A Call to Reinvest in the Hippocratic Tradition
Sumner
Abraham
M.D.
Chief Resident in Department of Medicine
University of Virginia
To borrow a question posed by Steven Garber of the world, the greatest question we will face as physicians is- can we know the world of modern medicine and still love it, still believe in it. Contemporary medicine’s landscape is dominated by technology, corrupted by money and perverse incentives, and its practitioners daily see the failures of the system to her patients. Can you love a medicine like this? Should you love a medicine like this?
The Hippocratic Oath frames the profession of medicine as bound by sacred obligations, but as Paul Starr rightly recognizes, the medicine we know today as a battlefield for the institutionalized medical profession for market and professional control. The larger cultural climate has exuded freedom from authority and autonomy. This is reflected both in biomedical ethics and medical education. This irrational pursuit of self-interested freedom, notably away from a guiding Hippocratic tradition, has fostered ceaseless craving and discontent among physicians at all stages. Though this seems like a recent phenomenon, Albert Jonsen contends that the original Hippocratic prescriptions were not ethics but “counsels of self-interest, good advertising and a skill its practitioners were craftsmen, and their objective was a good living.”
In this paper, I will give an account of how medical schools and graduate medical training fail to hold students and trainees to a Hippocratic tradition, and provide a prescription for what it may look like for GME to reconsider how it wields the Hippocratic tradition as it instills. This will be largely built on ideas discussed in Dobken’s piece “The ‘New’ Medical morality: Hippocrates or Bioethics?” I would argue that Hippocratic tradition has been abandoned due to shift to secularity (there’s no absolute truth, any narrative truth is one option among many) and the growing lack of trust patients have of physicians.
In today’s climate, only within a Christian worldview is medicine a matter of charity, self-giving love. The Hippocratic-Christian legacy of self-interest and altruism, respectively, make the fundamental tension with which the medical profession grapples with today.
The Hippocratic Oath was an ethical covenant that operated at multiple levels: it bound the physician to standards of practice in a compact of mutual assistance, cooperation, loyalty, and learning; it defined the goal of medicine as the care of the sick without regard to income or social standing; and it tied physicians to the good of society at large. The oath enabled trust as the reward for honorable practice came not from financial rewards but from the communities and citizens served by the physician.
As Dobken notes, the Hippocratic ideal envisions the care of the sick as individual occurrences in the context of the needs of the community. The shift seen as a result of bioethics demonstrates a focus away from the individual to the collective, thus the abandonment of the authority the Hippocratic tradition once possessed. Graduate medical training should re-emphasize the Hippocratic tradition as a source of authority to help design educational experiences that intentionally emphasize the cultivation of virtue.
The Hippocratic Oath frames the profession of medicine as bound by sacred obligations, but as Paul Starr rightly recognizes, the medicine we know today as a battlefield for the institutionalized medical profession for market and professional control. The larger cultural climate has exuded freedom from authority and autonomy. This is reflected both in biomedical ethics and medical education. This irrational pursuit of self-interested freedom, notably away from a guiding Hippocratic tradition, has fostered ceaseless craving and discontent among physicians at all stages. Though this seems like a recent phenomenon, Albert Jonsen contends that the original Hippocratic prescriptions were not ethics but “counsels of self-interest, good advertising and a skill its practitioners were craftsmen, and their objective was a good living.”
In this paper, I will give an account of how medical schools and graduate medical training fail to hold students and trainees to a Hippocratic tradition, and provide a prescription for what it may look like for GME to reconsider how it wields the Hippocratic tradition as it instills. This will be largely built on ideas discussed in Dobken’s piece “The ‘New’ Medical morality: Hippocrates or Bioethics?” I would argue that Hippocratic tradition has been abandoned due to shift to secularity (there’s no absolute truth, any narrative truth is one option among many) and the growing lack of trust patients have of physicians.
In today’s climate, only within a Christian worldview is medicine a matter of charity, self-giving love. The Hippocratic-Christian legacy of self-interest and altruism, respectively, make the fundamental tension with which the medical profession grapples with today.
The Hippocratic Oath was an ethical covenant that operated at multiple levels: it bound the physician to standards of practice in a compact of mutual assistance, cooperation, loyalty, and learning; it defined the goal of medicine as the care of the sick without regard to income or social standing; and it tied physicians to the good of society at large. The oath enabled trust as the reward for honorable practice came not from financial rewards but from the communities and citizens served by the physician.
As Dobken notes, the Hippocratic ideal envisions the care of the sick as individual occurrences in the context of the needs of the community. The shift seen as a result of bioethics demonstrates a focus away from the individual to the collective, thus the abandonment of the authority the Hippocratic tradition once possessed. Graduate medical training should re-emphasize the Hippocratic tradition as a source of authority to help design educational experiences that intentionally emphasize the cultivation of virtue.