I’m 16 years old and my mother and father drive me 4 hours to meet a surgeon with both a medical and dental degrees from Vanderbilt and Harvard. When he walks into the exam room, I am hyper focused on his waxed handlebar mustache combination. My parents hang on his every word, as he speaks with unwavering authority about my ‘condition.’
My diagnosis: degenerative arthritis of the TMJ with bilateral displaced discs and regressive modeling of the mandibular condyles. He explains the need for surgery with disc repair, bone biopsy, osteotomy, and alloplastic Silastic implants.
They didn’t question his method or technique because he was the doctor. In fact my parents never questioned anyone while I was growing up, not the mechanic, the air conditioning repair man, the pool guy, no one…they ran on blind faith.
My whole problem started in 1990 when I was 16 and my mother let this surgeon put Silastic implants in my face. They had already been recalled by the FDA, it he told her that they are safe for off label use as long as they aren’t used to replace the disc in the joint.
So he put them in and removed them 3 times from 1990-1993. The biopsy shows that I had pink healthy tissue during the first surgery and by the time of the second operation the findings were ‘foreign body giant cell reaction and the tissue specimen was grey and brown’
Dow Corning settled a class action lawsuit, but my family wasn’t part of it because my parents were convinced that this surgeon was God and they let him cut me open 14 times, before he decided that I was beyond his expertise, and he abandoned me.
Medical students take the Hippocratic Oath to ’first, do no harm.’ when they become Doctors
In cases of TMJ dysfunction, the diagnosis isn’t clear and there isn’t a standard course of treatment or definitive set of diagnostic tools. The best option is to run tests to ‘rule out’ possible diagnoses. The medical community uses the power of deduction to make an educated guess. By it’s very nature, practicing medicine by working backwards is certain to cause some harm.
Personal examples of the harm done while trying to ascertain a proper diagnosis often requires painful and invasive tests, trial medication regimens with dangerous side effects, and exploratory procedures that are nothing more than surgical fishing expedition to look for anything remarkable or an anomaly that doesn’t match the Grey’s Anatomy textbook page.
Since it’s virtually impossible to accurately compare the risk and benefit ratio of one course of action against another, patients have to weigh the pros and cons of their own healthcare using variables like finances, yelp reviews and rhetoric from other patients on social media.
Patients take calculated risks when deciding on a treatment plan, because we can’t tell ahead of time whether greater harm will result. In desperate times— the risk (no matter how great) will never outweigh the possibility of living another day in pain.
I have tremendous respect for the medical community, but after decades of incorrect diagnoses and ineffective treatments, it would be irresponsible of me to blindly move forward with a treatment plan just because a doctor has good ethical intentions.
Baby Boomers took the doctor opinion as gospel and never dared question how he came to his assessment. They were bound by some unwritten rules of proper etiquette.
BUT…we can’t allow this oath to stand in the way of patient rights. A patient has the right to question the treatments, methods, research and patient reported outcomes before blindly trusting a doctor. A patient has the right to advocate for themselves.
We need high-quality research to help us better understand the balance of risk and benefit for the tests and treatments we recommend. Ultimately, it is also a reminder that doctors should neither overestimate their capacity to heal, nor underestimate their capacity to cause harm
Why An Upgraded Hippocratic Oath Is Needed In The Digital Era
The Medical Futurist
8 min | 18 July 2018
The Hippocratic Oath is the most famous text in Western medicine and constitutes the ethical basis of the medical profession. For centuries, it has provided an overview of the principles of this noble mission and doctors’ professional behavior. At the dawn of a new era in medicine, it is high time to rewrite the Oath so that it would reflect the state of technological development, changes in social structures and in general, the requirements of the 21st century.
The Hippocratic Oath in historical perspective
The medical profession adopted the Oath of Hippocrates as its ethical code of conduct centuries ago, but it’s still being used today by many medical schools at graduation ceremonies. That’s not mere chance. The text articulates perfectly what the noble profession of being a doctor entails and in a compact overview takes a side in every major ethical issue a physician might encounter during their career.
Only a few know that although the oath bears the name of Hippocrates, the well-known Greek physician, there is no evidence that he wrote it. It is claimed that the document was created 100 years after his death. Some 2500 years ago.
Rachel Hajar in her study on the historical perspectives of medical oaths says that in 1500, a German medical school (University of Wittenberg) introduced taking the oath for its graduating medical students. However, it was not until the 1700s, when the document was translated into English that Western medical schools began regularly incorporating it in convocations. In 1948, it was adopted by the World Medical Association (WMA) based in Geneva – that’s the so-called Declaration of Geneva. Numerous medical schools use this version of the Oath ever since. Later, the text was rewritten by Louis Lasagna (the then Dean of the Tufts University School of Medicine in Boston, Massachusetts, USA) and this version was adopted by many medical schools in the USA.
Does the Oath have any significance today?
