Tuesday, 14 April 2015

Hypocrisy or the road to utopia - the medical Hippocratic Oath

Since MD2 happened to chuck in a piece from the Hippocratic Oath into his prose last week, I'd thought it would be a good idea this week to present you with the whole picture. Below is the whole oath, and as a newly qualified doctor I swore on a modified oath at graduation which is more pertinent to current times!


The original Hippocratic Oath by Hippocrates (460-370 B.C.) translated

Thirteen years as a practising physician, I still work by this ethos. The principals of the physician's oath has formed the backbone of modern day medical ethics, namely, respect for autonomy, beneficence, non-maleficence, and justice.

  • Autonomy - patients right to choose or refuse treatment
  • Beneficence - the physician should act in the best interests of the patient
  • Non-maleficence - "first, do no harm"
  • Justice - fairness and equality; concerns the distribution of healthcare resources 

Unlike the rest of the world, the current National Health Service (NHS) system makes it easy to practice these principles - in particular the last point believe it or not. Recently, a patient from the States pointed this out to me. Whether, or more accurately, how long this will last is the $64,000 question.


Just to put this into perspective is a snap shot of the British Medical Association's (BMA's) discussion points from this week:

"Austerity, sanctions, and the rise of food banks in the UK"

Doctors are witnessing increasing numbers of patients seeking referrals to food banks in the United Kingdom.



"The NHS in Wales: faring worse than the rest of the UK?"




Percentage of patients waiting longer than four hours in emergency departments



Health spending per person 2007-08 to 2012-13

In these confusing times, I believe it is important to keep a level head.

9 comments:

  1. If it was JUST that oath doctors were acting on, things might be better. Unfortunately there's an additional layer that supersedes all aspects of the oath; politics and commerciality.

    You only have to look at Avastin, Rituximab, HSCT, Cladribine, etc. to see that. If anyone believes the health system is geared to patient health over profit, I think they're missing the elephant in the room. Medicine has become a big business, and like most big business, morality comes a distant second to profit.

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    1. Well Matt, it will be interesting in the current UK economic climate that our politicians (whom I like to think of as the Eye of Sauron) will begin to question the utility of MS drugs. It is important to realise that neurology is considered an orphan disorder and when the choice is between cancer, heart attacks etc and MS - guess who will be left holding the short straw! It's imperative that the MS society/Trust/NMSS and neurology governing bodies start planning for this inevitablity now.

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  2. I've obviously tweaked a tail here!
    My original point was that in my opinion, the "first, do no harm" has been over-interpreted by some (and I stress, some) to be overly cautious in their treatment decisions leading to a wait and see approach which, if like me you have robust views can be viewed as 2do nothing". The brick wall Prof G is battering his head against trying to get NEDA accepted, to give but one example pertinent to MS, is a case in point.

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    1. Next it will be doctors in charge of the budgets and it will be do nothing if it costs too much, GPs are almost paralysed in what they can't do outside a critical path of care, I couldn't get a referral so that my workmates could check some nerve issue out because a neurologist was too expensive in the NHS internal market for them to do so I had to happy with my frozen shoulder...which was so obviously not a frozen shoulder.

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  3. The lower graphics aren't working for me...has the link to the original graphic gone dead.

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    1. If you click on the link "the NHS..." it should take you to the article itself with the pictures. I'll try to fix the pics later today.

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  4. Dear me- I've just spent an arm and a leg putting my daughter through her uni medicine course- I didn't realise it was part of the oath that doctors should teach for free!

    Apart from that, how do you define healthcare? In it's narrowest sense it could be the provision of prescription medicines, treatments and surgery that can only be given or undertaken by a qualified physician. Anything else, laundry, food etc, could fall outside of it. Or is it the widest interpretation, anything that will improve your health, through social care, GPs surgeries open 24/7, gastric band operations etc.etc. I think this is where the politicians come in

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    1. Well done for picking the most politically correct sentence of the bunch!

      It's an interesting question you pose there...I think if it was up to me I'll keep it as broad as can be. I don't want some '*' telling me in the future that bandages or something equally mundane was not included in the list, thereby making the provision bandages for the health service more expensive than a Herve Leger dress...

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