Ancient Egyptian Patients and their doctors 5000-2000 Years Ago

Ancient Egypt grew and prospered for centuries without a written language. It produced highly skilled craftsmen who could work with metal and stone and other materials. It bred sophisticated architects to design and build the pyramids and other funerary structures. The practice of preparing bodies for mummification was very intricate and required highly specialized knowledge. All functioned in an oral tradition. This long history predates the written word and is a critical source of the material which eventually appeared as hieroglyphic texts.

Some texts speak of secret information with ancient religious sources including humans who were deified. “Most famous was Imhotep, chief vizier to Pharaoh Zozer (2980 -2900 BC) renowned as a physician astrologer, priest sage and pyramid designer.” (Porter page 23). Some texts were accessible only to doctors who had trained in the temple medical schools. The idea that doctors have secret knowledge that can be applied to treatment, but kept from patients probably began well before this period. Secrecy has been an ongoing aspect of the doctor patient relationship as everything from secret diagnostic procedures to secret formulae for medications. It seems that some elements of the relationship between doctors and patients were forged several thousand years ago.

The decoding of papyri displayed the richness of Egyptian medical knowledge with a wide range of treatments, using herbal, as well as mineral remedies and employing a growing set of medical tools. Advanced medicine was for royalty and the wealthy as it continued to be for much of history. A papyrus depicts the richness and range of goods given to an Egyptian doctor who has treated a foreign king.

Egyptian Doctor receiving fees

If in Mesopotamia there were gods for each of the organs, in Egypt the doctors themselves began to specialize in particular parts of the body. Herodotus in reviewing Egyptian medicine makes special note of this when he points out that “the whole country is full of physicians of the eyes: others of the head; others of the teeth; others of the belly and others of obscure diseases.”  Herodotus on Egyptian Medicine.

Among the physicians in ancient Egypt were a fair number of women – there was a medical school for women that focused on birth practices and in women’s health. Unlike the Greeks who later conquered them, the Egyptians apparently did not believe that women were genetically weaker and less intelligent than men.

5000-4000 Years Ago Mesopotamian Patients

Written texts dramatically improved the recording, preservation and transmission, of information. Mesopotamia and the surrounding area was the cradle of written language  This was the first major western technological revolution. The introduction of the printing press was the second and some have argued that the World Wide Web is the third. Each marked great changes and made an enormous difference to the advancement and accumulation of knowledge.

In ancient Mesopotamia the writing has been preserved on clay tablets and though some of it remains to be translated, there is quite a lot that tells us about the healthcare system of the time. According to Roy Porter three types of healers are mentioned in the tablets which are the earliest written records of medical care:

“Under a head physician, three types of healers practiced: a seer called (bârû) who was expert in divination [by inspecting the livers of sacrificed animals]; a priest (âshipu), who carried out exorcisms and incantations [to allay the anger of the gods of each organ], and a physician (âsû) who employed drugs and performed surgery and bandaging.”  (page 23)

But of course like most medical histories, Porter’s ignores the role of female healers called asâtus, who primarily cared for women but are rarely mentioned in the clay tablets. Most of the active treatments included herbal remedies that were passed down through an oral tradition and there were apparently a large number of female healers who were not part of the formal system but were major recipients of that oral learning.

Other Mesopotamian tablets that mention health care are records of fee structures and begin to distinguish the different kinds of healthcare practitioners as well as different groups of patients. Below are some of the rules and regulations for health practitioners taken from Hamurabi’s Code which can help us distinguish the levels of patients in Mesopotamia.

If a doctor has treated a freeman with a metal knife for a severe wound, and has cured the freeman, or has opened a freeman’s tumor with a metal knife, and cured a freeman’s eye, then he shall receive ten shekels of silver.

If the son of a plebeian, he shall receive five shekels of silver.

If a man’s slave, the owner of the slave shall give two shekels of silver to the doctor.

