Thursday, January 19, 2012

Hippocratic oath or Hypocratic oath-where has medical ethics died

Though I'm not a medical professional(that's why I could write this bold title), I've quite a few relatives, friends and others in the medical profession. To them, I say that this is a general article not targeted towards any class, but that what I noticed reflects a non-significant proportion of doctors. The Hippocratic oath(http://www.pbs.org/wgbh/nova/body/hippocratic-oath-today.html) is not free from controversy, with even doctors questioning some aspects of it. But it is still largely accepted. Below, I reproduce a modern version of the oath in Italics, with my comments in normal print.Given the modern issues of high cost healthcare/medical insurance overcharging/reluctance to admit mistakes/cosy nexus with pharma companies marketing staff/low continuing education etc, it would seem at times that the hippocratic oath is practiced by hypocrites. Civil comments welcome below.


I swear to fulfill, to the best of my ability and judgment, this covenant:
  1. 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.  Doctors do teach and avoid plagiarism(atleast not much more than other professionals). So there, they escape censure.But seeing the very small number of multi doctor practices in India(as compared to USA), it is doubtful whether doctors care about sharing knowledge with non relatives. Also, while continuing professional education is implicit in this, it is an open question about how many doctors rely on industry funded seminars/sales representatives to educate them, rather than take the pain to subscribe to and read authoritative journals/attend study circles etc.
  2.  I will apply, for the benefit of the sick, all measures [that] are required, avoiding those twin traps of overtreatment and therapeutic nihilism. Afraid of being sued and mindful of the revenue generation obligation, doctors tend to prescribe unnecessary tests. Also, simple remedies like those of homeopathy are not advised-either the doctor does not know them, or prefer allopathy. While the doctor has the right to his professional judgement to reject alternative medicine, the patient should have an informed choice to that extent. And that is what is often missing today.
  3.  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 corporate approach of quick turnaround times, cold clinical approach and preferring standardized jargon/self education, this is easy to forget. And for those not so literate/tech savvy/assertive, the chance of being misdiagnosed/not receiving optimal treatment is there. Not all hospitals are as sensitive like say Sankara Netralaya, which despite being in the South, set up a Bengali speaking reception counter catering to its patients from that region. Doctors IMO prefer jargon to explaining in Plain English to the patient/those accompanying him.
  4.  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. While second opinions and referrals are taken, I doubt whether this is done on a old-friends basis, or purely on the basis of competence. 
  5.  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.  Abroad, the topic of doctor assisted enthusania is still being debated, but undoubtedly it is against the classical version of the oath.
  6. 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.  This is the closest that the oath gets to advising the holistic approach embedded in Eastern medicine approaches like homeopathy. However, I'm yet to see allopathic doctors follow that approach in practice..
  7.  I will prevent disease whenever I can, for prevention is preferable to cure. The family doctors(conversant with their patients and their family history) are likelier to do this. But for corporate hospitals/others, while they do have the data, they are likelier to use it for cross selling insurance/other services like checkup than use it for diagnostic purposes.
  8.  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. This is violated to the greatest extent in my opinion. Hospitals are reluctant to admit accident victims, render probono services etc. While this behaviour is rationally understandable in a supply constrained situation like India, shirking one's obligation of public service, undermines the right to be called a professional. And for practices like not reserving the agreed proportion of hospital beds/services for the poor, there is no excuse.  
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.

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