American Medical Oath

More interesting reading today. This came to me from Medscape and I thought I’d share it. As an aside, I would have no problem reciting the Weill Cornell Medical College’s Hippocratic Oath. Some excerpts:

Oaths for Physicians — Necessary Protection or Elaborate Hoax?
Erich H Loewy, MD

The ritual of taking an oath upon graduating from medical school is, with a few exceptions, a routine requirement for graduation. Albeit that many students believe that they have taken the Hippocratic Oath, this is virtually never the case.

According to the oath, physicians (in virtually all formulations) swear that social standing (and by implication economic factors) will not change the way in which patients are treated. This becomes impossible.”

I think that the prospective physician having to take an oath that promises to place the biopsychosocial interests of the individual patient first while at the bedside and to work for a healthcare system that is accessible to all is not coercive to students as long as students are aware before they enter medical school that taking such an oath will be one of the requirements for graduation — no more and no less than anatomy or a clerkship in medicine

[I]t is a problem that we must at least start to recognize as an imperative and consequently to work on setting up fair but strict criteria, which are known to the student. For example, it seems obvious that convicted felons should — even after they are released from prison — not be allowed to enroll in medical schools or practice. This sounds harsh: After all, the felon “has paid his price to society” (whatever that means) and should now be able to engage honorably in an honorable profession.

In my experience — and that of many of my colleagues — we have graduated the undoubted sociopath or psychopath, and have graduated students who falsified records, stolen books, and repeatedly made obviously demeaning remarks about patients or colleagues.

It is surprising — and disheartening — that medical boards are quite ready to either reeducate or otherwise sanction physicians who have a record of consistent malpractice or to give help to those who are substance abusers, but that medical societies are hesitant to deal with ethical violations.

I think this author has the current attitude among medical students dead to rights; I spend no time thinking about this oath and I don’t think others do. He’s also right about the ethical “slips” in medical school. I wrote previously about a student in my class that tried to cheat on a test (feigning sick, then asking about the test before his makeup) and I know plenty of students that take advantage of the “I’m sick” route test after test after test. And while it’s easy for me to agree with him that, if we take these promises seriously, then we should punish those that break them seriously, I stop short of his conclusions.

I think throwing all types of felons together is lazy and ignores the difference between a murderer and a drug offender (and he addresses this, indirectly, by the support that medical boards give to MD’s abusing drugs). I think sanctioning physicians with a history of malpractice fails to draw the distinction between suits that represent Deriliction of Duty resulting in Direct Damage (you need all four D’s for it to be malpractice) d those aimed at gold (the courts can’t even draw this distinction).

I DO AGREE that any of these precursor infractions in medical school should be grounds for immediate dismissal, if for no other reason than it’s easiest to monitor. Like him, I already know two sociopaths that (God help us all) will earn an MD and practice.

So, no, the oath doesn’t seem to be taken seriously in house, but it will probably make everyones’ chests swell with pride against the buttons of their white coats just the same.

As for me? I believe in all the parts that don’t conflict with my right to earn a living that correlates with my skill in whichever discipline I choose. If I end up being a shitty doctor, I shouldn’t get to charge as much as a great one. As I said before, the Weill Cornell Medical College’s Hippocratic Oath looks solid.

But while we’re talking about professional duties and the good of patients, the honor of the guild and role in society, how about we introduce one more oath? With all that is demanded and expected of physicians, shouldn’t the State remove some of its barriers to make it easier for us to fulfill these expectations?

The State’s Oath to the People’s Health:

The State does vow, to that which society holds most dear:

That the State will honor the Profession of medicine, be just and generous to its members, and help sustain them in their service to humanity; The State and its legislature will recognize the limits of its knowledge and allow physicians to pursue their lifelong learning to better care for the sick and will support physician-recommended programs to prevent illness; That no legislation will be passed that affects the practice of medicine without the expressed support of the physicians of the State as the State recognizes that physicians are more expert in medical matters; That the State will not withdraw from patients in their time of need; That the State will govern with integrity and honor, using its power wisely; That whatsoever the State shall learn of the lives of patients shall not be spoken, but kept in confidence; That the State will maintain this trust, holding itself to the highest standards, from corruption, from the temptations of industry, from any disruption to the practice of medicine and its physicians; That above all else, the State will serve the highest interests of the patients through the support of those providing their care, and the institutions that seek to suport it. The State enters this promise with its physicians to preserve the finest medical traditions, with the reward of long service and a well-served populace. The State makes this promise upon its honor.


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