If a doctor has treated a man with a metal knife for a severe wound, and has caused the man to die, or has opened a man’s tumor with a metal knife and destroyed the man’s eye, his hands shall be cut off.

If a doctor has treated the slave of a plebeian with a metal knife for a severe wound and caused him to die, he shall render slave for slave.

If he has opened his tumor with a metal knife and destroyed his eye, he shall pay half his price in silver.

If a doctor has healed a freeman’s broken bone or has restored diseased flesh, the patient shall give the doctor five shekels of silver.

If he be the son of a plebeian, he shall give three shekels of silver.

If a man’s a slave, the owner of the slave shall give two shekels of silver to the doctor.

If a man has destroyed the eye of a patrician, his own eye shall be destroyed.

If a man has knocked out the teeth of a man of the same rank, his own teeth shall be knocked out.

If he has knocked out the teeth of a plebeian, he shall pay one-third of a mina of silver.

The accompanying text gives some idea of the value of these fees: the cost of renting a middle class dwelling at the time was about five shekels of silver yearly and the daily pay for an ordinary craftsman was about one-fiftieth of a silver shekel. Medical fees for the best doctors were high and seem to have remained high since antiquity.

We can use the information from the tablets to distinguish the different classes of patients in Mesopotamia: there are, in descending order, patricians, freemen, plebeians, and slaves. The fees set for each is scaled as is the punishment for failure. It is not clear what differences in care are provided to each of these groups, but more than likely there was a difference either in the number of physicians involved, the services provided, or the delay in treatment.

The only healers whose work is directly regulated in the code are the âsû because they are the only ones who actually provide hands on care. The âshipu and the bârû never operate on the patient: they only serve as intermediaries between patients and the relevant deities. This may be an indication of the class level of the healers. Because the âsû are the only healers whose work is directly mentioned in the code, they are the most vulnerable to punishment. The ashipu or priests doctors and the bârû presumably share the fee but not the responsibility.

The particular gods related to each organ brings to mind the current extent of specialization. Specialist doctors are increasingly associated with particular body parts – from retinas to knees and the first among them are revered much like the ancient gods of particular organs. Patients have been often warned not to anger the gods of the organs from Mesopotamian times on. Many patients continue to have such fears today.

10000 Year Ago Patients and Agriculture

It has been argued, most notably by Nathan Cohen, in Health and the Rise of Civilization, that the development of civilization is a function of the increased density of human population. As the number of people increased and open land became scarcer. It was less possible to live merely by foraging. It became necessary to develop a source of food that could sustain a larger number of people. Humans adapted by learning how to domesticate animals and to raise crops. Labour-intensive practices like herding, clearing forests, getting the earth ready for planting, harvesting and preparing food for storage, all required workers and organization.

In larger groups, it was more difficult to make decisions by consensus. Specialist roles emerged for leaders and for experts in hunting game, healing the sick, or deciding when and where to plant next. Manual farm workers were also needed. Towns grew up to support agriculture: local merchants and manufacturers helped the farmers by supplying them with equipment and services they needed to produce crops and helped them distribute their excess products more widely.

Agriculture came with more diseases. Animal germs evolved into germs that affected humans. We began to share diseases with animals: measles from dogs, influenzas from pigs and ducks, colds from horses, and small pox and other viruses from cattle. Today we remain susceptible to diseases from domestic animals. The SARs virus was found to come from bats which infected domestic cats and animals that were being sold in markets in the Quandong province in China.

