Adam, congratulations—and thank you for sharing your take.
There isn't a word in it that I disagree with, and much of it genuinely moved me. That said, I'd happily quibble over plenty of it.
Of course, such quibbling would require an old Borello, showing the mellowing of age but still with strength and character and of course expansive hand gestures, over a long, memorable meal in the proper setting. Len
It’s quite simple: do what is best for your patient and their needs, everything else will fall into place; time, personal satisfaction, income. I practiced surgery for 40 years with this philosophy and did my best to share this with surgical residents I had the privilege to train over the years, I hope they listened! Dr. Cifu, you are a breath of fresh air!
Adam, I appreciate the turn to the oath, but your version leaves much of the moral substance out (as others have noted), while adding vague aspirational language inappropriate to an oath. An oath should be something people can keep, even if difficult. So the traditional Christian marriage vow states, "I, _____, take you, _____, to be my wedded (husband/wife), to have and to hold from this day forward, for better, for worse, for richer, for poorer, in sickness and in health, forsaking all others, till death do us part." It is basically a promise to stick with one's spouse no matter what comes and not engage in adultery. That is not very flowery or romantic on the surface, but it is the heart of the matter--and both difficult but doable.
The original Hippocratic oath is similarly substantive and spare: act for the sake of the sick, abstain from mischief (clear immoral behavior), don't give deadly potions or abortifacients, maintain appropriate confidentiality, respect the boundaries of one's competence, act with integrity." That is similarly difficult but doable. It is the heart of the matter with respect to medicine.
Meanwhile, not all scientific gains are "hard-won", the "twin traps" of overtreatment and nihilism are covered in acting for the sake of the sick, ultimate consequences are not knowable, thinking in advance about test results is laudable but also not always needed (the well formed physician will do this with tacit knowledge--not consciously thinking in advance but instead knowing in advance) and covered by acting for the sake of the sick, "art as well as science... warmth, empathy, sympathy" is vague and unnecessary--by being vague it is hard to know when one has kept this promise, a student can and should take the original oath before having any claim to "extensive and hard-won expertise" (the same is true for those marrying, who make a lifelong covenant before they have any expertise about being married), sometimes common sense should be discounted--precisely when doing so is required by a commitment to the patient's health, "i will never be ashamed" is a promise that cannot be reliably kept, and I'll stop here because the rest of the statements have similar problems.
Your version reminds of the wedding vows that people often write for one another these days--they sound very heartfelt and sincere and full of promises to never to this and always do that. I have at least twice listened as young brides and grooms promise "to never take you for granted." The problem is that such vows are broken within 48 hours of taking them, because they cannot be fulfilled.
So I propose keeping the original oath's substance, updating the preamble to avoid the anachronisms of swearing to Apollo and promising to teach only those who pledge to support you in old age. All best to you and the Sensible Medicine team.
From the original (which has since been removed in modern version). I wonder why....
"I will use those dietary regimens which will benefit my patients according to my greatest ability and judgment, and I will do no harm or injustice to them. Neither will I administer a poison to anybody when asked to do so, nor will I suggest such a course. Similarly I will not give to a woman a pessary to cause abortion. But I will keep pure and holy both my life and my art."
1) DO NO HARM ("Safe and Effective")
2) NO Injustice (This includes the out of control costs of medial "care")
3) DON'T Poison or Euthanize them!! (M.A.I.D. program in Canada anyone??)
4) DON'T cause Abortions (that would be killing small humans in the womb, a.k.a. "health care")
Yes doc, "The original oath, written between the fifth and third centuries BCE, is kind of amusing to read these days." It's the complete inverse of the medical-industrial complex operating in Western countries, which seem to venerate Death, rather than Life
According to John Hopkins analysis in 2016, preventable medical mistakes were the 3rd leading cause of death. So taking out “Do no harm” seems appropriate.
Adam, congratulations—and thank you for sharing your take.
There isn't a word in it that I disagree with, and much of it genuinely moved me. That said, I'd happily quibble over plenty of it.
Of course, such quibbling would require an old Borello, showing the mellowing of age but still with strength and character and of course expansive hand gestures, over a long, memorable meal in the proper setting. Len
It’s quite simple: do what is best for your patient and their needs, everything else will fall into place; time, personal satisfaction, income. I practiced surgery for 40 years with this philosophy and did my best to share this with surgical residents I had the privilege to train over the years, I hope they listened! Dr. Cifu, you are a breath of fresh air!
