User:Shiver&timbers85/sandbox/The expanding role of physicians in Ancient Medicine

The patient-physician relationship is exceedingly important for the healing of a patient. The American Medical Association states that, “the patient-physician relationship is of greatest benefit to patients when they bring medical problems to the attention of their physicians in a timely fashion, provide information about their medical condition to the best of their ability, and work with their physicians in a mutually respectful alliance”. Healing is described as “not only on the actual efficacy of drugs or other treatments, but also on the shared belief between sufferer and therapist that what is offered and accepted is likely to be of benefit”. The role of the physician has evolved in the way physicians interact, treat, and inform patients.

View of Disease
Ancient Greek physicians regarded disease being of supernatural origin, brought about from the dissatisfaction of the gods or from demonic possession. The fault of the ailment was placed on the patient and the role of the physician was to conciliate with the gods or exorcise the demon with prayers, spells, and sacrifices. The Hippocratic Corpus opposes these beliefs, offering biologically based approaches to disease instead of magical intervention. The Corpus contains the treatise the Sacred Disease, which argues that if all diseases were derived from supernatural sources, biological medicines would not work (240). The establishment of the humoral theory of medicine focused on the balance between blood, yellow and black bile, and phlegm in the human body. Being too hot, cold, dry or wet disturbed the balance between the humors, resulting in disease and illness. Gods and demons were not believed to punish the patient, but attributed to bad air (miasma). Physicians who practiced humoral medicine focused on reestablishing balance between the humors. The shift from supernatural disease to biological disease did not completely abolish Greek religion, but offered a new method of how physicians interacted with patients.

Humorism
Ancient Greek physicians who followed humorism emphasized the importance of environment. Physicians believed patients would be subjected to various diseases based on the environment they resided. The local water supply and the direction the wind blew influenced the health of the local populace. Patients played an important role in their treatment. Stated in the treatise Aphorisms, “[i]t is not enough for the physician to do what is necessary, but the patient and the attendant must do their part as well”. Patient compliance was rooted in their respect for the physician. According to the treatise Prognostic, a physician was able to increase their reputation and respect through “prognosis”, knowing the outcome of the disease. Physicians had an active role in live of patients, taking into consideration their residence. Distinguishing between fatal diseases and recoverable disease was important for patient trust and respect, positively influencing patient compliance.

Patient Consent
With the growth of patient compliance, consent became an important factor between the doctor and patient relationship. Plato found the distinction between a “real” doctor and doctors who are only assistants, but still had the title “doctor”, is that “real” doctors inform the patient of all the facts concerning their ailment. With the information, the patient makes the decision to accept treatment. Physician and patient responsibility is mentioned in the treatise Epidemics, where it states, “there are three factors in the practice of medicine: the disease, the patient and the physician. The physician is the servant of science, and the patient must do what he can to fight the disease with the assistance of the physician”.

Ancient Roman Medicine:
Out of the Greek medical tradition, Roman physicians relied on naturalistic observations rather than spiritual, but divine punishment was also practiced. Drastic famines and plagues were often attributed to divine punishment and appeasement to the deities through rituals was believed to alleviate such events. Miasma was perceived to be the root cause of many diseases, whether caused by famine, wars, or plague. The concept of contagion was formulated, resulting in practices of quarantine and improved sanitation.

Diet
Diet was seen as being essential to healthy living. Food was perceived to have a healing effect or a causative affect on disease determined by its impact on the humors. The power of food and diet gave a person control of how they lived their life. Food and diet also put emphasis on prevention of disease rather than treatment. Moderation of foods was key to healthy living and gave rise to healthy eating philosophies. When diet no longer promoted health, drugs, phlebotomy, cautery, or surgery was sought out. People having control of their lives, managing their own preventative medical diets, and the freedom to seek physicians indicates patient autonomy was valued.

Galen's Influence
The survival and amendment of Hippocratic medicine is attributed to Galen of Pergamum. Galen writes that a physician “must be skilled at reasoning about the problems presented to him, must understand the nature and function of the body within the physician world and must ‘practice temperance and despise all money’”. The ideal physician treats both the poor and elite fairly and is a student of all that affects health. Galen often references Hippocrates throughout his writings, attributing Hippocratic literature as the basis for physician conduct and treatments. The writings of Galen survived more than other medical writings in antiquity. The survival of Galen’s works is dependent on translations into other languages like Arabic. Galen’s writings being translated into other languages for physician use imply utilization of his practices and philosophies.

Hospitals
The Roman medical system saw to the establishment of the first hospitals. Despite modern interpretations of hospitals, Roman hospitals were reserved for slaves and soldiers. Physicians were assigned to follow armies or ships, tending to the injured. Medical care for the poor was almost non-existent, resulting in the poor to resort to spiritual aid. Statues and healing shrines were sights of prayer and sacrifice for both the poor and the elite, and were common throughout the Roman Empire. Reverence for shrines and statues ranged from people seeking healing, guidance, and alternatives to ineffectual human physicians and drugs (Nutton, pp 47-52).