The Spectator

The cult of the prima doctor

It’s not just today’s surgeons who can be arrogant, high-handed and disdainful of any other doctor (let alone patient)

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Ian Paterson, a ‘charming’ breast surgeon with a ‘God complex’, has been found guilty of intentionally wounding patients by carrying out ‘extensive, life-changing operations for no medically justifiable reason’, probably to enrich himself. It raises a long-standing question.

The brilliant Greek doctor Galen (129-216 ad) was the most famous doctor in the Roman Empire. In all, he may have written c. 500 medical treatises, of which more than 120 (c. three million words) survive. His influence on medical practice was to last into the 17th century. He wrote on ‘medical theory and practice, ranging from anatomy, physiology, pathology, diagnosis and prognosis, dietetics, therapeutics, pharmacology and surgery, gynaecology, embryology and the theory of reproduction to psychology and ethics, terminology, philosophy of nature and theory of causation’.

And he was a pain in the backside, staggeringly arrogant and high-handed, disdainful of any doctor (let alone patient) who did not believe every word he said.

In a treatise ‘On recognising the best doctors’, which survives only in Arabic translation, he wrote: ‘If a rich man falls ill, unscrupulous physicians, aware of their client’s desire for pleasure, do not provide treatment most conducive to good heath… they would be unable to, even if they wanted to. The reason is that they have never had any intention of applying the art of medicine properly. Their only aim is get money, power and position.’

Every incident of bad practice is contrasted with his own approach, which is always so successful that he is called a ‘miracle worker’. It is never in doubt who the best doctor is.

There lies the problem. If ever there was a doctor with a ‘God complex’, it was Galen. He was also very rich. At the same time, there is no questioning his extraordinary abilities. But there is a vital difference between him and Paterson: he showed off his work and argued his practices in public, before other professionals. Perhaps that is part of the solution to all those prima doctors.