Friday, 1 April 2011

On the Hippocratic Oath

I have more than a passing interest in all things Greek - particularly the language, which I have been learning for the past 10 years or so, and the history. When I say history, I am not talking so much about recent history, more the Classical period; the time when Greece was truly the cradle of modern European Civilisation.

One figure in particular is of interest: Hippocrates of Kos. Hippocrates (pronounced Hipp-o-kra-tees not hippo-crates - a la Bill and Ted and their colourful use of 'So-crates'!) was a physician, or at least the Classical equivalent to a physician, often referred to as the Father of Modern Medicine.

What did he do? Well he is credited with bringing medicine out of the realm of superstition and into a more real-world way of thinking with such notions as disease being caused by natural phenomena. One might say he is one of the first people to bring evidence-based practice to the forefront. There are quite a lot of other things he did and, assuming you have the time, I could recommend finding out more about his, and his students, teachings.

One of the more notable achievements of Hippocrates (or at least ascribed to Hippocrates and his followers) was the introduction of a code to which physicians subscribe to as part of their license to practice Medicine. The Hippocratic Oath forms the fundamental moral and ethical guidelines for practicing Medicine. For those lucky enough to be able to read Ancient and/or Modern Greek, excerpts of the original texts can be found here.

Whilst not a medical Physician myself, I have taken a little time to study what the Oath says and potentially implies. Herein I share some interesting parts of said Oath.

Depending on which version is used, there are some interesting points to be made.

First, the language used. Throughout all versions of the Oath there is use of the word 'art'. The various versions posted on Wikipedia (original, classic and modern) all contain 'art' and implicitly imply that medicine, whilst being science is also part art. I have to say that against all my scientific training and background, I do kinda like this. I like it because it suggests that science can take Medicine so far, but art perhaps takes it that little bit further. Importantly, it puts physicians in the driving seat when it comes to the care they provide for individuals perhaps differing from person to person. This article says pretty much the same. Remember also my post on autism and n=1?

Second, the Oath acknowledges that physicians, whilst respected for their science and their art, are not infallible. To quote from the modern text: "I will not be ashamed to say that I know not..". I think it is a mark of great strength when someone can admit that they don't know something and ask advice from those who might. This part of the Oath directs physicians to do just that.

Third, the Oath talks about treating 'people' not diseases or conditions. In these modern times, where finances for healthcare are being squeezed and contact time with patients is an issue to meet targets (certainly here in the UK), it is perhaps important to step back and understand that the patient is key, not the condition, disease, injury or state. The implication for autism for example is that 'underneath' the presentation of symptoms is a person (and their family, as also discussed in the Oath) and that the duty of care is to that person, whatever care they may or may not require either as a result of their autism or resultant from any associated co-morbidity.

Finally, the modern Oath quotes: "Above all, I must not play at God". Medicine has seen a few examples of physicians trying to play God. Here in the UK we had Dr Harold Shipman not so long ago; lest we forget his victims that ran into the hundreds in numbers. Away from just mortality (which this sentence of the Oath is specifically focused on) the message here is that physicians have an extremely important responsibility over their patients and their care; a responsibility that resonates throughout the medical and peripheral professions.
Some final words from a protagonist in our friendly neighbour-hood Spiderman movie (or was it Chris Eubank): "With great power comes great responsibility".