The most recent spring semester Benjamin Rush Institute (BRI) lectures at Marian University College of Osteopathic Medicine (MUCOM) focused philosophically on a doctor’s vocation. In Dr. Jason Eberl’s lecture, “The Hippocratic Oath: Still Ethically Valid?” attendees learned about the implications of taking an oath, and then applied those implications to the Hippocratic Oath, and other oaths that doctors take.
Attendees learned that when an oath is sworn, it “connect[s] our own core values as human beings and as professionals.” Pledging an oath indicates that one intends to be held accountable for the consequences of not following through, like loss of clients, malpractice suits, or license forfeiture. Therefore, when a physician swears an oath, he/she should fully believe in everything encompassed by the oath.
The Hippocratic Oath contains some great principles, like doctor-patient confidentiality and beneficence. One of the Oath’s eminent principles, “primum non nocere,” (“first, do no harm”), wasn’t actually stated in the original Hippocratic Oath but in one of Hippocrates’s other writings, Epidemics. Aside from these great elements, there are some problems with the oath. For example, the oath is sworn to multiple Greek Gods, creating an issue for physicians who aren’t polytheistic. The oath also extolls physicians in training to treat teachers as parents – a notion a bit extreme, even for those of us with great respect for our professors. Other oaths discussed were Louis Lasagna’s Modern Oath and the Osteopathic Oath. Both share many great principles critical to medicine. Even so, these also contain ideas — like in the Hippocratic Oath — that many doctors would have a hard time completely agreeing with.
Many doctors take some sort of oath, whether it be the Hippocratic, Lasagna, Osteopathic, or a personal one. In doing so, they set a professional moral standard for themselves, understanding that neglecting to uphold it has consequences. Most doctors naturally have the patient’s best interests in mind, otherwise they likely would not have entered the profession. If this is the case, then there ought not to be a central authority that forces doctors to change the way they practice medicine. Removing bureaucratic barriers allows doctors more quality time to focus on patients, large decreases in healthcare costs, and increased patient wellness. Why then is there a continued need for more centralization and compliance from doctors? There isn’t. More centralization creates burdensome regulation, diminishing doctor-patient encounter time and increasing healthcare expense. Physician burnout is rampant, leading to massive doctors shortages
In my own reflection, doctors should hold themselves to a high moral standard personally and professionally. Many of these popular oaths are great starting points for doctors. However, there are things that could be added or taken away from each oath as well. The best way to come up with an oath that a doctor can adhere to fully is through his/her personal beliefs shaped through empathy, experience, and wisdom.
In Dr. Richard Gunderman’s lecture, “Freedom Enriches Medicine,” attendees learned about two different perspectives through which to view medicine: that of Jean-Jacques Rousseau, and that of Soren Kierkegaard.
The Rousseau perspective on medicine is that the physician exists to serve the “healthcare system.”
The Rousseau perspective on medicine is that the physician exists to serve the “healthcare system.” In this “system,” the physician only has the authority that the “system” grants. The central authority, whatever it may be (government, insurance companies, hospital administration), collects data on everything. This authority’s agenda is to perfect the “system” in order to perfect healthcare, to be accomplished through efficiency, compliance, productivity, budgets, expenses, revenue, etc. Administrations are put in place to monitor data points and make changes where necessary for the “system.” There are some good things that come from this approach, like algorithms for treating patients in emergency situations, or making sure a medical center does not go bankrupt, leaving patients with no place to go. However, there are also consequences from central authority regulations: a decrease in doctor-patient encounter time in order to increase patient volume, the practice of “defensive medicine” to limit “lawsuits” (expenses) and increase revenue, and adding regulations to what doctors must do to increase compliance. Many of these things are done for the sake of the patient, yet lead to negative effects for patients’ actual well-being.
The Kierkegaard view is that the doctor is a free individual with beliefs, ambitions, and a moral code to help patients.
The Kierkegaard view is that the doctor is a free individual with beliefs, ambitions, and a moral code to help patients. The doctor-patient relationship is the most important part of healthcare, and healthcare can be perfected through strong patient advocacy. Encouraging doctors to continually work on becoming better human beings will make healthcare better. This is accomplished through dedication, experience, success, suffering, wisdom, and love. A path to having better doctors would include doctors spending more time with patients, promoting patient advocacy, and allowing doctors to be free to make plans through patient input.
Increased physician freedom benefits patients and the medical profession. Direct primary care is a great example. Doctors who use this business model do not take insurance, Medicare, or Medicaid. The doctor charges his/her patients an affordable monthly fee, which includes 24/7 access to a doctor, many free procedures, reduced imaging and lab prices, medications at wholesale prices, and no copays for visits. By not taking government subsidies (Medicare and Medicaid), the doctor does not have to abide by their accompanying regulations. Freed from this costly busywork, the doctor has more time for patients, reduces healthcare costs, and promotes patient advocacy. Further, the doctor does not have to appease these government entities to make sure medical treatments will be covered. The doctor is then free to choose labs, imaging, drugs, or procedures they feel will most benefit their patients from a holistic perspective.
Telemedicine is another example of what can arise from preserving the doctors ability to innovate. There is a growing need for more doctors, and telemedicine is a way to alleviate this shortage. People living in rural areas, where there are very few doctors, can utilize telemedicine to visit with a doctor within the comfort of their own home. It also allows doctors who live in a highly saturated doctor community to still get enough patients to be successful. Most doctor visits do not require both individuals to meet in person. So telemedicine can also be used as a mechanism to limit the amount of time wasted for patients (taking time off work, commuting to the doctor’s office, waiting in the waiting room), and doctors (waiting for patients to arrive, unnecessary visits). As telemedicine becomes more popular and competitive, it also will lead to cheaper prices for the patient as well as more innovation from the doctor.
“It is mutual trust, even more than mutual interest, that holds human associations together.” ~ H.L. Mencken
In summary, from both a philosophical and practical standpoint, allowing physicians to be free to practice medicine without coercion is essential for doctor-patient prosperity. If freedom is essential, steps should be taken to increase freedom for doctors, while decreasing regulations on them. Through a doctor’s training and practice, it should be understood and appreciated that they have professional, moral obligations to their patients. If that is not the case, a doctor will suffer consequences professionally, economically, and personally. As a society, we need to trust that doctors have patients’ interest in mind first and foremost. Without trust, there cannot be freedom. Without freedom, physician burnout is inevitable.