Every medical student who either does specialization or a regular graduation would know about The Hippocratic oath. The phrases of it are like “Medical Commandments” teaching morality and remembering the responsibilities of those who study and practice medicine. The Oath is created by Hippocrates and can be found in Hippocratic Corpus along with many other texts attributed to Hippocrates.
The original Greek version of The Hippocratic Oath is translated into English so that everyone could understand and follow the ethics proposed in the oath. In English, there are two versions that are popular – one is a translation from Greek by Ludwig Edelstein and other is a modern version, which varies from institution to institution. The classic version will not be kept under the microscope for it is not widely used now-a-days. Read the classic version from the image given at the end of this post.
I
“I swear to fulfill, to the best of my ability and judgment, this covenant:”
The first oath is pretty much like a reminder to the individual that The Hippocratic Oath is more like a covenant than an agreement of generality. The word ‘covenant’ is generally in religious matters and in matters of relationship. The insertion of this word means that the individual is entering into a more transcendental and personal agreement before becoming a doctor. As the responsibilities of a doctor are equal to that of a God and personal to that of a friend or family – a doctor should take care of his duties as such.
There is no doubt that only a few doctors or medical practitioners consider their position as Holy and are immersed into greed. The cruelest vice for a doctor is greed and it can be observed that no matter the size of the hospital, one would try to get as much money as possible from the patients. Most doctors have forgotten that being a doctor is holier than praying at a religious place. Hence, the Oath consist of the word ‘covenant’ rather than truce or agreement or deal.
II
“I will respect the hard-won scientific gains of those physicians in whose steps I walk, and gladly share such knowledge as is mine with those who are to follow.”
The growth of scientific medical approach and physicians was not easy. In history, there are many instances where people who followed the scientific procedures were burnt or excommunicated from the region. Although the Greek, Roman and Indian civilizations encouraged individuals to seek healing methods for many diseases; there were no sufficient tools and equipment that could aid them. Therefore, their efforts are more prominent than all of the efforts combined today. Great men like Charaka, Hippocrates, Dioscorides, etc. have bestowed their knowledge of medicine and its practice for the future generations to live without any diseases. So, it becomes the duty of the doctor to share the knowledge to anyone showing interest so that they could contribute to the well-being of others.
Well, this is one part of The Hippocratic Oath that every physician or a doctor would definitely do i.e. share the knowledge. However, this comes as bragging rather than trying to fill others with necessary information. It can be observed when someone is travelling with or attending a party with a physician; there will be words that are often confusing and only understandable to them. Of course, in the modern world this habit is seen with most of the humans who generally show great interest in shedding light on their area of interest.
III
“I will apply, for the benefit of the sick, all measures which are required, avoiding those twin traps of overtreatment and therapeutic nihilism.”
A doctor, by duty, is supposed to serve those in need of a treatment and help the patient to recover using the methods he or she knows. It is the part of The Hippocratic Oath where the individual should realize that their responsibilities should be done with “best of the abilities” rather than self interest. History has shown many such doctors who dedicated their lives to help patients who were in need. This selfless nature and the ability to understand the importance of either applying a method or restricting it are very important for a medical practitioner.
The concept of therapeutic nihilism was brought forth by Joseph Conrad believing that the human body needs time to heal itself and everything cannot be cured in a society with a doctor’s knife. Although, no one in this contemporary world would follow this – it would have certainly been a good idea to prevent the doctors from overtreatment. It is something that health industry is often criticized of; whether it is asking the patient to have several tests or making them pay in the name of building taxes, service taxes, equipment taxes, etc. the current day hospitals do not follow this Hippocratic Oath.
IV
“I will remember that there is art to medicine as well as science, and that warmth, sympathy, and understanding may outweigh the surgeon’s knife or the chemist’s drug.”
In the olden day’s art, medicine and science are treated as one with artists who showed interest in science and inventors who worked for medical practitioners. Hence, one can find many art works on medicine or science, medical books written as poetry, scientific inventions that helped an artist and the practitioner. The three fields are inseparable as can be exemplified with the painting – The Anatomy lesson of Dr. Nicolaes Tulp by Rembrandt.
Unfortunately, the contemporary practices have dissected art from medicine and science. Medicine and science have separated and developed many methods that helped human beings to prosper with health. However, the people who practice it have become rather like machines that follow their duty like clockwork as if they are equipment in a factory. It is because of the doctors are taught to be objective while treating a patient. This is contrary to The Hippocratic Oath that says warmth and sympathy are far greater than any tools. This truth has to be realized by doctors, pharmacists, pharmaceutical companies, API manufacturers and every individual involved in the health industry.
V
“I will not be ashamed to say “I know not,” nor will I fail to call in my colleagues when the skills of another are needed for a patient’s recovery.”
