Author + information
- aDepartment of Cardiology, Centro Hospitalar Gaia/Espinho, Vila Nova de Gaia, Portugal
- bDepartamento de Cirurgia e Fisiologia, Unidade de Investigação Cardiovascular, Faculdade de Medicina da Universidade do Porto, Porto, Portugal
- ↵∗Address for correspondence:
Dr. Ricardo Fontes-Carvalho, Alameda Prof. Hernâni Monteiro, 4200-319 Porto, Portugal.
Throughout the centuries, across cultures and distinctive religions, the patient-physician relationship remains the most fundamental element in the practice of medicine. The indissociable link between patient and the doctor is based on trust and honest communication. Over the years, several depictions have highlighted the protean and multidimensional issue of the patient-doctor relationship, and its broad sociocultural implications have influenced the history of mankind (1).
The classical painting “Alexander of Macedon trusts the doctor Philip,” by polish master Henryk Siemiradzki (Figure 1) (mostly known for his academic artistic style of portrayals of ancient Greco-Roman themes) provides a comprehensive outlook of this issue, while also recounting one key moment in Alexander of Macedon’s (also immortalized as “Alexander the Great”) campaign in Asia Minor (2,3). This painting was based on an interesting episode reported to have taken place as Alexander’s army was passing through Cilicia in 333 B.C. At this point, after having swam in the cold waters of the Cydnus river, Alexander became severely ill with shivering limbs and a high fever, as lavishly described by Arrian and Curtius (3,4). Although the specific disease process involved at this point has been the subject of controversy and debate, with potential causes ranging from exhaustion to a manifestation of epilepsy (5), ancient sources concur as to the gravity of the situation (3,4). Plutarch recounts that the court’s physicians were afraid to treat their king, as they were wary of the potential adverse consequences of a failed treatment (3,4). Therefore, Alexander decided to call a new physician named Philip “the Acarnanian,” who agreed to treat him (3,4,6). However, when the physician was about to begin the treatment, Alexander received a message from Parmenion, one of his greatest generals, informing that Philip had been bribed by the Persian King Darius III and meant to poison him (3,7). Notwithstanding this, Alexander kept his trust in Doctor Philip, and while he was drinking, without hesitation, the medicine that had been prepared by his physician, he showed him the letter sent by general (7). As documented by the several sources, Alexander of Macedon recovered and was able to continue his victorious campaigns across the region, which influenced the world at that time and afterward (7).
In the painting by Siemiradzki (Figure 1), we can observe in the center Alexander lying with the medical potion in his right hand, while Philip (previously unbeknownst to the letter sent by Parmenion) stands beside him reading the note provided by his king. Alexander watches attentively and assertively his physician’s reaction. This scene demonstrates us the importance of a solid and confident physician-patient communication that should be based on mutual trust, despite the harsh environment surrounding it. Healing begins when both patients and physicians build this trust. Moreover, the fact that Philip accepted to treat Alexander even while aware of the potential danger of this task (as reiterated by the unwillingness of the other court’s physicians to treat him) reminds us of his sense of duty, the commitment of physicians to caring for others, and shows the whole essence and the bond underlying the holistic patient-doctor relationship. It is also important to remember that Aristotle (the famous Greek philosopher, who was also Alexander’s tutor in childhood) was the son of a physician (Nicomachus). This intimate contact during childhood may have reinforced the monarch’s views and perception on both doctors and Medicine, which is consistent with several accounts attesting his interest in this area (4,6). The notion that a doctor’s actions can endure the test of time and have a major influence even in those at first not initially associated with the care process is also of paramount relevance. Looking again to this magnificent painting and seeing the child on the left of the picture, one can only hypothesize if this episode would have an impact on years to come. Also, on the left background of the painting (and expertly explored in a chiaroscuro quality), the remainder of Alexander’s entourage watch attentively while commenting among themselves, this episode that further reinforces the impact of medical practice (in its different expressions) in society in general, while attesting to the major responsibility which being a physician encompasses.
In summary, this masterpiece by Siemiradzki recalls several critical aspects of the unbreakable link of the patient-physician relationship, which is the first step of the healing process. As contemporary medicine continues to progress through the exponential growth of new technologies, new diagnostic and therapeutic techniques, big data analysis, machine learning, and telemedicine, we live a time when several external factors threaten this eternal relationship. The echoes that come to us from Alexander of Macedon’s world provide a beacon of hope and humanity in a rapidly changing world, showing that the patient-physician relationship will continue to endure.
Both authors have reported that they have no relationships relevant to the contents of this paper to disclose.
The authors attest they are in compliance with human studies committees and animal welfare regulations of the authors’ institutions and Food and Drug Administration guidelines, including patient consent where appropriate. For more information, visit the JACC: Case Reports author instructions page.
- 2020 The Authors
- Sarkowicz D.,
- Klisińska-Kopacz A.