Permanent settlement and reliance on agriculture had other effects. Human diet became less varied and had an

excessive reliance on starchy monoclutures such as maize, low in proteins, vitamins and minerals. Stunted people are more prone to illness, and poor nutritional levels in turn lead to pellagra, kwashkiorkor, scurvy and other deficiency diseases. (Porter page 5)

The result was that in the change from nomadic foraging to a more sedentary agricultural stage, humans actually became shorter and smaller. More critically the social relations between people began to change. Land owners acquired farm labourers as workers or slaves. Among the earliest written documents in the proto-Elamite tablets from around 3100 B.C. describe the meager rations of gruel and weak beer given to farm workers to keep them just above the starvation level. And so civilization by itself, as Cohen notes, does not guarantee a better diet for all – in the same tablets there are descriptions of the wealth of food choices available to the well off – things like yogurt, cheese and honey. From these earliest times and in many societies there were important distinctions in class levels, types of work and lifestyles. These differences extended to healthcare. There were different classes of patients that more or less correspond to the various social classes. The care given to slaves was no doubt different from that provided for the upper classes. Most medical history is about middle and upper class healthcare, because medical historians typically attach doctors to the higher levels of society. Throughout history these classes shift and their boundaries change: inequalities in patients tend to parallel inequalities in other aspects of society.


Father of Sickness

It might be a good idea to look at a story about healing taken from an unfamiliar tradition. This is a Siberian legend in which a sickness spirit becomes aware of his power to make people ill and a young shaman is needed to intervene with the sickness spirit so that he will leave the patient.


One of our kinsmen, Nya Nganas, went walking one day in the snow-clad taiga to look for game.  All of a sudden, however, the day turned foggy and he could not find his way home.

Although he searched this way and that he could not find the homeward path and eventually came upon a stream which seemed to have come from nowhere.  When he tried to jump across he lost his footing and plunged into the water.  Down and down he sank, far into the depths, until at last he came out on the other side, underneath the water.

The land there stretched to the horizon without a trace of snow; just the tips of the grass were slightly whitened as if touched by hoar frost.

He set out to cross this strange new land, looking to all sides for some sign of life.  At last he spotted a young girl travelling along a track in front of him.  She was riding a strangely coloured reindeer.  As he ran after her, he called out:

“Hello there, from what tribe are you?”

But the girl did not seem to hear him, for she paid no heed.  As he caught up with her he touched her lightly on the shoulder.

“Who are you?” he asked.

At his touch the girl cried out in pain.

“Why does my shoulder hurt so, as if someone is stabbing me?” she cried.

“What a strange girl,” Nya Nganas said.  “She certainly looks like a girl from our parts, yet whatever I say she doesn’t hear me.”

So again he tapped her on the shoulder and once more she let out a cry of pain:

“Oh, oh! An evil spirit sickness has pierced my shoulder.”

“What a strange thing,” thought Nya Nganas.  “I’ll travel behind her and see where she’s bound.”

On and on they went, with the girl constantly crying and groaning.  Finally, a camp of some five or six chooms came into view: they were of the Tungus people.  Arriving at the tents, the girl entered one of them, crying loudly:

“A sickness spirit struck me along the way.”

Nya Nganas followed the girl into the choom and sat down behind the tent pole some way from her.

“Where did the spirit strike you?” the girl was asked.

But she cried out in great pain and was too poorly to explain.  So sorry for her did our man feel that he tried to wrap her in his parka despite her shrieks of pain.

All the while the fire in the hearth crackled and hissed as if hostile to the visitor.

The people in the choom said:

“Why is the fire behaving so? Why does it crackle and hiss?  Something evil has entered our choom: the spirit sickness has come.  What shall we do?  Our poor maid will not last long unless we do something.”

One of the girl’s brothers then spoke up:

“Let us send for the old shaman who lives in the next camp; he may be able to cure our sister.”

It being agreed, he went off to fetch the shaman, returning with him that evening.  The shaman was a wizened old man who at once began to weave his shaman spells and to talk with the spirits.  Finally, he said:

“Three days will pass and the girl will get better.”

Thereupon, the shaman returned to his own choom.  But the girl continued to moan as one gravely ill: day and night she lay in a fever and at the end of three days was even worse than before.

All the time, our man sat uncomprehending in the corner unseen by all.