It seems it still does. Although not every medical student is required to take the Hippocratic Oath or any kind of oath for that matter, and no one is legally bound by the text, the majority of physicians believe the Oath still has relevance today – although it cannot reflect on many contemporary issues and possesses ambiguous, troubling passages.
In 2016, Medscape created a poll to measure opinions about the relevance of Hippocrates’ famous pledge. Total responses to the survey numbered 2674 physicians plus 134 medical students. Reactions were deeply polarized, and age was a decisive factor. Those under age 34, 39% said it was significant, compared with 70% of those 65 and older.
Still, statistics show that the majority of medical schools incorporate some kind of oath, in numerous cases the Hippocratic Oath into a ceremonial event. Thus it is essential for schools to give ethical guidance to medical students. But the Hippocratic Oath is in many cases exchanged with something else as it cannot offer young people the pieces of advice they need in the modern world.
Here, we suggest some changes to the original Hippocratic Oath to better reflect the 21st century.
The principles of the Hippocratic Oath -renewed
1) Patient inclusion
A passage of the Oath reads as follows, “I will respect the hard-won scientific gains of those physicians in whose steps I walk, and gladly share such knowledge as is mine with those who are to follow”.
However, where are the medical researchers, the nurses or the patients? The scientific community does not only consist of physicians. Thus it would be great to include more players in the field, also symbolically. By now, doctors are not the sole repositories of medical knowledge, and the ivory tower of medicine is crumbling under the weight of the digital sphere, social media, empowered patients or the DIY movement. The Hippocratic Oath should reflect that.
2) Healthcare must shift from treatment to prevention
Another section says that “I will apply, for the benefit of the sick, all measures [that] are required, avoiding those twin traps of overtreatment and therapeutic nihilism”.
However, with the recent advances in precision medicine as well as the appearance of preventive health, physicians should not only tend to those who already have symptoms and need treatment but advise the healthy how to stay fit and well. The appearance of health sensors, wearables, and health apps result in a massive chunk of data, which will help analyze as well as predict trends in the health of individuals and populations. This should be included in the Oath, too so medical professionals could act for the benefit of the healthy and the sick.
3) Acknowledgment for technologies
The Hippocratic Oath should not get by without the inclusion of technologies anymore. It has to acknowledge the transformative impact that medical technologies have on healthcare – traditional as well as digital solutions. However, like artificial intelligence, robotics, AR/VR, health apps, wearables, sensors, portable diagnostic devices transform healthcare, that will be even more essential.
So, what if the oath said, “I will remember that there is art to medicine as well as science, and that warmth, sympathy, and understanding may outweigh the surgeon’s knife, the programmer’s algorithm or the chemist’s drug?” What if we include “available technologies” into the following passage, so it will read this way: “I will help prevent disease whenever I can with my knowledge and available technologies, for prevention is preferable to cure”.
Physicians need to acknowledge the raison d’etre of technologies in healing, and one of the means to assume its rightful place in medicine starts with its inclusion into the Hippocratic Oath.
4) Recognition of life-long learning
Not only is it necessary to mention technologies in the Hippocratic Oath, but it’s also critical to be able to use the latest innovations. That also requires openness towards new concepts, ideas or medical devices, which seems to be evident for many physicians, but is not practiced in the medical community as often as it should be. Maybe a kind reminder in the oath could give at least a symbolic boost to life-long learning.
Thus, The Medical Futurist would add the following passage to the oath: “I will embrace life-long learning to continually improve my knowledge and skills to be able to use any technologies with scientific evidence for the benefit of my patients”.
5) The inclusion of equal-level partnership
Access to information and technologies is not a privilege of physicians sitting in the ivory tower anymore. Patients also have access to information about drugs, cures, methods online, and with a pinch of digital literacy, anyone can find curated and credible medical data online. It started to shift the hierarchical patient-doctor relationship into a collaborative partnership in the future. The oath has to address the changing social relations within the structure of the medical system, and The Medical Futurist suggests the inclusion of the following:
“I will treat my patients in an equal-level partnership, and I will not be ashamed to say “I know not,” nor will I fail to call in my colleagues when the skills of another are needed for a patient’s recovery”.
6) Addressing privacy concerns
Respecting patients’ privacy is a primary passage in the Oath. However, there is no indication of data privacy anywhere. Sure, there was no need for it 2,000 years ago as Odysseus did not check in to Facebook day after day when heading home to Ithaka, but that’s not the case today.
According to a Stanford Medicine White Paper, 153 exabytes (one exabyte = one billion gigabytes) of healthcare data were produced in 2013, and an estimated 2,314 exabytes will be generated in 2020, translating to an overall rate of increase at least 48 percent annually. The need for safeguarding that amount of information is paramount, so we need to include it in the Oath. How about the following solution?
“I will respect the privacy of my patients and their data, for their problems are not disclosed to me that the world may know”.
The Medical Futurist strongly believes that it is high time to adjust the Hippocratic Oath to the winds of change, so younger physicians could better relate to its overall principles, and older physicians could take more inspiration to work from it.