Thomas as more research was being carried out

Thomas Sydenham (1624-89)
stated “As for anatomy, my butcher can dissect a joint full and well; no young
man … you must go to the bedside, it is there alone that you can learn disease” (Dobson, 2013, p.63) This means that the relationship
between the doctor and the patient is extremely important because if the
patient’s opinion isn’t taken into consideration then that will have a negative
impact on the medical treatment of the patient. Therefore, the ‘Patient knows
best’ approach is when the doctors treat a patient based on what the patient
knows about their symptoms. They treated the symptoms instead of the cause.

This evolved into the 18th
and 19th centuries as more research was being carried out and
doctors had more knowledge but still nowhere near as today, this was the time
where doctors and patients had very little knowledge on disease and illness.
For example, they believed that illness was caused by bad smells, also known as
‘Miasma’. (Fielding et al 2017, p.1) During this time the ‘Patient Knows Best’
approach was used in the medical treatments of patients because the patient
came in with symptoms and the doctors would treat them based on their symptoms being
given, without needing evidence. This resulted in miss-diagnosis and medical
errors.

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To summarise, the ‘Patient
knows best’ approach effected medical treatment because the majority of
patients were upper class and had more authority because they were wealthy, the
doctors acted in a way that was aimed at pleasing the patient rather than
actually helping them. The doctors felt like they did not need to physically
examine the patient but to just listen to what they had to say instead, they
treated the symptoms of the patient rather than the cause. Most of the doctors
felt like they had to compete with each other to please the patient because of
their patient’s social status. The patients were paying to see a doctor,
therefore they had no respect for the professionals. Also, there were no
legislations in these times for people to purchase medication freely so people
tended feel responsible and in control of their own health. (R. Kaba, P.
Sooriakumaran (2007) ‘The Evolution of the Doctor-Patient Relationship’ Doctor-patient relationship from 1700 to
present day p.59)

In these times, the four
humours were the basis of treating illness and these were known to the patient
and the doctors. If a patient was showing any of the following humours then
they knew that they needed to be treated. The four humours consisted of black
bile, yellow bile, phlegm and blood. However, being able to see doctors was a
luxury for the privileged and wealthy, so the poor and middle-class people of
the community had to resort to quakes, barber surgeons and home remedies
because they couldn’t afford to see a qualified doctor. To save money, they had
to self-diagnose or rely on people that were not as sanitary or had little
knowledge on the subject which was why the death rate in the 18th
and 19th centuries were so high and people were dying a lot younger
than they are today because of the lack of knowledge and the way in which the
doctors and the patients had the same amount of knowledge.

Dissection has changed the way
in which modern medicine is led over time. For example in the 15th-17th
century’s cadaveric dissection was the most popular method. The advantages of
this method includes that it was able to teach medical students about the human
anatomy through practical demonstration. However, these demonstrations were
starting to become public, therefore breeching any ethical barriers such as
patient confidentiality. In 1543, Andreas Vesalius (with the help Gemma
Phrysius) dissected stolen bodies from graveyards and snatched the bodies of
criminals that had been hung. He proceeded to conduct a public dissection,
where he donated the skeleton to Basel University so that medical students
could learn about the human anatomy. The advantages include that he provided information
and resources for medical students and that he was able to identify where main
organs such as the heart, lungs and liver were. On the other hand, the
disadvantages include that the way in which he was doing this was unethical and
he had no respect for the bodies that he was taking. In those times, there were
no laws or legislations in place for the respect of bodies and patient
confidentiality so people did not have the same reaction as people would today.
From Vesalius, anatomy theatres were becoming more popular and more people were
carrying out public dissections. (Dobson, 2013, p.31)

Another case includes the William
Burke and Hare murders in Edinburgh which happened in 1827-1828. (Johnson, B,
2017 p.1)These two men would steal bodies from graves and sell them to medical
schools so that they could use them to dissect and learn. The more recent the
body was buried, the more money it was worth. When there were a shortage of
bodies, they would then resort to murder. They murdered at least sixteen
people. These murders then led to the Anatomy Act 1832. Due to this Act,
anatomy lecturers, medical students and doctors were allowed greater access to
bodies and it also allowed bodies to be legally donated to medical science. This
protected graves from body snatchers because that was now illegal. (Brine, R.
2009. p.1)

During this time, surgeons and
hospital based professionals did not require many qualifications or training,
as dissection was being further discovered and more research into the human
anatomy was being carried out, this was about to change. In 1822, summer
courses were no longer accepted as a qualification to be able to be accepted
into the Royal College of Surgeons. (McLachlan, J. and Patten, D. 2006. p.243) Dissection
did not need to be in a clean environment and the surgeons often did not wear
gloves or any protective clothing/equipment because in those times, they had
little knowledge on the subject.