Advocacy and Community: The Social Roles of Physicians in the Last 1000 Years. Part I in a 3-Part Series.

Karen E. Geraghty, PhD (c), Matthew K. Wynia, MD, MPH

In This Article


By the close of the Middle Ages, tremendous growth in population, coupled with the increased wealth produced by trade and the risk posed by plagues, transformed informal interactions between healers and patients as the health of the populace became viewed as significant to the strength and prosperity of the community. As cities and communities became increasingly sophisticated in their organization, relations between healers and patients were reconstituted through formal mechanisms such as charitable hospitals, university training, and poorhouses. Educational requirements for physicians increased, and regulations were instituted to define and circumscribe the roles of the various healers in the medical marketplace.

Patients were likewise subjected to increasing regulations, with distinctions being drawn based on citizenship and employment. Patients were often accorded care depending on whether they belonged to the community in which they fell sick (travelers and beggars were often banished to their home communities for treatment) or on whether they were deemed worthy, such as the working poor or the aged. As these political and institutional factors entered into treatment considerations, a fundamental tension was raised in the patient-physician relationship: that of balancing the individual needs of patients with the needs and resources of the larger community.[12]