The Oath of Hippocrates (extracts)

I swear by Apollo the physician, and Aesculapius, and Health, and All-heal, and all the gods and goddesses, that, according to my ability and judgment, I will keep this Oath. I will follow that system of regimen which, according to my ability and judgment, I consider for the benefit of my patients, and abstain from whatever is deleterious and mischievous. With purity and with holiness I will pass my life and practice my art. Into whatever houses I enter, I will go into them for the benefit of the sick, and will abstain from every voluntary act of mischief and corruption; and further, from the seduction of females or males, of freemen and slaves.

Whatever, in connection with my professional practice or not, in connection with it, I see or hear, in the life of men, which ought not to be spoken of abroad, I will not divulge, as reckoning that all such should be kept secret. While I continue to keep this Oath unviolated, may it be granted to me to enjoy life and the practice of the art, respected by all men, in all times! But should I trespass and violate this Oath, may the reverse be my lot!

Hippocrates was an influential Greek physician circa the fifth century BC. His writings both influenced Greek medical thought, and formed the ethics of medical practice.

All of us will need a doctor at some time or another in our lives. It is the nature of our highly complex anatomy, as a species, that something or the other will go wrong. As nature will have it, with time, with age, the machinery begins to rust, falls apart more. Ears stop hearing, eyes grow dim, the heart weakens, kidneys malfunction, livers are corroded. Even in the young, cancer sets in, unpronounceable mysterious and complicated diseases spread. Eventually all of us will die. Most of us are afraid of death. The only barrier between us and the enemy of sickness and death is the physician. No wonder he is often seen as a demi-god swathed in a halo: conferring health and life in his voice and touch. We will gladly reach deep into our pockets, mortgage our homes, get into debt for his divine gift of healing, of life itself.

If we have niggles of doubt over our treatment, we squash it or complain in private, partly because there is little recourse, and partly because we don’t know enough about medicine to be sure. The unsaid fear is that if we dare question the doctor’s authority, exorbitant fees (in the case of private practitioners) or terrible conditions (in the case of public health care), we will remain untreated.

Over the years, I have heard a hundred hushed conversations about how various doctors nearly killed this person or that either with their fees, negligence, testing when not required, not testing when required, not diagnosing correctly, going into tantrums when another opinion is solicited; about the way they guard their territory; how, more often than not, they openly brawl with their peers rather than collaborate - even at the expense of the patient’s life.

In private practice especially, many have described that let-down feeling (almost that of exploitation) after being summarily and quickly looked over, given a prescription and ushered out kindly but firmly to the cashier.

The practitioners, for whom medicine is a business rather than a vocation, are alchemists turning sickness into gold with supreme detachment and betrayal of their vocation. Had I not met several practitioners who embody the essence of the Hippocratic Oath, of a vocation, who are on call 24 hours a day (and sometimes work for all 24 hours), who put the patient first, with humour and skill, who work primarily “for the benefit of the patient” and only secondarily for their due financial rewards in this demanding profession, I would have completely lost faith in the medical profession in this country.

I interviewed one such young doctor on the condition of anonymity.

“Ideally the Port-of-Spain, San Fernando, Sangre Grande, Caura and Mount Hope hospitals should handle acute illness and emergencies and the Regional Health Authorities (RHAs) are supposed to provide the bulk of service in primary health care. But I haven’t seen any real changes with the establishment of the RHAs since rural health centres, which could play a vital role in small communities, are not generally well staffed or efficiently run.

“There are several recurring problems: nurses are being recruited by hospitals abroad with better salaries and perks. The ones left behind are overworked and morale is low. The ICU (Intensive Care Unit) is inadequate and patients often die while waiting to have operations done. Both the RHAs’ and hospitals’ complaint has always been shortage of funds for equipment, staff, drugs and administration. (But the ministry has hired consultants who are paid exorbitant fees.)

“Add that to mediocre management and you get a system where hospitals have the same number of beds they had 30 years ago for a growing population. Patients lie on chairs until they can get a bed, scrape around for funds for private care or they just don’t come. The problem is more acute in San Fernando Hospital.

“The problem with private practitioners is that of accountability. Unlike America, for instance, they operate without fear of being sued, their fees are random and often exorbitant, and they don’t explain to patients exactly what is wrong with them. Patients, too, are at fault. They place complete trust in doctors, fail to ask questions, are intimidated by them, and rarely seek second opinions.

“Ours is not a profession but a vocation, but when the money comes rolling in, it colours their vision. There are exceptions: doctors who will treat poor people, and who maintain a balance between financial gain and vocation.

“Private health care fees are not exorbitant when compared to developed countries but are too high for a small developing country such as ours.

“The Medical Board is ineffective. There is little policing and practitioners are rarely disciplined for negligence. In some countries, medical practitioners have to be re-certified after a certain number of years but that’s not done here.

“The Medical Board’s lecture series are optional, and many doctors don’t keep up-to-date. The Board has not set any guidelines with respect to fee structuring, ball-park figures for specific operations, for instance. That leaves the door wide open for exploiting the public.

“The people who end up in the public health care system are afraid to complain since it is their last resort, so politicians don’t see it as a big issue since nobody is making a big fuss about it.

“Health care is extremely expensive. It is impossible for the state to subsidise treatment for complicated diseases such as Aids, renal failure, or open heart surgery. In these cases if you’re poor, you may as well be dead.

“And if drugs, personnel, equipment are badly managed, the system is bled dry. Few countries can afford health care without health insurance, which we don’t have. To improve, it needs more funds and better management.

“But we must strike a balance. There are many dedicated health care professionals in this country. Even under a trying public health care system, much is done. More than a hundred people pass through Casualty and Emergency everyday and are treated. Operations are being performed not fast enough to cope with the load but it’s done.

“Our vocation is not about just saving lives or cures but giving care, comfort, relieving distress, and managing pain, and also helping to improve the health care system itself. If somebody could say they did all that, then at the end of their careers they can confidently say they have kept the oath:

“‘I will go into them for the benefit of the sick, and will abstain from every voluntary act of mischief and corruption’.”