At last, the girl’s father spoke up:

“Our daughter is doomed, the old shaman could do nothing for her.  Somewhere I’ve heard there is a young orphan who has become a shaman; he even has his drum and powerful charms.  Let us summon him.”

The old man’s eldest son again went forth and this time brought back the young shaman.  Sitting alongside the girl, the orphan-shaman first took a bite to eat, then laid out his shaman’s attire and drum upon the floor ready for his work.  Having eaten, he began to pull on the shaman’s bakari, the long fur boots.  As he tied the laces of his boots, he stole a glance towards Nya Nganas.  Having put on the remainder of his attire, he began to do up the thongs of his robe and again stole a glance in the direction of our man.

And our man thought to himself:

“This shaman knows that I am here.”

The shaman finished his dressing and now took up the drum; yet he still refrained from playing it.  Nya Nganas meanwhile tried to hide behind the girl, pressing his face close to the girl’s back so that the shaman could not see it.  First from one side, then from the other, however, the shaman peered behind the girl as he beat the drum.

Beating the drum now very hard and fast, he chanted loudly:

“A sickness spirit has come.  It came to you on the road and pierced your left shoulder.  Do I speak truly?”

“You do,” whispered the girl.

“You have the sickness of koga nguo, the evil one,” continued the shaman; and turning to our man, he said,”How is it, Nya Nganas, that you cling so tightly to the girl?  You will tear out her soul.  Tell us what it is you want; she shall have it, but let the girl go free.”

“Give me the strangely coloured reindeer on which the girl rode here,” our man said. “Give me that and I shall depart at once.”

The shaman now addressed the girl’s father:

“The sickness spirit asks for the reindeer the girl rode.  Do you give your consent?”

“Yes, certainly, certainly,” said the old man quickly.

“Good, it is settled,” said the young shaman.”Now, brothers and sisters of the Tungus tribe, you must make a reindeer out of wood.”

So they set to making a reindeer out of wood; legs and horns and tail.  And with the charred wood from the fire they drew patterns on its body.  When the job was done, the shaman took up his drum and beat it loudly jumping up and down as if running fast.  Our man, Nya Nganas, quite lost his senses from the drumming and dancing; he thought to himself:

“They’ve prepared the reindeer for me, I must mount it and get away from here.”

And he climbed on the wooden reindeer’s back and galloped away like the wind across the plain.

All the while the shaman played his drum and danced round and round in circles until he dropped down exhausted.  At the same time, far, far away on the bank of a stream, our man came to a sudden halt on his reindeer.  When he looked about him, he found to his surprise that he was sitting on a wooden reindeer on the bank of the self-same stream upon which he had stumbled in the fog.

“What sort of shaman did this to me?” he wondered. “The old shaman was not powerful at all; he did not even see me.  But that young orphan-shaman was very strong; he made me lose my senses.”

Slipping down from the reindeer, he left it on the riverbank and walked home, soon coming to his choom.  Once there he told his kinsfolk of his adventures in that other world.

“So I learned that some of us really are sickness spirits,” he said in conclusion.  “One of you, my brothers, is a piercing sickness; another is a fever sickness, and another the terrible smallpox spirit.  One of us, it may be, will one day find himself in that other world, and then the same orphan-shaman will not let him go.  He is a very clever shaman.”

With these words, everyone present turned into sickness spirits.  No longer were they people, they had each and every one become a sickness.

Henceforth, when someone is ill, folk say it is one of our kind who has come.  And if the shaman cannot help, it is because he is like the weak old shaman.  But should our sickness spirit find itself in a choom visited by the young orphan-shaman then he will see it and the spirit won’t be able to steal a single soul.

This narrative like many others including those of the Judeo-Christian bible, Greek mythology and many eastern traditions emerge from oral traditions in which stories are told and retold over long periods of time before they finally are transcribed into written form.

