Saturday, June 13, 2009

Seeing the Hippocratic Oath in a New Light

I've always had trouble with the second paragraph of the Hippocratic Oath:
To hold him who has taught me this art as equal to my parents and to live my life in partnership with him, and if he is in need of money to give him a share of mine, and to regard his offspring as equal to my brothers in male lineage and to teach them this art—if they desire to learn it—without fee and covenant; to give a share of precepts and oral instruction and all the other learning to my sons and to the sons of him who has instructed me and to pupils who have signed the covenant and have taken an oath according to the medical law, but no one else.
It's not the exclusively male focus of the oath that bothers me - there's been an opportunity for change in the 2500 years since the oath was written! What turned me off was interpreting the paragraph as a promise to protect our guild. Guild protectionism is the worst aspect of the AMA and medical specialty societies.

But last night I came to a different view. I attended the graduation of the residency in Primary Care and Population Health, sponsored by the Brigham & Women's Hospital and Harvard Vanguard Medical Associates, a program I teach in. If you're interested you can read about the program here. (If you go to the website, I'm in the blue shirt, third from the left.)

The graduation was a love-in. The four graduating residents received their diplomas from the outpatient preceptors they had worked with for three years. The preceptor described the resident. The resident described the preceptor. They hugged. Then the graduating residents said something about each of the juniors and interns, and the juniors spoke about the graduates. Most of the comments included funny stories, but the essence was talk about the qualities of the individual being discussed as a caring, committed physician.

I've thought a lot about the concept of "medical calling" and where - in secular settings - the calling comes from. (See here for a previous post on the topic.) What the graduation brought home for me is how much the calling that physicians profess is based in mutual affirmation within a group. The ceremony, with its repeated emphasis on clinical excellence, rapport, empathy and care was like a prayer service, in which fundamental values were affirmed again and again.

Those who come to health care from a religious faith perspective can explain their sense of calling in terms of their religious beliefs. But the experience of calling can be just as strong in an atheist. Some of the force comes from each person's psychology - whatever in their development and their genetics sparks devotion and caring. The graduation ceremony brought home to me just how much group solidarity around these shared values contributes to the sense of calling. It's not each person alone - it's "us."

I see Hippocrates' second paragraph differently now. It's about cultivating a family of caretakers, not about guild protectionism.

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