…to save the doctor’s time.”

So read a notice in a family doctor’s waiting room. The considerate patient knows that the art of medicine is for the doctor and not the patient, of course. The doctor must elicit symptoms and mentally arrange them in an order of decreasing importance to reach a disease diagnosis. All very time-consuming and exhausting.

Nowadays, medicine generally has become computerised. One would hope that the doctor would have more time available for the patient. However, it seems that computerisation has added yet another level of complexity.

The dialogue between doctor and patient has changed over the last few centuries and is worth investigating. In the Middle Ages, most people died young, fighting in many battles, but survivors died of pestilence, plague and the pox, with little time to consult doctors, who were a rare breed with no curative treatments. Most people did not survive long enough to develop the diseases we see today. Surgery in Britain was performed by master barber-surgeons who were not, in fact, doctors.

However, in the 1600s they were replaced by doctors trained in medicine who learnt the art of surgery. They still prefix their surname with ‘Mr’ representing ‘Master Barber Surgeon’.

The medical textbooks of my uncle, who qualified as a doctor in the late 1800s and practised for a while in Malta, revealed the wonderful, pragmatic and short names of various symptoms described by the patient.

The patient might say “I have the ague” (malaria), “dropsy” (swollen ankles from heart failure), “acidosis” (self-diagnosed indefinite stomach pain), “grippe” (influenza), “gripe”, “colic”, “scrofula” (enlarged neck lymph nodes), “quinsy” (tonsillitis), or “apoplexy” (a fit followed by a stroke).

Patients are using the internet to find the truth so the doctor can no longer hide his ignorance

Consequently, consultations were very short. Symptomatic treatment, rather than disease treatment, was the norm as often no definable disease could be identified. Later, medical knowledge surged forward with the recognition of many new diseases, but curative treatment (still mainly herbal) lagged behind.

In the 1970s I practised as a medical doctor with a ‘witch doctor’ in a Canadian indigenous reservation. The patient described his symptoms with a similar brevity of words. Remarkably, the witch doctor’s incantation and shamanism effected dramatic cures – probably a form of hypnotherapy and mind over matter!

It was not until the 1950s that treatments finally caught up with the diseases, but by that time even more new diseases had appeared especially with the advent of routine laboratory tests, X-rays and scanning. The patients, who previously accepted their doctor’s paternalistic approach, now demanded answers.

Sometimes these doctors hid their ignorance by using obfuscating terms such as “idiopathic” – meaning “I don’t know the cause of your troubles”.

Another trick was to give the idiopathic condition a Greek/Latin name, such as “dementia praecox” (present day schizophrenia) which seemingly explained everything, but of course it did not.

In desperation, the final ruse was for the doctor to give his own name to the condition. As a medical student I marvelled at some wonderful eponyms and tried to guess what condition they portrayed. Was Kawasaki Disease an affliction of motorcyclists, and was Goodpasture’s Disease from eating too many greens?

Often the more ambitious doctor linked his name with those of others, such as Cronkite Canada or Charcot Marie Tooth to give further gravitas. Then there was Madura Foot, which I thought was the foot soldier regiment of the Indian army, but it was just an infection of the foot.

All these ruses comforted the patient enough that he stopped questioning the doctor. Also, the patient was pleased that he had a condition with an esoteric name to impress his friends who, not wishing to reveal their ignorance, never asked for further details.

Nowadays the eponyms have mostly been replaced by pathological nomenclature of disease and furthermore the patients are using the internet to find the truth so the doctor can no longer hide his ignorance.

Recently a few treatments have appeared where there is no definable disease. Victor Borge, the comedian, quipped, “My father, a doctor, invented a cure for which there was no disease. Unfortunately, my mother caught it and died of it.”

Dr Corney is a medical practitioner and researcher.

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