Hippocrates - Part III: Honestly, Love ... From Afar, Keep Your Mouth Shut, and Be Nice to Mother Nature
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Richard Colgan, MD
This is the third and last blog on lessons to be learned from arguably the Father of Medicine, Hippocrates. In addition to “First Do No Harm” and “Observe All” Hippocrates cautioned that we evaluate honestly. The fact that physicians of his time were observed as being less than honest speaks of the human frailties we are all susceptible to. We have all heard stories or perhaps been witness to physicians today who do not evaluate honestly. The Hippocratic Oath, recited by most medical students prior to graduation, is one way to teach us to act in a professional manner and not provide therapy for our patients, which only serves to bring financial gain. “I will not cut persons laboring under the stone but will leave this to be done by those who are practitioners of this work,” Hippocrates wrote in The Oath. Many occupations refer to themselves as “professional,” but this term takes on a special meaning when it is used to denote a physician, dentist, nurse, or other health practitioner.
In the healing arts, the practical and simplified definition of professionalism implies that the professional will follow a course of action that is best for the patient, even at the expense of what may be best financially or personally for him- or herself. The commitment to this notion is symbolically conveyed by recitation of the Hippocratic Oath upon graduation of medical school. Many non-physicians are at least superficially familiar with the Hippocratic Oath, likely because of the great importance it represents not just to physicians but to the public we serve. [The Hippocratic Oath can be found easily by using any internet search engine and in the interest of space will not be reduplicated here.]
The Hippocratic Oath expresses many significant concepts regarding health and healthcare expectations. It is interesting to reflect upon the issues that were felt to be important over two millennia ago and moreover, to recognize that many of these remain controversial in modern times. Clearly these were considered critical and honorable notions at the time of its creation. Have they evolved to mean something different over the centuries? Or are we, as physicians, still learning them?
The idea that physicians should practice beneficently and do what is best for their patients is truly a recurring theme in medicine and society, and it will surface many times in this book. This concept is certainly not contentious, but as we will see it is felt by several teachers in the current century to be in need of reiteration. Euthanasia and abortion were clearly concepts, which Hippocrates felt strongly about. Throughout the centuries, these topics evoke strong emotions from both patient and healthcare provider and continue to polarize many people in medicine, politics, religion, and society. It is up to the physician to sort through his or her own values on these controversial subjects and decide their practices accordingly. This is followed in the oath by a declaration that as healers we should live a life of purity and holiness. From this interpretation, it almost sounds like we are entering a religious order, yet the analogy that the healer’s examining room is often likened to a confessional strengthens this notion. It may be a stretch to compare practicing physicians to priests; however, in both instances those seeking service divulge the innermost secrets about their bodies and personal lives to a trustworthy advisor. Both physicians and religious figures are healers of people, and like priests, rabbis, and teachers we share a common vocation dedicated to serving society.
Passion follows next in the Hippocratic Oath. While it is important to show compassion for our patients, Hippocrates notes it is not appropriate to be passionate with our patients. Unfortunately throughout the United States and the world of medicine, there continues to be reports of physicians who engage in inappropriate relationships with their patients. It is beyond the scope of this book to discuss in detail what may or may not represent an inappropriate relationship or to impose certain morals or excuse exceptional situations. Suffice it to say that the American Psychiatric Association has decreed that a sexual relationship with any patient, past, present, or future, is not advised. It is important to remember that although both physician and patient are human, protocol and professional expectation creates boundaries that must be followed to provide unbiased and effective care.
Perhaps one of the most important notions emphasized in the oath is that of physician–patient confidentiality. The Hippocratic Oath reminds us that we should not divulge what we have learned from our patients. Our communications and patient interactions must be kept secret in order to maintain patient trust, safety, dignity, and uphold the protocol established by past professionals. In the United States, Health Insurance Privacy and Portability Act (HIPPA) governmental laws serve to emphasize this point. HIPPA was enacted by the United States Congress in 1996.
Not in the Oath but ascribed to Hippocrates was the admonition that when it comes to therapeutics we should “assist nature.” He strongly advocated the encouragement of patients to take better care of themselves by changing their lifestyles, particularly when it came to following a prescribed diet. “A slender and restricted diet is always dangerous in chronic diseases.” Likewise, Hippocrates advocated exercise or activity for certain ailments. “It should be kept in mind that exercise strengthens, and inactivity weakens.” Although many of his prescriptions would now be viewed as ludicrous by today’s standards, his concern for well-being is parallel to current medical practice’s mindfulness of the importance of diet, exercise, and activity with regard to patient’s health. In recent years, this concept has become more applicable with the overwhelming surge of metabolic syndrome diagnosis, childhood and adult onset diabetes, obesity, coronary artery disease, hypertension, and many other preventable health problems currently plaguing our country.
Next Blog: “Contributions to Medicine from Ancient Greece.”
Richard Colgan, MD, is associate professor of family and community medicine at the University of Maryland School of Medicine in Baltimore, Maryland. He was the School's nominee to the Association of American Medical Colleges for its Humanism in Medicine Award, the recipient of numerous faculty teaching awards including the School's Golden Apple Award for excellence in teaching. Dr Colgan is the author of Advice to the Young Physician: on the Art of Medicine. For more information, go to www.advicetotheyoungphysician.com.