey worth an exception? e 02:15, 16 May 2004 (UTC)

ps *other pages = first aid, cardiac arrest, BLS, medical emergency


errr... had anybody else noticed [1]?? e 02:50, 17 May 2004 (UTC)

This may be a good project for our group: Come up with a list of articles that define first aid in a medical emergency. Post the list here, and we get to it! Sort of like the wikipedia:Article of the week. Maybe Medical topic of the month? Every month we choose a general medical topic that's not well written in the wiki. Probably shouldn't be limited to a single article. Any thoughts?Ksheka 10:13, May 17, 2004 (UTC)

From the village pump: The names of diseases: policy?

There is a wide gap between lay terms and doctors' jargon when it comes to the naming of diseases and medical procedures. Several doctors on Wikipedia (see WikiProject Clinical medicine) feel that articles should be named by their scientific names, rather than the lay terminology (myocardial infarction instead of heart attack).

Arguments:

  • Many of these terms appear to denote something that they're not (heartburn does not affect the heart, nor has it anything to do with burning);
  • Some terms are imprecise: heart attack does not specify the nature of the attack (infarction) nor does it mention the fact that the heart muscle (myocardium) is affected;
  • Some terms are bound by geographical constraints; diseases have different names in different communities and countries;
  • People might actually learn something about medical terminology, especially if the redirects are in place and the page explains that myocardium is heart muscle and that infarction means dying tissue due to lack of blood.

See also Wikipedia_talk:Naming_conventions#Medicine, where I've raised this point and received a deafening silence.
JFW | T@lk 15:50, 9 May 2004 (UTC)

Why not name it to the scientific name and have a redirect of the lay name? RickK 22:40, 9 May 2004 (UTC)

Yes, RickK seems to have the best solution there. The trouble with using medical terminology alone is that it will render the articles invisible to anyone but doctors. The person suffering from the condition who may come here for information won't find them. --bodnotbod 23:00, May 9, 2004 (UTC)
I suggest that you'll need to preemptively create redirects to the common names for diseases, otherwise well-intentioned users will inevitably come along and create new articles using the common names. No biggie and it happens all the time here, but just thought I'd mention it. You might even want to create some sort of cross-referencing index page to help keep track of things (also helpful to use the Related Changes function to see updates made to the articles on the list). older≠wiser 23:52, 9 May 2004 (UTC)

RickK: User:Ksheka tried moving heart attack to myocardial infarction but there was no consensus on the issue because "Wikipedia policy" was supposed to be that lay terminology is employed. My aim is to see if this should indeed be/remain policy, or that we can follow your suggestion and employ judicious redirecting. The Wikiproject Clinical medicine policy is to keep pages aimed at the general readership, only escalating the difficulty to address technical issues (e.g. what cellular molecules participate in the development of atherosclerosis in patients who smoke?)
JFW | T@lk 09:10, 10 May 2004 (UTC)

It should work to have --using heart attack as an example-- an article in layman's terms in that location, and one in medical terms filed under myocardial infarction, each with reference to the other at the top of the article. (Is this discussion redundant?) I don't think redirecting is the answer here. ;Bear 01:01, 2004 May 11 (UTC)

If the question is lay man's terms, most medical topics are very difficult to describe solely in lay mans terms. Using myocardial infarction as an example, the article talks about metabolic demands of the myocardium, arrhythmias, thrombolysis, etc. To explain each of these terms using exclusively layman's english is, of course, possible. However, it'll make the article more unwieldly and difficult for anyone who knows the correct terminology from learning anything. This is, of course, solved with the use of proper terminology with judicious use of links to explain difficult concepts and to define medical terms. If someone wants to write a complete article in laymans terms on myocardial infarction, perhaps it should go in the simple english wikipedia instead. (Only half-joking here :-) ) Ksheka 19:07, May 17, 2004 (UTC)

Two separate issues here. One I think is easy and one hard.

