The Hippocratic Oath

I have been thinking, lately, on what makes us enter the Medical profession.  Any one person will have their personal reasons but in discussions with my classmates, I've come to see that we all share similar passions for the field.

We all love helping people.
We all love challenges.
We like being able to look at a problem and devise solutions.
We like being around other people.
We like working with like-minded individuals.
We're interested in the life story.
We think health is important.
It just felt right.

Many people, upon telling them that you study Medicine, will immediately respond that we'll have a 'great salary' to which we can look forward.  Yes, great, we'll have a guaranteed salary.  In many years.  Until then, we're all poor university students who are just as interested in cheap groceries as the next university student.  And the money is definitely not why you get into this profession. A 4-6 year degree, years of slogging it as a junior doctor, 6-8 years of fellowship (where 'life' is that time between ordering your 10th coffee of the day and receiving it at the other end of the cafe) don't exact make for a quick financial fix.  So yes, there will be security. One day.  I can promise that's not why (the majority) of us got into Medicine.

Explaining why you want to partake in a career isn't easy.  It really just feels right.  You might think that's a cop-out excuse.  I'm going to use the evidence in Gladwell's Blink as a defence here.  Sometimes big decisions need to run with your gut (or your instinct).  Something fits with you - with all of the things that you are.  When I was thinking, years ago, about where I wanted to go in life, I wrote myself a list.  It was very specifically an abstract list.  It didn't say anything about what I would be doing in my ultimate profession.  It just said how.  I wanted to do good things.  To be with people. To constantly learn. To thrive on knowledge. To create knowledge. To talk and teach. To mentor and be mentored. To have mobility if I wanted it. To have a community. To always have interesting things on. To have both instant results and long term goals. To never get bored of it.

I left the list.  And then, one day, I thought about Medicine.  And I thought about the list.  Like two perfect last bits of the puzzle, they fit together.  Medicine was the enzyme to my substrate.

Now that I'm studying this wonderful course, I think on what qualities I will need into the rest of my career.  Everyone talks about the Hippocratic Oath as if it is the answer to the world's innumerable problems.  I thought I should share it with those of you who've only used the phrase without reading the words.  It is an important historical document, yet contains many sentiments no longer practiced in the medical world.  We increasingly discuss euthanasia as a humane way of allowing those suffering terribly to let go of the pain that they are in.  We also give deadly drugs to patients in order to give them life back.  This is the principle of many cancer drugs.  Some drugs stop the heart in order to perform life-saving surgery.  Hippocrates suggested that abortions should not be performed and yet the logic suggests that if a doctor were not to perform the procedure safely, a women or her family may attempt to perform one in unadvisable ways.  Whether you agree with abortion or not, it has been argued (and won) in many areas that legalisation/decriminalisation is a much safer option.  The Hippocratic Oath suggests this shouldn't be allowed - and certainly in his time these were abominable ideas.  Times change and the documentation must change with it. 

Instead of using this Oath, many Australian Medical Schools now construct their own, based on the thoughts and ethics of the cohorts.  This provides adequate reflection on time on how we should behave, rather than handing us these ideas on a plate.  The AMA suggests that doctors abide by the Geneva Declaration, something far more modern that Hippocrates.

Whatever you follow...ask yourself, why? Why do you think this is right or wrong.  Write it down.  Leave it and come back to those thoughts in a few weeks.  Discuss with your friends.  You never know how you will progress your own field as a result.

The Oath 

By Hippocrates 

Written 400 B.C.E 

Translated by Francis Adams, sourced from MIT

I SWEAR by Apollo the physician, and Aesculapius, and Health, and All-heal, and all the gods and goddesses, that, according to my ability and judgment, I will keep this Oath and this stipulation- to reckon him who taught me this Art equally dear to me as my parents, to share my substance with him, and relieve his necessities if required; to look upon his offspring in the same footing as my own brothers, and to teach them this art, if they shall wish to learn it, without fee or stipulation; and that by precept, lecture, and every other mode of instruction, I will impart a knowledge of the Art to my own sons, and those of my teachers, and to disciples bound by a stipulation and oath according to the law of medicine, but to none others. I will follow that system of regimen which, according to my ability and judgment, I consider for the benefit of my patients, and abstain from whatever is deleterious and mischievous. I will give no deadly medicine to any one if asked, nor suggest any such counsel; and in like manner I will not give to a woman a pessary to produce abortion. With purity and with holiness I will pass my life and practice my Art. I will not cut persons laboring under the stone, but will leave this to be done by men who are practitioners of this work. Into whatever houses I enter, I will go into them for the benefit of the sick, and will abstain from every voluntary act of mischief and corruption; and, further from the seduction of females or males, of freemen and slaves. Whatever, in connection with my professional practice or not, in connection with it, I see or hear, in the life of men, which ought not to be spoken of abroad, I will not divulge, as reckoning that all such should be kept secret. While I continue to keep this Oath unviolated, may it be granted to me to enjoy life and the practice of the art, respected by all men, in all times! But should I trespass and violate this Oath, may the reverse be my lot! 

The Declaration of Geneva
From the AMA
At the time of being admitted as a member of the medical profession:
I solemnly pledge to consecrate my life to the service of humanity;
I will give to my teachers the respect and gratitude that is their due;
I will practise my profession with conscience and dignity;
The health of my patient will be my first consideration;
I will respect the secrets that are confided in me, even after the patient has died;
I will maintain, by all the means in my power, the honour and the noble traditions of the medical profession;
My colleagues will be my sisters and brothers;
I will not permit considerations of age, disease or disability, creed, ethnic origin, gender, nationality, political affiliation, race, sexual orientation, social standing or any other factor to intervene between my duty and my patient;
I will maintain the utmost respect for human life;
I will not use my medical knowledge to violate human rights and civil liberties, even under threat;
I make these promises solemnly, freely and upon my honour.


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