Thursday, March 18, 2010

Oaths and Aphorisms

Laudator Temporis Acti, master blogger, has posted the full Hippocratic Oath, in Greek and in translation.

Few new medical graduates of my generation swore an oath, Hippocratic or otherwise. I seem to remember new fellows of the Royal Colleges must affirm consent to the college laws, but otherwise I have never met a physician who has sworn to obey a code of practice.
There was talk that the graduates of the new 'Omani medical school should take an oath, but I don't think anything came of it.

The Hippocratic Oath demands that all patient contact and information be strictly confidential and professionally responsible. That is perhaps the most important and enduring of its provisions.
Senior physicians no doubt approve the the duties owed to them by their pupils, but there is a whiff of secret society about some of its provisions.

Physicians should leave surgery to those skilled in the art - amen to that.
More controversially today, physicians should not give a pessary to procure an abortion - although I don't know of any material available for this purpose in Hippocrates' time. But amen to that too, save in exceptional circumstances.

For this elderly English physician, the Hippocratic text which resonates most strongly is the first aphorism. Remember this is the opening of one of the earliest textbooks of medicine; a remarkable summary of the physician's dilemma. It would serve well to open the introductory lecture in any syllabus of medicine.

βίος βραχύς, δ τέχνη μακρή,
δ καιρς ξς, δ περα σφαλερ, δ κρίσις χαλεπή

[ ho bios brakhys, hi de tekhni makri,
  ho de kairos oksys, hi de peira sphaleri, hi de krisis khalepi ]

Which may be translated thus.

Life is short, but the skill is great;
opportunity is fleeting, experience fallacious, and judgement difficult.

Opportunity fleeting: miss the early signs of meningitis and a child dies or is crippled for life.
Experience fallacious: prescribe a drug safely used many times, and a patient reacts fatally.
Judgement difficult, but may be needed urgently and on insufficient information.

Any physician who denies bad mistakes is a fool or a liar. We can only learn and do our best to minimise error and the consequences of error. And hope for understanding - and mercy - when we get it wrong.

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