The easy one: we should title the article with the title most commonly used by doctors and patients who have just been diagnosed by their doctors. We should redirect from more technically and less technically "sophisticated" names. As someone famous around here once said, "No one ever died from a redirect." I certainly intend to continue to title my medical articles with the name a doctor or sophisticated layman would use, but will try to redirect from anything more "lay" that seems likely to attract people. I don't think anybody can fault this (or at least wouldnt persuade me to change).

What level to write for

The much harder issue is deciding what level to write the article for. One obvious answer would be to write two articles: one for scientifically literate adults, and a second article at a much lower level designed for average folks. The problem would be what level to choose: 8th grade (average public reading level), 12th grade, or higher. I don't enjoy trying to intentionally oversimplify to an 8th grade level, nor does the idea of writing several articles for several different levels appeal to me.

I am becoming increasingly aware that I am writing my articles above a high school level. I am not writing for other specialists because they wouldnt look here for info on a disease, but I am trying putting enough detail in that primary physicians, other specialists, medical students, or other college educated people will understand. I was planning to ask for opinions on whether the articles are too advanced or not. Take a look at puberty, sexual differentiation, androgen insensitivity syndrome, and growth hormone deficiency and tell me if you think they are too detailed, too advanced, or don't explain enough. Two of them are replacements for articles that I thought had insufficient detail plus some errors. These were a lot of work if they don't match the needs and tastes here. Thanks. Alteripse 21:10, 17 May 2004 (UTC)

Hi Alteripse – I just a very quick scan of growth hormone deficiency. It looked excellent (of course). My only comment is that it would be good to add very non technical introduction (maybe 200 words or less) before the detail. something like:
"ghd is a rare medical condition, occurring in xxx people. It is one of the causes of dwarfism. Untreated ghd in childhood makes you short. In adults it does somethingelse. Once diagnosed the condition responds well to treatment. "
Better than that obviously but you know what I mean! (i'm not sure if all my pages have a basic intro- i better check!)Erich 03:31, 19 May 2004 (UTC)
This is a good suggestion. I'll see what I can do. I'm otherwise done with deficiency. I'm struggling with the growth hormone treatment article because it seems so much more interesting and controversial but keeps exceeding the 32kb limit. Is it worth taking the history out into a separate article? Am I overrating its interest? Unlike the GH physiology and deficiency and acromegaly stuff, I don't think anyone has compiled a lot of this GH history stuff in one place on the web, and I think the social controversies and ethical issues are worth covering. But I would value a fresh opinion. PS I have no idea what what you and Jiang are arguing about (see below). Alteripse 03:49, 19 May 2004 (UTC)
IMHO, if you've got the passion and knowledge about a topic, megabytes are cheap, so go for it! I think you're right about GH treatment having fascinating ethical implications. It may not be the most read article in wikipedia, but any history well told is fascinating. If your major intent is to do the world a favor, as opposed to venting your passion, you could probably help humanity by having a squiz at the common paeds topic for parents, med students, and RMOs. (I haven't looked at any lately but I bet there isn't a decent article on fever in kids, etc etc.) I also think trying to better integrate existing content so that other contributors can more quickly get to work on the missing bits is useful. (that's really why I created Anaesthetic drugs and the even more pathetic Anaesthetic equipment pages). But, most importantly, I think: go with your passion! (mmm perhaps not debate with your passion… mmmm) ;-) oh and i'd split up articles if they are too big - but all my pages are a bit weeny so I'm no expert on big pages Erich 06:57, 19 May 2004 (UTC)
How about targeting those that are personally interested in the topic (ie: they know someone afflicted with a disease, or they are a physician taking care of someone with a rare disease). When you do a google search for a medical condition and look at the discussion groups built around a disease (I'm not talking about usenet), they are typically well informed laymen that have a good idea of the tests and treatments for their disease processes. I say let's aim for that level. Ksheka 22:18, May 17, 2004 (UTC)
Must agree heavily with Ksheka. In my own experience, once someone has a disease, the urge for info becomes ravenous. Go deep. I'm willing to bet that disease pages will mostly be searched for by those with (or who know someone with) the disease/condition in question, and that means they're usually willing to put in the brainwork. It's amazing what proximity will do to focus the mind. --Penta 22:37, 17 Jun 2004 (UTC)

