Hippocrates in a Rage

Reference is often made by the public and the Main Stream News Media, to the Hippocratic Oath, and it drives my wife wild. “I doubt they have ever read it” she proclaims, and is probably right in her suspicions. If they have, I suspect that it is the “Modern” sanitized version, and not the true “Classic Version”. And believe me there is a difference!
Of note is: the Classic Version starts by swearing by all the gods known to Hippocrates at his time, and making these same gods his witness, that we physicians will live by this oath. He goes further and ends the oath by saying that if we honor this oath, “may it be granted to me to enjoy life and art, being honored with fame among all men for all time to come, if I transgress it and swear falsely, may the opposite be my lot”. The Modern Version starts by simply saying “I swear”. God or the acknowledgement that there is a higher power only comes up with “I promise not to play at God”. The Modern Version ends with the politically correct “If I do not violate this oath, may I enjoy life and art, respected while I live and remembered with affection thereafter. May I always act to preserve the finest traditions of my calling and may I long experience the joy of healing those that seek my help”. What? No fame and fortune if I live up to my oath? No hell and damnation if I don’t?
One must remember that the Modern Version was written by Louis Lasagna in 1964, and seems to be a very watered down version of the Classic imposes in strong terms “principles”. Perhaps the “flower generation” was already having its impact and making responsibility a grey area. Take, for example the Classic Versions commitment of doctors to each other. We are to consider other doctors and their families equal to our families, and help them in every way we can “without fee or covenant”. Therefore, the profession is to be considered as a family in its own right. The Modern Version states that we should respect and share scientific knowledge. It does not mention our commitment to each other. Little wonder the pride of the profession is almost non-existent. Before Medicare, I never charged other doctors and their families, nurses, and clergy for the medical care I gave them. Now there is no preferential treatment even though the Classic Hippocratic Oath specifically states there should be. In fact, I believe Alberta has a law that prohibits doctors from offering any preferential care.
Accordingly, Hippocrates would be furious with the treatment given to retired Dr. J. Don Johnston of Calgary by the Peter Lougheed Hospital emergency department March 15/06. Dr. Johnston, a Calgary physician for many years and dying of cancer, lay in an emergency bed for nine hours without medical care, and eventually went home where his wife could care for him. Don’t get me wrong, Hippocrates would be shocked at anyone being treated in this fashion, but specifically, we in the medical profession are to look after members of our profession as though they were members of our personal family. I doubt if the doctors working the emergency department that night would have left their dying father lying in an emergency bed without treatment for nine hours! And I don't care what the penalty is for preferential treatment.
But I digress. Specifically, the Classic Hippocratic Oath states that “according to my ability and judgment, I will keep them (meaning the sick) from HARM and INJUSTICE”. (Capitals are mine). Wow, where were we as a profession as “risk” times grew longer and longer in Canada? Then the classic version goes on to specify that we should have no part of euthanasia or abortion. I wonder how that part of the Hippocratic oath sits with those people who keep harping on us to honor the Hippocratic Oath when we talk about the precipitous fall in our standard of living since Universal Health Care in Canada?
The Classic Version states: “Whatever houses I may visit, I will come for the benefit of the sick, remaining free of all intentional injustice”. What’s this? House calls? Yes, you’re right. The Modern version doesn’t mention house calls. But what is this about intentional injustice? Could this mean that we should not have ulterior motives or be in a conflict of interest? That sounds good! Unfortunately the Modern version omits this area. It does, however, try to micromanage our practice of medicine by saying politically correct things like: we shouldn’t over treat, that prevention is preferable to cure, that we should be humble in the face of our “awesome responsibility”, and specifically to remember “that I remain a member of society, with special obligations to all my fellow human beings”. Now this last part really burns me! Keep in mind that this is a special oath taken by practitioners of medicine, as set out by Hippocrates, the recognized “Father of Medicine” who clearly states that our obligation is to the patient we are attending. All of a sudden, in 1964, one university elite decides that I, as a physician, have “special obligations to my fellow human beings”. “More special than any other member of society”, I ask, “and more than my special obligations to my patient”? Is my responsibility to society more special than to my fellow physicians? More special than to my family and friends? And who made this Louis Lasagna the “new father of medicine”? Over the last thirty years we have lost our allegiance to our patients, our pride in our profession and in ourselves, have become pawns to the whims of government, and have bought into the premise that we should be everything to everybody. Predictably, we are rapidly becoming nothing to anybody.
Hippocrates would be in a rage if he were alive today. Although he advocated that we dedicated our lives to serving those that need our skill and knowledge, he advocated that we do it with pride and independence, for it is only as independent practitioners that we can truly advocate for our patients. And we don’t leave our fellow physician who has given his life to caring for the ill, lying in a bed in the emergency department for nine hours waiting for care he never did receive. Shame on us all!