We seem to have a mixed view of doctors – many can point to positive encounters with a physician, but also tell stories of bad experiences. There are those who will complain about their abilities or bedside manner. Doctors were around in the Middle Ages too, and according to one twelfth-century writer, many of them were failing their patients.
This writer also happened to be a doctor himself, and considered one of the best of his profession during his time. Ibn Jumay (d.1198) was a Jewish physician living in Egypt, and served as the court physician to the famous Middle Eastern ruler Saladin. He also wrote several works about medicine, most notably his Treatise to Saladin on the Revival of the Art of Medicine.
This text began as a conversation between Ibn Jumay and the Sultan, in which the doctor talked about “why the art of medicine is effaced and obliterated and why its merits are erased and destroyed”, and ways it could be reformed. Ibn Jumay explained that in ancient times the medical practice had its high and low points, with famous healers like Hippocrates and Galen reviving the profession. The situation had deteriorated in more recent years, and Ibn Jumay offered these reasons why:
1. Doctors don’t read enough
His first complaint was that physicians were relying on only twenty well known books, and often just summaries of them. By not trying to learn more these doctors were failing to understand things such as “the anatomy of the brain, the liver, the stomach, the compound parts of general; the functions of all the parts of the body; the properties of foodstuffs and of simple and compound drugs.”
2. Doctors use “deception and falsehood”
Ibn Jumay complains that doctors replaced knowledge with what we might term underhanded marketing. He writes that:
Some deceive the masses by means of a pompous attitude in clothing, appearance, use of perfume, and the like. Others deceive the people by endearing themselves to them, by currying favor with them, by winning over their wives through things suitable and saleable with them such as aphrodisiacs, drugs for or against conception, gaining weight, and hair growth, and by arranging with the lady-companions, the hair-dressers, the nurses, and others that they should praise and extol their medical and human qualities.
3. Patients don’t know how to pick a good doctor
Ibn Jumay does not just complain about physicians, but also finds fault in the general public. He believes that people, especially the rich, don’t look hard enough to find a good doctor, but follow the advice of their friends. Being able to tell a good joke is more valued than actual medical knowledge, and that they often just want their doctor to be waiting by their door in case they are needed. He concludes:
It is obvious that a practitioner of medicine does not deserve to be associated with medical excellence or to be preferred to any other physician on grounds of his his standing at their doors or on the basis of long acquaintance. What he deserves for standing at their doors is, rather, to be made of the gatekeepers, for he does not do anything physicians should do; and what he deserves for his long acquaintance with them is to be praised and treated nicely.
4. Bad doctors don’t take risks
Ibn Jamay also complains about the:
insecure and cowardly physicians who lack the courage to use strong treatment that would procure considerable benefits, restricting themselves to the use of rose-water potion, rose-wine, draughts of hot water, or the abandonment of drugs and the restriction of diet, in short, restricting themselves to the so-called “gentle treatment”, trusting that the physical strength of the patient might rise and act upon the disease. These physicians they consider reasonable, striving for health, and avoiding risk for the sick one; and they believe that this treatment, even if it may not be beneficial, is at least not harmful.
He adds that the so-called ‘gentle treatment’ is a bad idea because it rarely deals with the real problems of a patient, and can even make the situation worse.
While these are the complaints that Ibn Jumay has of his own profession, his work also offers solutions, which include selecting better teachers and students, and more testing of doctors. You can read the English translation of this work in Treatise to Salah ad-Din on the Revival of the Art of Medicine, edited by Hartmut Fahndrich, which was published in 1983.