Talk page box

Over at WikiProject Evolutionary biology they have decided to put this box on the talk pages of articles belonging to the project. Something for this project? Fuelbottle | Talk 23:03, 17 May 2004 (UTC)

good idea... but why does your requested article link link to mathematics? ;-) e 23:55, 17 May 2004 (UTC)
Good idea. Our project blue-box should definitely give a disclaimer, though. Also, it would be nice if there was some sort of index page to all topics of clinical medicine. I'm having a hard enough time over in cardiology... Ksheka 00:29, May 18, 2004 (UTC)
Ksheka - there a few (too many??) index pages already! but have a look at what i've done with my box (see notes above) to try and organise and structure anaesthesia. A well worked through cardiology box may provide a better template for other disciplines because it has more of standard 'diagnosis and treatment' approach unlike anaesthesia which is bit odd in its approach to patients (doesn't diagnose, interested in all of patient but only for a little while). JFW's boxes make a perfect top level structure, and I'd propose my style for the second level. anyway up for discussion. e 01:42, 18 May 2004 (UTC)

I've made a box at Template:CMedWikiProject

{{CMedWikiProject}}

how many doctor pages do we need??

Ok well i've just been told by a Californian first year college student that disambiguating doctor is a "stupid idea"... so be before i upset anymore freshman (or more likely upset the same one again), does anybody else see the need for M.D. in addition to the doctorate page and the two pages now linked to from doctor? (Dr) e 06:49, 18 May 2004 (UTC)

The disambiguation is fine. One thing, though. In the United States, I think those that go to osteopathic schools get a Doctor of Osteopathic Medicine (D.O.) degree and practice medicine without an M.D. degree. If so, Doctor of Medicine should be rephrased a bit (not all physicians in the United States have an M.D.). Please correct me if I'm wrong. Ksheka 17:37, May 18, 2004 (UTC)
You are correct; at least in the U.S., doctors of osteopathic medicine receive a D.O. degree, not an M.D. I've updated Doctor of Medicine accordingly. --Diberri | Talk 20:35, May 18, 2004 (UTC)
I added Doctor of the Church, which is neither an MD nor a Ph.D. -- Finlay McWalter | Talk 17:52, 18 May 2004 (UTC)
Ok, since the page seems to have a role I've just added a huge pointer off to physician and medicine. does that look alright or should it be toned down? e 00:50, 19 May 2004 (UTC)
Aceademics get all in a twaddle about physicians being addressed as doctor. Usually along the lines of "Well I did a disertation, so I am just as much a Doctor as a mere MD, even more so". This is then often followed by discussion of unfairness of income in the fields, amount of respect by the public, and other whining, worse with some EtOH when the PhD's are all gathered together. Of course, you don't find many PhD's getting out of bed at midnight to attend to someone ill with an MI, pneumonia, or a GI bleed (or all three). The disambiguation is needed. Lots of folks don't know the difference. The freshman is not yet aware that folks exist in the world without his unique insights into the world. Stephen Holland, M.D., Kd4ttc 23:48, 22 May 2004 (UTC)
There is in addition, the various licensing issues in assorted jurisdictions. In the US (a particulary complicated place in re these matters) one may licensed as a physician (w/ MD or DO) to perform diagnose and treat in one state, yet not be able to practice a few miles (km, for those with rational mensuration systems) away in another. Kansas City Missouri is just across a river from Kansas City Kansas, for instance. Confusing matters is that practice in Federal Service (in the military or Public Health service (?)) is legal in all states, except under certain conditions... And then there are assorted Samaritan laws which impose obligations on passing licensed folks (in some cases these may apply to those not locally licensed, I have been told).
In other jurisdictions, the educational requirements prior to licensing differ. In the UK, for instance, specialists generally don't (or at least haven't) used the Dr, but rather Mr. (or Ms, I suppose). Only generalists...
It's a wildly variable matter and deserves some WP illumination, if only to illustrate human cultural / legal variance. ww 14:53, 26 May 2004 (UTC)
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