|
The Hippocratic Oath in Modern Health Systems
The advances of medical sciences have offered many insights into the causes and affects of ill health. Nevertheless, it seems as though these advances have out-stripped and compromised the ability to provide a consistently high standard of ethics, hygiene and patient-care. This sets a challenge for the value of the Hippocratic oath in the 21st century. All physicians swear to the Hippocratic oath, which is 2500 year old. However, back when the oath was created hospitals were open 24 hours daily and physicians didn’t charge for their services (Ucalgary, p.2). Without the overheads of modern medical services, it was possible to deliver a patient-centered service. With changes in hospital facilities and methods of treatment it has become harder and harder for doctors to really live by their oath. Some of the biggest challenges to the modern physician are: too many patients, lack of education, use of drugs instead of natural remedies and the increasing number of pathogens that have become immune to modern remedies.
In Britain, it has been a case of waiting for treatment for so long that one becomes chronically ill. Health Secretary Alan Milburn pledged to build a “fairer, faster, and patient-centered National Health System where no one would wait longer than 12 months.” However, if a twelve-month wait is an improvement, then Britain is already in trouble. The rising number of patients has also created much confusion in overbooked and understaffed hospitals, that may also employee undereducated doctors.
 |
|
Since 1998, the number of operations performed at wrong surgical sites or on the wrong patient rose dramatically in the U.S. From 15 incidences in 1998 to a current 150, the Joint Commission on Accreditation of Healthcare Organizations found the most common errors to be orthopedic and podiatric operations. Out of 126 cases, 41% were analyzed. Of these, 20% of cases were in general surgery, 14% in neurosurgery, 11% in urologic surgery and the rest in dental and oral operations. In some cases there were operations on the wrong body part or the wrong surgical procedure (Reuters #2, p.1). In one case, the New York State officials went as far as to bar the Mount Sinai hospital from further partial-liver transplants for six months. In response to the death of a donor, it was considered that he received inadequate care from inexperienced physicians resulting in his death. The hospital was also fined $48,000 on 18 violations and ordered to review all aspects of the hospital’s liver transplant program (McShane, p.2). Using live liver donations is a way to overcome the growing shortages of organs from the recently deceased, but there is no consensus amongst the medical profession on the process.
The pressures and cost of modern medicinal practice contribute to the problem. Analysis of 115 residents of the University of Washington Affiliated Hospitals Internal Medicine Residency Program revealed burnout, depersonalization, perceived low personal accomplishment and debts from their educational training (Wong, p.1). This naturally affects service provision.
 |
|
Another major factor is the use of drugs instead of natural remedies. A recent report in the Journal of American Medical Association has revealed that the 4th and 6th leading cause of death in 1998 was the adverse reaction to drug therapy. It wasn’t a case of slack practices either, for the report involved hospitals that were under monitored conditions. The drugs were properly prescribed and administered. On this issue, MD Richard Ruhling referred to the Greek physician Hippocrates who said: “Let your food be your medicine”, but as Ruhling reminds us “ but we are using chemicals [drugs], and they all have a long list of adverse reactions listed in the Physicians Desk Reference at most libraries.” The chemicals added to or used to grow food complicate treatments further. Symptoms of allergy range from asthma, attention deficit disorder, arthritis, muscle tension, nervous disorders, depression, dizziness, gastritis, headaches, insomnia, sinusitis, rashes, urinary infrequency and chronic symptoms. This long list of adverse reactions could also be symptoms for something else (HealthWorld, p.1).
Another reason could be the increasing number of pathogens that have become immune to modern antibiotics. Every year 30,000 cases of salmonella poisoning occur in Scotland. At the Glasgow Victoria Infirmary January 2002, 88 non-urgent operations were postponed whilst emergencies were admitted elsewhere. Three patients died from an apparently unrelated outbreak of salmonella including 74-year old Rudolfo Ionta who was admitted with multiple sclerosis (Kelbie, p.1).
Two million American patients acquire an infection after being admitted to a hospital for another reason, and over 90,000 Americans die annually in hospitals infected with disease causing organisms that have become resistant to at least one antibiotic. The Center for Diseases and Prevention are leading a campaign to overcome this problem. “We want to make sure people really appreciate how rapidly and ominously this problem is evolving in health care systems” they commented (HealthWorld #2, p.1).
Although in general society is more informed, the speed at which the modern man lives can also effect healthcare. Patients expect physicians to know everything and some go too far in trying to live up to those expectations. The increasing demand never ceases and with that increased demand there is increased pressure and then there are mistakes arising from those pressures.
The rising malpractice claims in Germany are a point of reference. Using data from physician groups, insurance companies and government agencies, The Robert Koch Institute and the German Statistics Office compiled 40,000 claims. Surgical claims represented 38% of the 40,000, orthopedics 15%, gynecology and obstetrics 14%, internal medicine 8% and general medicine 5%. In 1999, 126,000 malpractice claims involved hospital physicians. Looking at the root causes of these claims, it was discovered that the claims stemmed from “organizational deficiencies”. Weak consulting co-ordination between physicians accounted for 23% of incidences, inadequate documentation for 20% and incorrect referrals to other professionals 13%. Also it was found that there was an inability to assign physicians to recognize and treat complications. (Reuters #1, p.1, 2).
The above factors then become additional stress factors for the ill. ‘Ali ibn Rabban al-Tabari synthesized the Hippocratic and Galenic traditions of medicine with the traditions of India and Iran. As a master of prognosis and psychosomatic medicine maybe today this approach could offer some guidance (iad p.1). Principles that seem to be difficult to sustain. MD Richard Ruhling believes that physicians have forgotten the meaning of the Greek root word
“physis” meaning “nature” (HealthWorld #1, p.1.).
However, one does need a system to support this ethos. Addressing the Hippocratic Oath in the 21st Century, this February, two American medical groups and one European group issued an updated version bearing in mind the pressures of industrialized nations. Known as the “Charter of Medical Professionalism”, it is committed to patient-well-being as stated in the original Hippocratic Oath with some additions. The charter honors patient autonomy and social justice, patient confidentiality, look to improve access to care and eschew conflicts of interest. The American College of Physicians, the American Society of Internal Medicine and the American Branch of Internal Medicine (Morse p.1) have endorsed this charter. It will take all those involved in training, management and service provision to make this charter a reality for those they serve - the patients.
You can find a copy of the Muslim Oath of the Physician at:
The Hippocratic Oath used by MD’s around the world has many versions.
Sources:
|
