The British Medical Association thinks it is bad for doctors to work weekends. Why do we still treat the medical profession as special?

In this age of public cynicism, few professions remain in high public esteem. No one ever liked journalists, politicians or estate agents. But in recent years, bankers and lawyers have become much less-trusted: for good reason you might say. The teaching unions continue with their long campaign to undermine the regard which much of the public still have for their members. But doctors have bucked this trend. Even recent scandals in the National Health Service (conveniently blamed on managers) haven’t really dented the way the public see physicians, or how physicians see themselves.

That isn’t too surprising. Doctors can do amazing things to heal us. They save lives habitually. In some circles, it is sacrilege even to criticise them. But, remarkably, doctors enjoyed a healthy professional reputation even back in the days when they couldn’t really help us at all. The miracle of modern medicine is much more recent than we realise. It was only from the mid-nineteenth century that doctors were more likely to cure than kill. Our expectation that we won’t die of infectious disease dates from after the Second World War.

It’s impossible to overstate just how useless pre-modern medicine was. If you fell ill, there was nothing, and I mean absolutely nothing, that a doctor could do to cure you. Granted, he had plenty of treatments and his learning was considerable. But bleeding, purgatives and the like would do you more harm than good. In essence, doctors were charging fat fees to hasten patients towards the grave.
Actually, I was slightly exaggerating when I said doctors could do nothing. There were some drugs available, like opium, to lessen pain. But you didn’t need a doctor to access these drugs and, although opium could reduce discomfort, you wouldn’t be cured. It was palliative only. Luckily for them, doctors did have another trick up their sleeves, although they did not know it. It’s called the placebo effect.

It’s well known that when you give a patient a sugar pill, something with no active ingredients, it can have marked beneficial effects. The mere fact that the patient thinks that they are being treated with an effective medicine makes them better able to heal themselves. And this effect is even more marked if the doctor himself thinks he is doing some good. That’s why new drugs are tested using the double-blind method. Patients are divided into two groups. One group is given the drug under test and the other is given a placebo. It’s called double-blind testing because the researchers giving the drug don’t know which is which any more than the subjects do. Only a second lot of researchers, who never actually come into contact with the patients, know who has received the real drug and who has received the fake.

So, a doctor in the eighteenth century, with his training and aura of competence, could help his patients cure themselves merely because all parties thought that he could. This might even offset the damage that the doctor was doing by administering dangerous drugs or ordering bleeding. Clearly, the doctors who could best help their patients were the ones who didn’t do anything besides having a reassuring bedside manner and giving out harmless placebos. That’s generally what village healers and cunning folk did. Their magical cures were less likely to hurt you than the treatments of professional doctors. Most effective of all was praying at a saint’s shrine. If you believed in it, prayer would do as much good as a visit to the doctor, and it was unlikely to do you any harm at all. Physicians made their living by cloaking themselves in learning, jargon and professional qualifications. But it was all an illusion. No matter how many long years they studied Galen and Avicenna, they couldn’t help their patients one jot.

Incidentally, that’s how homeopathy got going. It was founded by Samuel Hahnemann in 1796 while doctors were still more likely to be licensed killers than saviours. Now, I hope I won’t offend anyone when I say that homeopathic medicines do precisely nothing. They rely entirely on the power of suggestion – in other words the placebo effect. But when homeopathy was founded, doing nothing could be a huge improvement on conventional treatments. So, it appeared to work better. This meant that homeopaths gained a respected place in British medicine that they have never really relinquished. Homeopathy is still available on the National Health Service.

All this raises a slightly disconcerting question. If doctors could maintain a professional reputation back when they couldn’t help their patients, is some of the reverence in which we hold them today really just a function of good public relations? That’s not to say that today’s medical professionals don’t deserve a large measure of respect. But placing them on a pedestal doesn’t do us or them any good at all. So when the British Medical Association say that doctors are too important to work at weekends, we should treat the suggestion with the scorn it deserves.

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