Hippocrates – Part II: Prognosticate When You Can

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AUTHOR:
Richard Colgan, MD

According to Hippocrates, one of the important qualities for a physician to cultivate is the ability to prognosticate.

For by foreseeing and foretelling, in the presence of the sick, the present, the past, and the future, and explaining the omissions which patients have been guilty of, he will be the more readily believed to be acquainted with the circumstances of the sick; so that men will have confidence to entrust themselves to such a physician... He will manage the cure best who has foreseen what is to happen from the present state of matters[1].

In the Book of Prognostics (c. 400 BC) we also learn one way in which Hippocrates avoided the malpractice of his day—censure[1]. This implies that by being aware of the natural history of a disease and whether or not medical intervention will indeed improve a condition, the physician would best be able to counsel a patient about what to expect in the course and outcome of their illness. In the age of Hippocrates, it was recognized that effective communication between physician and patient was one of the best ways to avoid censure, particularly in matters when the prognosis was poor. Honest information about what the patient should or should not expect regarding his or her illness was as important then as it is now. Not only does it base the patient’s apprehensions in reality, but it also allows for informed decision making of both parties involved. Furthermore, it strengthens the physician–patient relationship as the patient’s trust in his or her doctor is reaffirmed.

In acute diseases the physician should first observe the “countenance” of the patient. Hippocrates compiled some prognostic indications of a poor patient outcome, which are still recognized as valid. These are listed below: 

• Hollow eyes.
• Collapsed temple.
• Cold ears.
• A black, green, livid (black and blue; deathly colored), or lead colored face. 
• Seeing the whites of patients’ eyes when they are sleeping. 
• Cold sweats to the head, face, or neck (these in acute fever prognosticate death). 
• A swelling in the hypochondria (the area that is just underneath the anterior rib cage, to the left and right of the epigastrium bilaterally) that is hard or painful. 
• All dropsied (disease with drops, or water, edema, e.g., congestive heart failure) arising from acute diseases is bad. 
• It is a bad symptom when the head, hands, and feet are cold while the belly and sides are hot.
• Strong and continued headaches with fever, if any of the deadly symptoms be joined to them, are very fatal.

Other of his prognostics are not as applicable to medical practice today and may be placed under the category of just plain funny, such as:
"It is best when wind passes without noise, but it is better that flatulence should pass even thus than it should be retained."

Hippocrates' teachings have stood centuries of scrutiny. In this blog, we have only briefly reviewed a few of his lessons. Lessons from the “Father of Medicine” that still are applicable to the young physician of today are many. Some of the most important lessons I think the reader should learn from Hippocrates follow: first do no harm, observe all, evaluate honestly, prognosticate when you can and when it comes to therapeutics, and assist nature. Additionally, healers of any era should recognize that our duty is to serve our fellow man and that we would be wise to learn from our predecessors in medicine and by carefully studying our patients. Hopefully, I have generated an interest in you to read more about the “Father of Medicine” and the Corpus Hippocraticum.

But there are other Greeks we have yet to discuss!
Next Blog : Contributions to Medicine from Ancient Greece

Reference: [1]: The Genuine Works of Hippocrates, Trans. Francis Adams, 1886 vol 2, 283.

Richard Colgan, MD, is associate professor of family and community medicine at the University of Maryland School of Medicine in Baltimore, Maryland. He was the School's nominee to the Association of American Medical Colleges for its Humanism in Medicine Award, the recipient of numerous faculty teaching awards including the School's Golden Apple Award for excellence in teaching. Dr Colgan is the author of Advice to the Young Physician: on the Art of Medicine. For more information, go to www.advicetotheyoungphysician.com