A young girl is riding a beautiful multi-colored reindeer. She begins to feel terrible pain when touched by Nya Nganas who does not yet know that he is a sickness spirit. We can see that several aspects of the patient/caregiver/doctor relationship have already been established in this culture. The patient is too ill to do anything but express pain. She never sees the source of the pain but only feels the result of his touching her. Her father as a family caregiver recognizes that this illness is beyond his capacity to alleviate. And so he calls for the most experienced shaman – one from the next door community. This shaman, like the patient and her family caregivers, cannot see the sickness spirit in the room. He examines her and declares that the girl will be better in three days. It seems that a wait-and-see diagnosis was a widespread medical precept even then.

But in this case the girl does not get better because Nya Nganas does not leave the room. And so her father sends his son to get a second opinion from a younger shaman. New to the field, he is the only one who has the special ability to actually see and speak to the sickness spirit. He negotiates an agreement – an exchange of the multi-coloured reindeer for the departure of the spirit (and hence the illness.) The family does not give up the actual multi-coloured reindeer, but builds a replica of it: something like a rocking horse as an ikon of the reindeer. The spirit accepts this and leaves, riding on the wooden reindeer. The girl is cured.  When he gets home, the spirit informs the others in his village that he and they are all sickness spirits.

This tribe in Siberia had already identified the roles of shamans and patients. Their overall belief appears to be that sickness spirits, even though they might not be aware of their powers are the source of all diseases. According to the story, the objective of sickness spirits is to steal souls – by making people ill and taking their lives. Each spirit is responsible for a particular disease. That the tribe is a fairly large herding society is suggested by the presence of a spirit of small pox in their midst. The story, full of people not knowing who they are, what affects them and what can be done about, is yet another explanation of how sickness comes to the world and especially of how its cure needs the intermediary of especially sensitive healers.

Georges Cuvier and the Garden of Eden

Georges Cuvier (1769-1832) was the originator of Paleontology, the scientific study of prehistoric life, primarily through the examination of fossils. Cuvier’s great accomplishment was to begin to systematically classify fossils of prehistoric plants and animals. Lest we think that paleontology was created fully-formed, we must be reminded that Cuvier himself maintained throughout his life, a belief in the biblical account of the creation of the world and of human beings: the first humans were the Caucasian Adam and Eve. (From this originating premise he ended up developing an early scientific theory to support racism: the three races he proposed were white, yellow and black. He compared each to the originating humans and graded them accordingly: whites were the model race, yellows somewhat inferior, and blacks, the least developed.) Cuvier believed that prehistoric skulls that were of pre-humans were fakes.

Georges Cuvier

At the time of Cuvier ancient stories of world creation and the origin of humans were the main source of beliefs about the prehistoric world. The biblical creation story is not atypical. In it God creates an ordered world out of chaos. He makes Adam, the first man, and places him in the Garden of Eden. He then fashions Eve from his rib as Adam’s companion. Similar creation stories abound in other cultures, where either one or more gods create the known, ordered world and human beings from a disordered chaotic beginning.

In the bible, the Garden of Eden is presented in contrast to the more current situation in which people must work for their food and where illness is part of everyday life. It may be that the biblical story derives from a cultural memory of prehistoric times when foragers could find everything they needed to eat without having to labour at growing food or caring for domestic animals. The expulsion from the Garden of Eden can be seen as the transition from an idealized world of where humans live in absolute harmony with nature. Food was easily available and there was enough to feed the humans without any need to control or over-exploit natural resources. Humans were participants along with all other creatures (except possibly the serpent) in a well balanced natural environment. The transition was to a world of agricultural labour which made the most of the riches of the natural environment. The domestication of animals, the preparation of land for planting and reaping required vigilance planning and constant effort. Adam and Eve in the Garden represent the earlier world.  Their sons Cain, the crop farmer and Abel, the shepherd, are the first agricultural workers.

