Practice of Medicine in the Fourth Year — the widest clinical survey

Practice of Medicine is the clinical subject that runs longest through BHMS, and its Fourth Professional course — HomUG-PM-III in the NCH curriculum — is its widest. The second-year course began with symptoms and reasoned towards causes; the third year took five systems one at a time. The fourth year completes the survey of the body’s systems and then goes further, into whole populations of patients — children, the elderly — and into the settings of care at the edges of medicine: palliative care, end-of-life care and critical care. It closes with a look at newer fields.

The CBDC course content has thirteen chapters. As in the third year, most begin with an approach to the patient or the system before they study the disorders themselves.

**The remaining systems.** Six chapters complete the systemic survey.

– Disorders of the cardiovascular system, opening with a clinical approach to cardiology that revisits the second year, and covering the heart’s failure, its blood supply, its valves, its muscle, rhythm and pericardium, congenital heart disease, blood pressure, and the aorta and vessels of the limbs.
– Musculoskeletal and connective tissue disorders, opening with the basic science of connective tissue, cartilage and joints and the classification of rheumatic diseases, and covering the arthropathies, connective-tissue and inflammatory disorders, disorders of bone, of the spine and of the soft tissues, with an approach to low backache.
– Disorders of the central and peripheral nervous systems, opening with an approach to the neurologic patient and covering vascular, degenerative, infectious, movement, demyelinating and neuromuscular disorders, and tumours of the brain and spinal cord.
– Disorders of the haematopoietic system, opening with an approach to anaemia, bleeding and platelet disorders, and covering the classes of anaemia, marrow failure, haemolysis, malignancies of blood and lymph, clotting and platelet disorders, and the enlarged spleen.
– Psychiatric disorders, opening with an approach to mental disorder, and covering mood, anxiety and psychotic disorders, organic brain syndromes, personality disorders, substance abuse, and conversion and somatoform disorders.
– Dermatological and sexually transmitted disorders, opening with an approach to the patient with a skin disorder, and covering infections and infestations of the skin, inflammatory and papulosquamous disorders, disorders of pigment, hair and nails, blistering disorders, and sexually transmitted infections.

**Populations.** Three chapters organise medicine around people rather than systems. The paediatric chapter begins with basic paediatric parameters, normal growth and development and the approach to the sick child, covers the diseases of the newborn, immunisation, the common illnesses of childhood, developmental and behavioural conditions, and ends with adolescent care and communicating with adolescents. The chapter on nutritional and metabolic disorders covers undernutrition, overnutrition and malnutrition, deficiencies of vitamins, iodine and micronutrients, and several metabolic disorders. The geriatric chapter covers disability in the elderly, common geriatric problems and multimorbidity, gait disorders, and elder abuse.

**The edges of care.** Three chapters address settings that ask the most of a physician’s judgement. Disorders associated with environmental exposure covers altitude, cold, heat and environmental poisoning. Palliative and end-of-life care covers its principles and indications, symptom management, psychosocial and spiritual support, communication with patients and families, multidisciplinary care, ethical and legal issues, and quality of life; the syllabus also names homoeopathic care in palliative settings as a topic. Critical care medicine covers the recognition of critical emergencies, collaboration in a multidisciplinary critical-care team, life-saving procedures, the interpretation of data and decision-making, stabilisation and infection-control protocols, and ethical issues in critical-care decisions.

Two words recur in those last chapters: multidisciplinary and collaboration. The curriculum places the homoeopathic physician inside a team, with a clear sense of what each member contributes. That frame matters, and it is the one in which this platform writes.

**Newer fields.** The last chapter, Miscellaneous, looks outward: stem cell biology and the current status of therapy, tele-medicine and tele-homoeopathy, and integrative health care — its current status and possibilities.

**How it connects.** Almost every subject of the course feeds this one. First-year Anatomy and Physiology underlie every system; second-year Pathology, Microbiology and Community Medicine supply mechanism and context; third-year Pharmacology surveys the drugs used in the same systems. First-year Psychology meets the psychiatric chapter; Community Medicine’s chapters on child and geriatric health meet the paediatric and geriatric chapters. On the homoeopathic side, the fourth-year Repertory course applies clinical repertories to the conditions of Practice of Medicine, and the Materia Medica course integrates the subject into its reading of medicines.

**How this room is written.** Pieces here are study material for BHMS students. They describe disorders, clinical approaches and the syllabus’s reasoning. They do not advise anyone about their own health, they never pair a condition with a medicine, and they will not suggest that any condition be managed by homoeopathy in place of the care it needs. The curriculum’s own emphasis on approach, collaboration and multidisciplinary care is the frame.

As this room fills, a student will find pieces written to this syllabus: orientations to each chapter, study notes on the clinical approach that opens each system, review pieces that link each system back to its anatomy, physiology and pathology, and reflective pieces on the chapters on palliative care, critical care and integrative health care as the syllabus frames them. Everything here carries the fourth-year tag and the Practice of Medicine category, so it also stands on the Practice of Medicine topic in Homoeopathy Knowledge.