Perhaps today’s practice of medicine conflicts with the common oath and increase burnout. A recent article investigated the question, Does an oath that medical students swear to cause burnout?
Medical students common agree to “apply, for the benefit of the sick, all measures [that] are required”. Do medical students struggle with that agreement when they enter the real world of health care?
If ethical issues interest you, consider joining our Medical Student Burnout Project.
At the end of medical school a recently graduated physician typically agrees to an oath similar to the following:
I swear to fulfill, to the best of my ability and judgment, this covenant:
- 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.
- I will apply, for the benefit of the sick, all measures [that] are required, avoiding those twin traps of overtreatment and therapeutic nihilism.
- 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 or the chemist’s drug.
- 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.
- I will respect the privacy of my patients, for their problems are not disclosed to me that the world may know. Most especially must I tread with care in matters of life and death. If it is given me to save a life, all thanks. But it may also be within my power to take a life; this awesome responsibility must be faced with great humbleness and awareness of my own frailty. Above all, I must not play at God.
- I will remember that I do not treat a fever chart, a cancerous growth, but a sick human being, whose illness may affect the person’s family and economic stability. My responsibility includes these related problems if I am to care adequately for the sick.
- I will prevent disease whenever I can, for prevention is preferable to cure.
- I will remember that I remain a member of society, with special obligations to all my fellow human beings, those sound of mind and body as well as the infirm.
If I do not violate this oath, may I enjoy life and art, respected while I live and remembered with affection thereafter. May I always act so as to preserve the finest traditions of my calling and may I long experience the joy of healing those who seek my help.An interesting article discusses the relationship of the Hippocratic oath to the potential of physician burnout.
Clark Sharon A. The Impact of the Hippocratic Oath in 2018: The Conflict of the Ideal of the Physician, the Knowledgeable Humanitarian, Versus the Corporate Medical Allegiance to Financial Models Contributes to Burnout. Cureus. July 30, 2018;10(7):e3076. doi:10.7759/cureus.3076.
The above article discusses the potential conflict between this common oath and today’s practice of medicine. Keep in mind that much of the understanding of the Hippocratic Oath is based on myth and inaccurate, but the reality is almost all physicians agree to some oath at the end of their training even if the words “do no harm” are missing from that oath.
A key element is to put the patient’s needs first. This places the physician potentially at odds with the increasingly business-focused finance constrained health care system. They may perceive that a patient’s needs are being subordinated to other requirements that ignore the patient’s health care needs. Unfortunately, the article does not present data demonstrating that such a conflict actually exists.
One interesting concept is the potential of considering the Hippocratic Oath (or an equivalent) at the beginning of training rather than at the end. One might also argue that it should be considered even before applying to medical school or even considered before considering becoming a pre-medical student. This would help the individual start to resolve conflict at an earlier stage.
Much of the discussion of burnout discusses more behavioral explanations for burnout, that is those related to actions and situations. The article highlights a more ethical/philosophical basis for the challenge of two ideals that cannot both be met. Specifically the need to put the patient’s needs first versus the need to address economic models with a movement toward more corporate based healthcare delivery.
Some questions to ask yourself. Would it help avoid burnout if you were to agree to a statement (or the complete oath below) at the beginning of medical school? Would it help if you understood what you would agree to before you applied to medical school? Or even earlier, say, when you decide to pursue pre-medical studies?
It’s easy to write off such dissonance as it irrelevant. However, conflicting moral standards are certainly a potential for longer lasting stress that is more difficult to resolve. This is a topic without a simple solution but one which will gain from reflection. By presenting different scenarios one can determine if this is potentially a problem and then consider ways that the conflict can be resolved.
We are looking into this issue, as well as how to address medical student burnout, in our game-based intervention – BurntOut. And we need your input and help as we develop our solutions.