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 Table of Contents  
EXPERT COMMENTARY
Year : 2021  |  Volume : 7  |  Issue : 2  |  Page : 79-80

Can the Hippocratic Oath survive medicine becoming healthcare?


1 Baylor College of Medicine Menninger, Department of Psychiatry and Behavioral Sciences Baylor College of Medicine 1504 Taub Loop Houston, TX, US
2 Director of Research and Scholarly Activity for the Oak Hill Hospital EM Residency Program in Brooksville, FL, Professor of Emergency Medicine and Research for William Carey University College of Osteopathic Medicine, US

Date of Submission20-Aug-2020
Date of Acceptance22-Feb-2021
Date of Web Publication29-Jun-2021

Correspondence Address:
Dr. Nidal Moukaddam
Baylor College of Medicine Menninger Department of Psychiatry and Behavioral Sciences Baylor College of Medicine 1504 Taub Loop Houston, TX
US
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/IJAM.IJAM_109_20

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How to cite this article:
Moukaddam N, Tucci V. Can the Hippocratic Oath survive medicine becoming healthcare?. Int J Acad Med 2021;7:79-80

How to cite this URL:
Moukaddam N, Tucci V. Can the Hippocratic Oath survive medicine becoming healthcare?. Int J Acad Med [serial online] 2021 [cited 2021 Sep 26];7:79-80. Available from: https://www.ijam-web.org/text.asp?2021/7/2/79/319795



He will manage the cure best who has foreseen what is to happen from the present state of matters.

– Hippocrates

In “The Book of Prognostics,” Part 1 (400 BC), as translated by Francis Adams, The Genuine Works of Hippocrates (1849), Vol. 1, 113.

The Hippocratic Oath has long been a prestigious, symbolic landmark of medical education. A doctor's path starts with taking the oath that shall guide their career path and cast them as a protector of humanity. Similarly, a nurse's path starts with the Nightingale Pledge. Both are moral frameworks laying down a delicate, nuanced, yet forceful moral obligation system. Through thousands of years, the Oath, written in the fifth century and translated in 1943 by Ludwig Edelstein, has undergone only one major re-haul, in 1964, by Dr. Louis Lasagna, then Dean of Medicine at Tufts University, with changes that made the concepts more applicable to modern medicine. The Nightingale Pledge, modeled after the Hippocratic Oath, is similarly aligned in values of dedication and professionalism.

Sadly, honorable intentions and traditions have hit the wall of reality with COVID-19. The pandemic has highlighted existing ethical dilemmas in our current medical system, as well as added a layer of complexity with medical decision-making regarding patients afflicted with COVID-19[1]. The basic question that has arisen is about allegiance. In a way, the invisible shackles of morality embedded in the Hippocratic Oath and the Nightingale Pledge bind the clinician into protecting the patient and society and selflessly care for others in their times of need and misery. But, is this where allegiance still lies? The doctor–patient relationship? The greater good of society? Or one's personal safety, as almost a fifth of infected patients are healthcare workers?

Let us start by taking a closer look at the American medical system. Notice, dear reader, that we are using the term medical. However, news media, magazine articles, and government never mention medicine anymore; they mention healthcare. This is where the confusion starts. The noble art of medicine is simply not healthcare. The dedication of a nurse or a doctor at a patient's bedside as the individual takes their last breath can be highly monetized, scrutinized, but could never be fully operationalized. This is where healthcare ends and medicine begins. To be fair, the depersonalization and dehumanization of the profession of medicine had started before the current pandemic, with the gradual change from doctor or physician to the very derogatory, generic term of provider. This transition, well hidden, insidious, has preyed on the trust of the public and focused on the delivery of a monetized product, boxing medicine into a deliverable. However, the COVID-19 pandemic has uncovered the corporate takeover of the medical system. When we are dying in lonely hospital bed, surrounded by staff wearing a mask that hides their kind smile, or their worn-out, tired faces, it is not healthcare we call for, it is not the administration looking at the patient as a client, a source of money.

The United States continues to have one of the most expensive healthcare systems in the world; administrative costs and billing-related costs have increased steadily since the 1970s, rendering the behemoth system, one of the most opaque and bureaucracy-laden among civilized countries[2]. The growth in the number of physicians and nurses has not kept up with actual or projected demand, and various clinicians of intermediate levels of training (building upon a nursing degree, but shorter than medical training) have been incorporated in the system to meet such demands. Growth of physician numbers (and salaries) has remained at <10% while growth in administrator number and salaries has been reported to be close to 2300% according to the Bureau of Labor Statistics' Occupational Outlook Handbook. This is our first question about allegiance: In a world governed by management and financial priorities, what happened to the spirit of medicine, and are individuals at the frontline of healthcare still bound by the moral shackles of the oath? The way medicine is being practiced suggests a resounding yes: The level of sacrifice of healthcare workers on daily basis has been touching, desperately dedicated. However, a note of sadness emerges. That same group, so selflessly jumping into medicine, is being mistreated by healthcare, with salaries being cut, and sick healthcare workers being asked to use personal leave or unpaid time off when they get ill doing their job.

Let us then turn to the realities of practicing medicine in everyday life. When we don on personal protective equipment and step into the emergency department or the intensive care unit, there are no administrators or managers. Only people in scrubs who want to save lives. But also people in scrubs trying to help dying patients, wondering if holding an iPad, so the family members can say good bye, is the right course of action. Medicine says yes, it is absolutely the right course of action, you will not want your loved one to die alone, scared, and isolated; healthcare says no, this time is not necessarily billable, and can that bed please be emptied faster, other patients are waiting. Hence, here it is, our big question: Is my loved one a client or patient? I want them to be a patient, not a client, a commodity that pays the bills. Healthcare has no heart and no allegiance. Medicine does. Medicine sees my loved one as a patient, to whom care, dedication, and sacrifice are due, and in this time of suffering, this is what we need, the moral shackles of the Hippocratic Oath and the Nightingale Pledge.

Hence, where does the Oath stand in this pandemic? Is it time to lose the allegiance to putting patients, human beings, first? Is it time to stop doing what is right for fear of pay cuts and ire of administrators? Healthcare says yes, but Medicine says no…



 
  References Top

1.
CDC COVID-19 Response Team. Characteristics of health care personnel with COVID-19 - United States, February 12-April 9, 2020. MMWR Morb Mortal Wkly Rep 2020;69:477-81.  Back to cited text no. 1
    
2.
Papanicolas I, Woskie LR, Jha AK. Health care spending in the United States and other high-income countries. JAMA 2018;319:1024-39.  Back to cited text no. 2
    




 

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