Adam, I appreciate the turn to the oath, but your version leaves much of the moral substance out (as others have noted), while adding vague aspirational language inappropriate to an oath. An oath should be something people can keep, even if difficult. So the traditional Christian marriage vow states, "I, _____, take you, _____, to be my wedded (husband/wife), to have and to hold from this day forward, for better, for worse, for richer, for poorer, in sickness and in health, forsaking all others, till death do us part." It is basically a promise to stick with one's spouse no matter what comes and not engage in adultery. That is not very flowery or romantic on the surface, but it is the heart of the matter--and both difficult but doable.
The original Hippocratic oath is similarly substantive and spare: act for the sake of the sick, abstain from mischief (clear immoral behavior), don't give deadly potions or abortifacients, maintain appropriate confidentiality, respect the boundaries of one's competence, act with integrity." That is similarly difficult but doable. It is the heart of the matter with respect to medicine.
Meanwhile, not all scientific gains are "hard-won", the "twin traps" of overtreatment and nihilism are covered in acting for the sake of the sick, ultimate consequences are not knowable, thinking in advance about test results is laudable but also not always needed (the well formed physician will do this with tacit knowledge--not consciously thinking in advance but instead knowing in advance) and covered by acting for the sake of the sick, "art as well as science... warmth, empathy, sympathy" is vague and unnecessary--by being vague it is hard to know when one has kept this promise, a student can and should take the original oath before having any claim to "extensive and hard-won expertise" (the same is true for those marrying, who make a lifelong covenant before they have any expertise about being married), sometimes common sense should be discounted--precisely when doing so is required by a commitment to the patient's health, "i will never be ashamed" is a promise that cannot be reliably kept, and I'll stop here because the rest of the statements have similar problems.
Your version reminds of the wedding vows that people often write for one another these days--they sound very heartfelt and sincere and full of promises to never to this and always do that. I have at least twice listened as young brides and grooms promise "to never take you for granted." The problem is that such vows are broken within 48 hours of taking them, because they cannot be fulfilled.
So I propose keeping the original oath's substance, updating the preamble to avoid the anachronisms of swearing to Apollo and promising to teach only those who pledge to support you in old age. All best to you and the Sensible Medicine team.
I will never book more than 6 patients per hour.
I will spend 5 minutes, ad minimum, to find out who my patient is.
I will recite 20 times a day that the patient is the customer and not the insurance company.
But may be the most important one.: I will immediately fire front-office staff who are rude, condescending, and NASTY to the patients.
From the original (which has since been removed in modern version). I wonder why....
"I will use those dietary regimens which will benefit my patients according to my greatest ability and judgment, and I will do no harm or injustice to them. Neither will I administer a poison to anybody when asked to do so, nor will I suggest such a course. Similarly I will not give to a woman a pessary to cause abortion. But I will keep pure and holy both my life and my art."
1) DO NO HARM ("Safe and Effective")
2) NO Injustice (This includes the out of control costs of medial "care")
3) DON'T Poison or Euthanize them!! (M.A.I.D. program in Canada anyone??)
4) DON'T cause Abortions (that would be killing small humans in the womb, a.k.a. "health care")
Yes doc, "The original oath, written between the fifth and third centuries BCE, is kind of amusing to read these days." It's the complete inverse of the medical-industrial complex operating in Western countries, which seem to venerate Death, rather than Life
According to John Hopkins analysis in 2016, preventable medical mistakes were the 3rd leading cause of death. So taking out “Do no harm” seems appropriate.
I am old fashioned - still like the tried and true phrase “Do no harm”.
Well written. Sadly several people never understood the following
“I will strive to have a good personal life but will not allow my patients needs to suffer attaining that goal.”
“I understand I will be compensated for my efforts and accept that time spent on vacation and maximizing income are often inversely proportional. “
While some may scoff at this Cifucratic Oath I applaud the effort. Consider:
“may I never allow ulterior motives be they financial self aggrandizement to factor into my decision making “.
Good!
Beautifully put. Sensible oath. Can I share it ?
Of course. Send feedback!
Beautiful- you nailed it!