Friday, November 19, 2010

Sworn in

Yesterday, I received my stethoscope in the mail. Today marks the two-week point since our White Coat Ceremony (shout-out to Dr. Lovering!). And this got me thinking.

One of my absolute favorite ICM sessions to date was the one a week before our ceremony, when we read through and discussed the various medical oaths that have come down through the centuries. Our profession is infused with a rich, inspiring history that brings with it the heavy weight of responsibility -- that day, we got a chance to touch on a small fraction of it.

I marked up my copies of the passages, but I just wanted to put down my thoughts on the parts that resonated the most. So, chronological order.

Hippocrates' Oath
Hippocrates, in the late 5th century B.C., set down many of the most basic tenets of medicine that we now take for granted. He swore his responsibility holding the Greek gods as witnesses. He stressed the familial/brotherhood aspect of medicine, and the importance of passing knowledge down to the next generation of disciples. His oath implied a separation between the art of medicine and the art of surgery. The oath introduced the concept of patient confidentiality. But most interestingly, in my opinion, was his very last sentence:

"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."

He didn't settle for, oh, if I do right, I'll do okay in life, but also stressed, should I do wrong, I should suffer the consequences of the violation of my responsibility. I think that idea, while not completely lost in the revisions and versions that came later, wasn't stressed quite as much as it was here, in Hippocrates' writing.

Oath of Maimonides
Maimonides, a Jewish physician and philosopher, also invoked his faith in his oath, written in the 12th century. He brought in another crucially important idea in practicing medicine: "May I never see in the patient anything but a fellow creature in pain." I can't speak from extensive personal experience, but from what I've heard and what little I have seen, this idea sometimes is forgotten in our over-eagerness to 'fix what's wrong' with our patient, and is often difficult to face. Another stigmatized idea Maimonides made mention of is admitting that yes, even doctors make mistakes. We can't afford to freeze up in face of them, but must learn, internalize, and carry forward.

Nightingale Pledge
A pledge first taken by nurses in 1893, named after Florence Nightingale, it made mention of something I don't think was quite as explicitly mentioned in any of the other oaths. Hippocrates did make mention of not administering deadly drugs to one's patients. This pledge, however, stressed neither taking nor giving any harmful drugs, acknowledging a medical practitioner's responsibility to both self and patient. It was strange to see that the pledge didn't make explicit mention of the 'art of nursing,' so to speak, the warmth that is often associated with it.

Declaration of Geneva
The Declaration of Geneva was first written and adopted by the World Medical Association in 1948. I suppose because it was an obviously international document, it more explicitly acknowledged issues of discrimination across many lines -- religion, race, nationality, political affiliation, social status, none should come between the doctor and his/her patient. This was also the second of our selection of oaths that included anti-abortion sentiments, after Hippocrates', which I suppose given the timeframes makes sense. 

Oath of Louis Lasagna
This one was by far my favorite of the oaths. Louis Lasagna put out a revision of the Hippocratic Oath in 1964, and injected a bit of quiet humor and poetry into his comprehensive breakdown. He acknowledged ongoing research in medicine and stressed avoiding the "twin traps of overtreatment and therapeutic nihilism." Lasagna wrote of the art and science of medicine, of speaking to patients regarding matters of life and death, taking care not to play God with a patient's life, remembering that you are treating a sick human being, that prevention is preferable to curing, and that we now are joining the ranks of a society that carries many an obligation. But most important, I think, is his hope to never lose the "joy of healing."

Student Oath
The student oath we read at our White Coat Ceremony was an amalgamation of many of these oaths, and incorporated almost all of the elements I most admired in the other oaths we read through. Wearing my shiny new white coat, I stood holding a sheet of paper full of words that grew heavier in the air as I breathed life into them anew, along with the rest of my class. As I reached the end of the oath, I felt the weight of those words settle from the air onto my shoulders, woven into the seams as tightly as they were into my psyche.

And it feels simultaneously humbling and thrilling.