A Case? A Person? A Partner? The Patient in the History of Medicine

Our President, Dr Patricia Wilkie, recently completed a paper for the Society of Apothecaries, which explores the history of the patient – from a case, to a person, to a partner.

Beginning the paper with a number of startling anecdotes, Wilkie brings to life how, for the vast majority of civilisation, the patient has been merely regarded as a case: “…patients are seen not as a whole person but a bit, a specimen…”

Looking at patient experiences from various perspectives, Wilkie goes on to describe the inquiry around the Royal Liverpool Children’s Hospital Alderhey report, involving unauthorised removal, retention and disposal of human tissue between 1988-1995.

“Parents talked about their distress at having buried a shell, an incomplete body. They insisted that their permission had not been sought to remove the organs nor had anyone explained why it was necessary,” explains Wilkie.

When exploring the patient as a ‘person’, Wilkie begins by quoting Sir William Osler, 1849-1919: “The good physician treats the disease, but the great physician treats the patient”.

This was relatively forward thinking for the time, as it was not until after World War II that we saw health emerge as an important personal and public priority, resulting in a need to communicate about the topic. As Wilkie suggests, many organisations started to identify and advocate on behalf of health issues that were not widely recognised at the time, such as Child Poverty Action Group, National Association for the Welfare of Children in Hospital and Help the Aged.

Wilkie explains: “By the mid-20th C there was evidence of a very gradual shift in attitudes in society to professions and services. The consumer movement had started, and many voluntary health organisations were beginning to focus on the patient as a person.”

Concluding the paper by delving into the patient as a ‘partner’, Wilkie recognises three GPs who, unbeknown to each other, established patient participation groups in their practices. Following this, in 1978, the National Association for Patient Participation (N.A.P.P.) was established by Dr Tim Paine. More than forty years on, our voluntary led organisation remains the go-to voice of patients in primary care. Upholding the vision of N.A.P.P.’s founders, we continue to promote shared decision making in consultation, as well as in discussions about the planning of health care at regional and national levels.

You are welcome to watch the full presentation of the paper here.