Garden of Eden - Hieronymus Bosch-www_anuttara_net_103

Hieronymus Bosch: The Garden of Eden

When Eve is tempted by the serpent to eat the forbidden apple and convinces Adam to do the same, they are expelled from paradise. But more than that: Adam will have to work to survive; Eve will feel the pain of childbirth. Because she is the first to feel pain, we can declare that she is the first patient. We are led to believe that Illness and mortality are the consequences of her actions. She has angered God and this is her punishment. Feminists have widely pointed out that this very early account places the burden of wrong doing on women. It may be that in earlier societies, women’s knowledge, for example of herbal cures had placed them in a more dominant position which was now being eroded.

There are similar stories in other traditions. In Greek mythology Pandora, who is, like Eve, the first woman, opens a forbidden box and releases spirits of death and illness into the world. Pandora is depicted more negatively than Eve. Her action results not only in pain, but in all manner of evils that now come to humans.


One of the mysteries about early humans is the relatively frequent occurrence of prehistoric skulls with bored holes in them. The practice of creating holes in skulls, called “trepanning” has been found in more pre-historic skulls than would be suggested by medical need. For some cases it may have been used to relieve painful pressure, but the frequency is too high to conclude that that was the only reason. In some skulls there are several such holes. In medical histories these skulls are often marked as early surgical intervention performed by early doctor/surgeons using specialized tools. Although many of the patients did not survive the procedure, the evidence suggests that some did. In cases where pressure on the brain was very intense there is little doubt that the holes relieved pain and may even have saved lives. But the large proportion of found skulls has remained a mystery. Possible explanations have included everything from the performance of mystical rites to the experiments of visitors from outer space. A more current possibility is that this might have been an early case of over treatment. The motivations to drill the hole were that the tools were available and the new treatment was an exciting innovation, and so it was used at every opportunity. Here are several pictures of these early patients’ skulls.

A skull with bored holes

A skull with bored holes


Prehistoric Patients

Who were the first patients? Who were the first healers? How did they live?

Anatomically, Homo sapiens first appeared more than 200,000 years ago, but it is believed that the first humans to exhibit human behaviour such as using symbols and planning actions appeared between 70,000 and 50,000 years ago. There is little solid evidence of exactly how they lived, but it is believed that they formed small hunter-gatherer groups that foraged for fruits, and other plants, and caught game. Much of the basis of our knowledge of them has come from archeological digs where bones, tools and other remains survived the ages. We also learn about prehistoric people by observing the behaviour of existing hunter-gatherers in remote locations. Our current belief is that these early groups were not very organized; that they were non-hierarchical and made decisions consensually.

It is generally agreed that these early humans did not suffer from the kinds of plagues and infectious diseases that killed large populations in later ages. According to Roy Porter, “primitive humans were nomads who lived in small and scattered groups. Infectious diseases (small pox, measles, flu, and the like) must have been virtually unknown, since the microorganisms responsible for them require high population densities to provide reservoirs of susceptibles.”

Sicknesses at that time most likely included malnutrition, stomach upset, broken bones, and bad backs. There is little doubt that women who were the gatherers were also largely responsible for dealing with illness. Sick people – patients – were cared for by those close to them. The relationship between patient and carer was more familial than formal. And women were more than likely the first healers: as they gathered food plants they discovered that some caused minor illnesses such as diarrhea. And so, for example, when someone suffered from constipation these very plants were employed to relieve it. Recent discoveries in paleoethnobotany of the remains of plants and seeds confirm that early humans used many plants with medicinal properties.

Herbal medical knowledge is the kind of thing that gets passed down from parent to child through the ages. If we jump to today, we find that according to the WHO, traditional and complementary medicine that can be traced back to prehistoric times continues to be the most prevalent form of health care for the majority of patients throughout the world. The WHO has begun to develop ways to include the various traditional medicines as part of overall healthcare strategy.

