12 Jan, 09 | by BMJ
The news item was embedded in the margin of the paper. “100 Years Ago – In Our Pages,” subtitled “1908: Fraud Beauty Doctor” would have attracted the attention of anyone at least minimally concerned about charlatans, quacks, or fakes in medicine. Originally published on November 6, 1908, the piece in the International Herald Tribune tells the story of Mrs Heath, a woman from London. An advertisement in a women’s magazine for the services of Madame Auguste, a beauty specialist based in Bond Street, had promised to painlessly and harmlessly rejuvenate the type of lesions Mrs Heath had on her face as a result of smallpox. Mrs Heath contacted the specialist, seeking permanent cure. Liquid treatment was applied to her nose, but, unfortunately, caused her considerable pain, leaving her skin swollen and patchily discolored. To reverse the inflicted damage, the beauty specialist suggested breaking the three scars into one, an improvised procedure that produced further unanticipated complications. The outcome? Mme Auguste, a London jury ruled, was ordered to pay £500 damages for injuring a woman’s face.
The piece made me think. Medicine is a fertile field for charlatans. Pretending to have healing powers may lead desperate patients on. Consenting to being treated by a self confessed “expert” is something I could easily see myself doing in similar circumstances. But what might discourage frauds from maiming innocent people and keep such “imitators” outside the circle of care providers?
Doctors’ insights, professional competence, and communication skills are the result of years of interaction with patients. It is a paradox, then, that some medical tools – such as the stethoscope, scalpel, white coat, or reflex hammer – seem to confer such authority that some people equate their mere presence with the skills of the doctors who handle them.
What would help patients understand that what may guide them to improved health is not instruments, but doctors, who have made alleviating human suffering their goal in life? Should doctors spend more of their time with patients talking, negotiating, and contemplating, and using their neck-hanging device or patellar reflex hammer as adjuncts rather than as the main tools of personal connection? What about exposing patients to more clinical information than is obligatory?
Just a few days after reading the newspaper story, I took part in a surgical seminar in one of Haifa’s main hospitals. Having completed a procedure, the paediatric surgeon led a group of seven medical students, yours truly included, from the operating room to the observatory cafeteria, with a view of Mount Carmel’s slopes bordering the endless turquoise Mediterranean. The surgeon pointed his finger at a golden domed roof distant in sight. Referring to the case he had just completed and the patient’s family, he announced: “You are crowned their king. You have received a patient, pinpointed the pathology, corrected it, and ameliorated suffering … they salute you; you experience an unparalleled euphoria nobody can take away from you.”
I thought of the beauty charlatan in London, 1908. This sense of pride and triumph – which is rarely gained outside medicine – may be the most tempting of all reasons for some to pursue a “career” in medical deception. Medicine is not for amateurs. Regulation should be extremely tight to ensure that only qualified doctors are permitted to practise, otherwise our profession may lose some of its beauty – just as Mrs Heath did when she innocently followed the misguided wisdom of a medical imitator.
Ohad Oren, fourth year medical student
Bruce Rappaport Faculty of Medicine, Technion – Israel Institute of Technology, Haifa, Israel