The physician might be proficient in one aspect and less informed in another aspect. If there is something a physician needs, then he or she should accept this ignorance out of humility and ask the help of others. The Hippocratic Oath teaches humility in this way so that the individual can reach out to anyone who is fit for the job.
This part of The Hippocratic Oath is slightly confusing and misleading for the fact that no human would accept the fact that he or she is ignorant about a fact; especially, when it comes to their profession. On the other hand, there are “multi-specialty”, “International”, hospitals that are always willing to bring in an extra hand. This is not because of their willingness to serve, but due to the fact that they can charge more for the patient.
VI
“I will respect the privacy of my patients, for their problems are not disclosed to me that the world may know. Most especially must I tread with care in matters of life and death. If it is given me to save a life, all thanks. But it may also be within my power to take a life; this awesome responsibility must be faced with great humbleness and awareness of my own frailty. Above all, I must not play at God.”
Physicians have to deal with life and death situations everyday and it takes a lot of mental strength and stability to handle the cases. In case of an abortion, the doctor might have to take a serious decision of saving only the infant or the mother. Hence, taking life when it matters or preserving it is the greatest responsibility given to a doctor. Further, the patient would relate to many problems that are personal and those related to the health condition. The doctor is expected to conceal those facts and do not disclose them elsewhere.
Apart from a few doctors who are maligned, most of them follow this aspect of The Hippocratic Oath to the heart. They pretty well know that interfering with the work of God could only mean disaster; hence, a lot of practices like cloning, etc. are banned from practice.
VII
“I will remember that I do not treat a fever chart, a cancerous growth, but a sick human being, whose illness may affect the person’s family and economic stability. My responsibility includes these related problems, if I am to care adequately for the sick.”
Doctors should never look at the disease first and look at the patient; on the contrary it should be a fundamental thought for the doctor to understand the patient and then the disease. This helps to provide a subjective view on the patient and treat accordingly. As a result, the patient can maintain his relationships despite treatments and the doctor can take care of the sick in the right manner.
It is points like these that make The Hippocratic Oath an old woman’s complaint. Which doctor is looking at that patient’s problems? None; may be with the exception of psychotherapists who are obliged to hear everything. In a few years, this part of the Oath of Hippocrates would definitely change to thus:
“I will treat the patient as a necessary means to my growth and ensure that more money is spent in the hospital. Either the relations or the human constraints of the patient are not a concern to me and would try to gather riches in adequacy.”
VIII
“I will prevent disease whenever I can, for prevention is preferable to cure.”
The role of a doctor is to identify any chances of onset of diseases while performing a regular checkup. Unfortunately, not many people are willing to go to hospitals to have regular checkups. Therefore, prevention before cure is not something that one can expect in the current era.
The physicians are not to blame in this aspect, but the population which is nearing eight billion. With such sprouting population, it is easily understandable that people are either unable or uninterested to go to a hospital.
IX
“I will remember that I remain a member of society, with special obligations to all my fellow human beings, those sound of mind and body as well as the infirm.”
Doctors, although, are prohibited to consider themselves as gods while looking after patients; but, they sure are given some ‘special obligations’ that direct them to better the human civilization with their knowledge. Such knowledge should allow them to look at everyone, from a scholar to mentally disoriented individual, in the same way. This is the greatest philosophy of The Hippocratic Oath and by realizing the meaning behind this particular statement in the Oath, a doctor could become a humanitarian bound to serve the society.
There is no doubt that doctors certainly feel very special in society and this has grown into overestimating their capabilities rather than teaching humility. Most research doctors tend to experiment even with the darkest of secrets that man should never tread in. As the society has become such, that they too are encouraging such research. Disastrous would be end, when one becomes over ambitious in the mind.
X
“If I do not violate this oath, may I enjoy life and art, respected while I live and remembered with affection thereafter. May I always act so as to preserve the finest traditions of my calling and may I long experience the joy of healing those who seek my help.”
The final statement of The Hippocratic Oath is about self satisfaction that a physician could get if the oath is followed to the full. The Oath of Hippocrates is all about realizing the ethics that one should follow after giving a responsibility that is more or less equal to the gods. Hence, following them would ensure people’s affection even after the death of the doctor. There is definitely joy in helping others and doctors are gifted to heal others, which is a ‘special obligation’ that makes their lives even more pleasurable than a normal human being.
The modern day doctors need to realize that The Hippocratic Oath is not present as a ritual, but as a reminder of what they can become if every ethic is followed. History has given people like Galen, Al-Zahrawi, Andreas Vesalius, James Parkinson, Hans Asperger, BC Roy, Elizabeth Blackwell and many who revolutionized the way physicians perform their duties. All the rush of a hospital and the need to run its administration for futile benefits are temporary; doctors who strive for the permanent are those who would follow The Hippocratic Oath without any deflection. Such doctors would become immortal in the field of medicine and would definitely contribute to the well-being of humanity.
Author: Dr. Mallela Raghavendra, Dermatologist.