Histories of medicine usually begin after this early period and exclude mention of the earlier use of herbal medicines. Once groups of hunter-gatherers have grown to become tribes, more formal roles begin to be assumed, as leaders, healers and religious figures. Though little evidence remains of their particular roles, artifacts from that time suggest that such roles were assumed. The earliest cave drawings are over 37,000 years old. Some appear to represent healing rituals by figures wearing animal skins. The introduction of formal healers suggests that people began to believe that some kind of external agency was needed to cure at least those illnesses that somehow demanded special interventions beyond the use of familiar plants and herbs. Healers began to have authority and knowledge that was exclusive to them including magical powers, religious influence, as well as specially attained skills. The relationship between healer and patient became more formal quite early on. The religious healer is an intermediary between powerful forces that create illness and the patient who hopes to be relieved of it.

A Patient`s History of Medicine

In most histories of medicine doctors are the heroes. Patients are rarely mentioned by name unless they are famous in their own right, and even then they are almost always presented as grateful (and passive) recipients of medical and nursing care. Our perspective as patients is rarely described, unless it is about our gratitude for the heroic work of the doctor and how the doctor has overcome our fear of treatment and eradicated the terrible symptoms we exhibit. We are rarely seen as active partners in our care and certainly not as contributors to the advancement of medicine or the rest of healthcare. The same or similar treatment of patients appears in almost all histories of other health professions like nursing and pharmacy where there are often vigorous complaints about how their profession is ignored in medical histories. While it is worthwhile to celebrate extraordinary scientific discoveries and the healthcare professionals who achieve them, it may be useful to point out the critical role that we as patients and families have played in the development of modern healthcare. Ignoring our perspective is to lose the great richness of our contributions in the past, our growing participation in the present and the need for our partnership in the future.

No one has so far written a history of medicine from our point of view. Yet we as patients have always been the object of concern and care. What does the history look like from our perspective? Have we really been as passive as the term “patient” implies? How has the view of patients changed over time? Who is a patient? Has this supposed passivity helped us? Has it harmed us? Where and how have we been active participants? Where have we led advances in healthcare? Who have been some notable patients in the past? What have they accomplished? The blogs will explore these issues and more. We will try to shrink this large gap in the history of healthcare and medicine.

As sick people we have often had a role in our own care. Most of us manage our own minor ailments. We often get support from our families and at times we find help in unlikely places outside the formal healthcare system. It is not surprising that a record of these aspects of health care have been neglected in the face of the enormous success of professional medicine. The truth is that as well as family and friends, there has always been a multiplicity of health care providers, and that the virtual monopoly of professional medicine is a relatively recent phenomenon.  I will be writing a series of blogs with the view to preparing a book that takes a wider view and looks historically at the roles that we as patients have assumed and the kinds of care that we have chosen (or been subject to) from prehistoric times and what that care has contributed to healthcare today.

When we became so ill that self care was no longer an option, the choice between doctors and other practitioners was at one time a major decision for patients and their families,  but it has had little place in the history of medicine. For medical practitioners all non-doctors were always quacks. But as William Osler pointed out, the real trouble with quacks is that their cures work. Osler was arguing for the professionalization of modern medicine and the removal of even the temptation to go to non-professionals. Despite this we as patients have been drawn to a wide variety of treatment and much of it has worked. This book will consider the successes and failures of the choices we make for care and how that has affected the history of medicine. We will also think about the search for magical cures and silver bullets that has always been, and continues to be, part of the patient environment.

Finally many patients have been sacrificed on the altar of progress in medicine, some willingly, some unwittingly, and some despite their protests. This book will look at the history of patients as clinical material throughout history and the role we continue to play as subjects of study with and without our consent.

I am Back to Blogging

I am back to blogging. My last blog was about learning about a diagnosis of cancer and preparing for the Whipple Procedure – a major surgery that cuts out lots of your insides to make sure that you don’t die of pancreatic cancer. Well, I underwent the procedure and survived it. I no longer have cancer and I’m back to blogging at last.  Still need more time to recover.

