Dec 27 2008

When Is An Oath Not a Hippocratic Oath?

Over the past several months I’ve had the pleasure of getting to know Dr. Gregory Eastwood. He may claim he is retired, but that would hardly be true. He is the former president of SUNY Upstate Medical University and former interim president of Case Western Reserve University.  Today he teaches bioethics and humanities to medical students.  They will realize someday how lucky they were to have been guided by this gentle and learned man.

The opportunity to work with Dr. Eastwood comes about as part of the weekly radio show I host.  We’ve begun a series of ethics conversations, airing monthly, tackling tough questions faced by patients and their families every day. Questions such as: How do we make end-of-life decisions for loved ones with diminished capacity (like Alzheimer’s disease)?  Should we have the right, as autonomous human beings, to decide when we are ready to die? Should a woman who is pregnant with multiples be able to selectively reduce the number of fetuses when she knows they are all at risk because there are so many of them?  Should doctors tell their patients how long they have to live?

See?  Not easy to answer, not any of them….

As we worked on the next ethics show, the conversation turned to how physicians view their professions. The possibility that they start out in med school with very idealistic views of what that career will look like (saving lives and improving quality of life) to the realities of conducting business — dealing with insurance and time constraints and all those shackles their work ends up imposing.

The conversation turned to the Hippocratic Oath.  That’s the oath we patients believe all our doctors took as they became MDs or DOs or whatever their title is… and most of us believe it includes the statement “First, do no harm.”

They don’t.  And it doesn’t.

In fact, it turns out that different medical schools use different oaths.  Not only that, many of them edit the oath their students take to fit… what?  I’m not even sure. But the point is, especially when it comes to medical errors and the question about whether doctors should apologize for mistakes they have made, we patients cynically ask why they have violated that Hippocratic Oath — and it turns out they may not have even taken it.

Does that give physicians a free pass to make mistakes?  Of course not!  I just find it interesting that there’s one more assumption on the part of patients about the medical profession that isn’t true.

Upon further discussion with Dr. Eastwood we also learned that there is another oath which many students take, called the Oath of Maimonides.  According to Dr. Eastwood, Maimonides was a physician, judge, and Jewish rabbi who lived in Muslim Egypt 1135-1204. He had a huge following and was very influential.

But — you’ve got to love this, too.  The Oath of Maimonides wasn’t even written by Maimonides. It was likely written by a German physician, Marcus Herz (1747-1803).

This oath is lovely, lyrical, almost prayer-like and honestly quite moving. I bring it to you because I think you could print it, take it to your physician, and perhaps begin a conversation with him or her.  A reminder of whatever oath your doctor took may cause him to pause for a moment and reorient himself to his reasons for choosing such a noble profession.

(Thanks to Dr. Eastwood for providing the following):

OATH OF MAIMONIDES

Thy eternal providence has appointed me to watch over the life and health of my fellow human beings.

May the love for my art actuate me at all times; may neither avarice nor miserliness, nor thirst for glory, or for great reputation engage my mind; for the enemies of truth and philanthropy could easily deceive me and make me forgetful of my lofty aim of doing good to my patients.

May I never see in the patient anything but a fellow creature of pain.

Grant me the strength, time, and opportunity, always to correct what I have acquired, always to extend its domain; for knowledge is immense and the spirit of man can extend infinitely to enrich itself daily with new requirements.

Today we can discover our errors of yesterday and tomorrow we may obtain a new light on what we think ourselves sure of today.

I have been appointed to watch over the life and death of my fellow human beings.  Here am I ready for my vocation and now I turn unto my calling.

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2 comments

    • Tim Dawes on December 28, 2008 at 4:56 pm

    Hi Trish,
    Thanks for this thought provoking post. The doctor-patient relationship may be our most intimate professional relationship. And we often don’t know their core beliefs about it.

    Yo might find yesterday’s post (Dec. 27) on the Bioethics Discussion Blog interesting. Dr. Bernstein asks if physicians shouldn’t get a bit of the compassion when they make a mistake.

    Another of those imponderables you could discuss with Dr. Eastwood.

    Thanks for your thoughts.

  1. Readers — Tim refers to this post by Dr. Bernstein: http://bioethicsdiscussion.blogspot.com/2008/12/partially-misplaced-sympathy-should.html

    Tim — I don’t believe that is an imponderable at all. In fact, I do believe that if the doctor behaves and engages as a partner with the family, then yes, there should be an acknowledgment that the doctor is suffering after a mistake is made, too. At the very least, I don’t believe any doctor intends to make a mistake. No doubt it’s a difficult experience that it deserves compassion — sometimes. Even, perhaps, most of the time.

    There is a huge difference, however, between a doctor who is engaged with the family or patient and is truly saddened by the mistake, and one who is not. In my case, not only would the oncologist who participated in my misdiagnosis (by not reading the test results that indicated another report was missing, the one that eventually showed I had no cancer at all) NOT admit he had made a mistake, but he also sent me a three page letter explaining how he had been right! That was after the NIH had already proven he was wrong. There was never an apology, never any indication that he had erred. He was arrogant and egotistical and believe me, I have no sympathy for him or his feelings AT all.

    Do I think that the oncologist who tried to treat me is the norm? Absolutely not. But if there is one thing I’ve learned as I have jumped into the entire topic of healthcare, it is that we can’t make blanket decisions — not about diagnoses, treatment, or even whether any participant — patient or physician — deserves compassion.

    Thanks for posting. I didn’t know about your blog or Dr. Bernstein’s — always like to find new sources of info and food for thought.

    Trisha

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