Your Doctor Does Not Believe in the Hippocratic Oath

It never seems to fail that whenever a doctor is perceived to have mistreated a patient, somewhere along the line someone will accuse him of violating his Hippocratic Oath. It will come as quite a surprise to most people to learn that most doctors cannot violate the Hippocratic Oath -- because they have never taken it! I have never taken the Hippocratic Oath either, and furthermore, I would refuse to take it if asked. And I'll bet your doctor has not taken it either.

In order to understand this seemingly incomprehensible fact, we must first understand what it is that we're talking about. Everyone has heard about the Hippocratic Oath and the name is bandied about like it is some irrefutable axiom of medicine. But I suspect that most people (and likely most doctors today) have never actually read it. So let's do so right now.

THE HIPPOCRATIC OATH
I swear by Apollo the physician, by Æsculapius, Hygeia, and Panacea, and I take to witness all the gods, all the goddesses, to keep according to my ability and myjudgmentt, the following Oath.
To consider dear to me as my parents him who taught me this art; to live in common with him and if necessary to share my goods with him; To look upon his children as my own brothers, to teach them this art if they so desire without fee or written promise; to impart to my sons and the sons of the master who taught me and the disciples who have enrolled themselves and have agreed to the rules of the profession, but to these alone the precepts and the instruction.
I will prescribe regimens for the good of my patients according to my ability and my judgment and never do harm to anyone.
To please no one will I prescribe a deadly drug nor give advice which may cause his death.
Nor will I give a woman a pessary to procure abortion.
But I will preserve the purity of my life and my art.
I will not cut for stone, even for patients in whom the disease is manifest; I will leave this operation to be performed by practitioners, specialists in this art.
In every house where I come I will enter only for the good of my patients, keeping myself far from all intentional ill-doing and all seduction and especially from the pleasures of love with women or with men, be they free or slaves.
All that may come to my knowledge in the exercise of my profession or in daily commerce with men, which ought not to be spread abroad, I will keep secret and will never reveal.
If I keep this oath faithfully, may I enjoy my life and practice my art, respected by all men and in all times; but if I swerve from it or violate it, may the reverse be my lot.

Okay, so why have most doctors not taken this Oath? Let me rephrase that -- why have most physicians not taken it? Why do I make that distinction? Because the Oath does. The words "physician" and "doctor" are not synonyms, at least in medical parlance. A "doctor" is anyone who has graduated from medical school and been granted an advanced degree in the study of medicine. A "physician" is a person trained (today exclusively in medical schools) in the diagnosis and treatment of illness. "Physician" is distinguished from "surgeon" by the Oath in the phrase "I will not cut for stone, even for patients in whom the disease is manifest; I will leave this operation to be performed by practitioners, specialists in this art"; those "practitioners" were surgeons, who in the days of Hippocrates were glorified barbers. Thank goodness surgeons today are highly trained, skilled specialists with advanced degrees in the study of medicine. Also note that the world famous medical dictum "First do no harm" (Primum non nocere) is not actually in the Oath. This translation does say "and never do harm to anyone" but other translations do not use these words. Primum non nocere comes from another source.

Going through the Oath from top to bottom:

"I swear by Apollo the physician, by Æsculapius, Hygeia, and Panacea, and I take to witness all the gods, all the goddesses" -- Few if any physicians today would swear by these pagan gods, whether they are Christian, Jewish, Muslim, Hindu, or other. This is the part that would keep me from taking the classic Oath.

"To consider dear to me as my parents...but to these alone the precepts and the instruction" -- Medicine is no longer taught by the apprenticeship method as it was in antiquity and up until the latter part of the 19th Century. Also, I doubt in this modern world that any physician could afford to teach disciples free of charge.

"To please no one will I prescribe a deadly drug nor give advice which may cause his death" -- Even over 2400 years ago, Hippocrates recognized the slippery slope of allowing physicians to participate in assisted suicide. He recognized that in order for people to trust and respect physicians, they had to know that the physician would not try to kill them. Additionally, one must remember that poisoning was a common form of assassination, so the physician had no way of knowing who the lethal draught would be used on. Unfortunately today some physicians have forgotten this and are ready and willing to slide down that slippery slope.

"Nor will I give a woman a pessary to procure abortion" -- It's amazing how much we have forgotten in 2400 years about the sanctity of life. Besides, 2400 years ago abortion agents (they didn't have D&C's) were as likely to kill the mother as they were to kill the fetus.

"I will not cut for stone, even for patients in whom the disease is manifest; I will leave this operation to be performed by practitioners, specialists in this art" -- Cutting for stone means surgical removal of kidney and/or bladder stones, a procedure that was almost universally fatal at that time. Best to let the barbers, uh surgeons, do that. Of course, unless you passed the stone, you would die anyway, but at least that way you had a little bit of a chance. Today it's irrelevant, as we have figured out how to do this safely. Would you want youphysicianan or surgeon to swear to not do this and let you die of a kidney stone?

"In every house where I come I will enter only for the good of my patients, keeping myself far from all intentional ill-doing and all seduction and especially from the pleasures of love with women or with men, be they free or slaves" -- Can you believe there are people today that object to this clause being in the Oath? Naturally, I understand the bit about slaves, but there are those that object to the prohibition against having sexual relations with patients. Those people don't sit on state licensing boards however; do this and you'll likely lose your license to practice medicine.

The Hippocratic Oath came under assault beginning in the 1960's and 1970's, with various special interest groups wanting certain pieces dropped out of the Oath, for reasons similar to those listed above. 'How dare we prohibit performing abortions!' 'We don't dare mention or even imply the idea of homosexual relations!' 'It makes no sense to prohibit kidney stone surgery!' 'People have a right to choose when to die, and doctors should be allowed to help them do this in comfort!' So modern versions of the Oath were created, and even entirely new oaths were written. Most of these are so bland they'd put you easily to sleep. Interestingly, most of them are also longer than the classic Oath. A 1993 survey of medical schools showed that only 14% of modern oaths prohibit assisted suicide, 8% prohibit abortions, 11% mention any deity at the beginning, and only 3% forbid sexual contact with patients. I'd lay odds that in 2006, these numbers are even lower, especially for euthanasia and abortion. A recent survey of American medical schools revealed that only 2 schools still use the classic Hippocratic Oath.

So it is likely that your doctor did not take the Hippocratic Oath, and it is just as likely that there is something in the Oath that he just doesn't believe in. Yes, he took an oath when he graduated medical school, and it may have been called "the Hippocratic Oath", but it likely wasn't. But don't hold it against him. After all, it's been a long time since anyone built any temples to Apollo.

For further reading see these websites:

http://www.pbs.org/wgbh/nova/doctors/oath.html
http://en.wikipedia.org/wiki/Hippocratic_Oath

And, Medicare Part D must be destroyed!