In my absence, Patients Canada survived and flourished. I was very grateful for all the help and especially for the way in which some of my very own ideas were effectively used by my colleagues, Alies Maybee, Brian Clark, Emily Nicholas and others to move the organization forward.

This was especially notable in the application of Key Performance Targets to some of their projects. Let me remind you. The basic idea that I have been working on since 2005 is that the actual experiences of patients and family caregivers must be heard and understood in order to make healthcare more patient friendly. In order to do this we have assembled a small group of people, some of whom have worked together since well before Patients Canada was founded in 2011. We meet monthly and review patient experiences in order to identify potential changes.

These continued discussions have enabled us to dig ever more deeply into patient experience and to create lasting partnerships with patients and their families.

Some of the earliest examples were stories about hospital visits. Family members often felt excluded by hospital staff who wanted to only talk to the patients themselves (often to “preserve confidentiality of the doctor patient relationship.”) In one outstanding case mother with advanced dementia, who could no longer boil water safely or dress herself, insisted that all was well. She was interviewed by a young psychiatrist who did not let her daughter/caregiver into the room. The psychiatrist was surprised at how well the patient was, while the excluded daughter was in tears of enraged grief because her mother’s situation was not properly presented or assessed. Her own distress and her mother’s real condition were entirely ignored.

This exclusion of family members often occurs in more subtle ways. In emergency departments the triage position is often a tiny space with two chairs: one for the triage nurse and one for the patient. Even though family caregivers who accompany the patient may have very useful information about the patient’s condition and previous treatment, there may be no physical space for them – no room to listen to what they can contribute.

After several years of discussion, during which we noted the tendency to leave out anyone but the individual patient, we decided that a simple and easily measurable intervention might make the biggest difference. How many of you have had the experience of going to an emergency department with a family member and to find yourself in the triage area but with no place to sit?

Hence was born the idea of the “third chair in the triage position” for family caregivers. When we presented this as a key performance target to patients and families, they immediately recognized its relevance. Some laughed with pleasure and suggested that they would be happy to donate the chair to hospitals that would accept it. From this very clear example we developed more Key Performance Targets which I will describe in future blogs.

Cancer appears

Over the last month or so, I have been feeling a bit sick. My appetite went and I noticed changes in my urine and bowel movements. And so I went to my GP for some tests and discovered that my liver was not working properly. She sent me for an ultrasound where they found a stone in my bile duct that was causing my liver to malfunction. She scheduled an endoscopic procedure that would remove the stone. The hope was that that would be the end of it, but it was not. The endoscope showed that there was indeed a blockage but no stone was found and the biopsy of a scraping showed the presence of malignant cells. The upshot of all this is that I am being scheduled for a major surgery called the Whipple Procedure which will hopefully rid me of cancer and allow me to recover my health.

This was a totally unexpected turn of events, and it comes just when we are turning the corner at Patients Canada: we are in the midst of preparing for our first benefit concert; we are becoming more actively engaged in the Ontario Strategy for Patient-Oriented Research (SPOR) grant; and there are many requests for our help with a wide variety of projects in other organizations.  And of course, there is never a good time for major illness in one’s personal life.

Luckily we have a group of very dedicated volunteers at Patients Canada who have pitched in and taken over many of my obligations. We also have a strong Board that can continue to oversee our projects and other activities.  From a personal standpoint, many close friends and extended family are extremely supportive, and will be there for me and my family.

I am preparing myself for major surgery by trying to stay as fit as I can and making sure that I understand what this all entails. Oddly, I am not particularly frightened by the fact that I have cancer and I wonder if that is because I have immersed myself in the experience of so many patients over the last few years. I am sure that the reasons are far more complex and probably much more personal, but the fact is that I seem to feel relatively well-prepared for what will no doubt be a major ordeal full of surprising twists and unpleasant events.

I just want all of my friends and those involved with or interested in Patients Canada to know that I will be away for a while, but that the work will continue in my absence. My wife and I feel the love and support from all of you.