Check-up

The Father of Medicine, Hippocrates, created this oath for the practicing doctor in the forth century BC.   While the words are certainly dated the essence of the oath remains relatively true today. Original, translated from Greek.

“I swear by Apollo, Asclepius, Hygieia, and Pancea, and I take to witness all the gods, all the goddesses, to keep according to my ability and judgment, the following oath.To consider dear to me, as my parents, him who taught me this art, to live in common with him and, if necessary, to share my goods with him: To look upon his children as my own brothers, to teach them this art.I will prescribe regimens for the good of my patients according to my ability and my judgment and never do harm to anyone.To please no one will I prescribe a deadly drug nor give advice which may cause his death.Nor will I give a woman a pessary to procure abortion.But I will preserve the purity of my life and my arts.I will not cut for stone, even for patients in whom the disease is manifest; I will leave this operation to be preformed by practitioners, specialist in this art.In every house where I come I will enter only for the good of my patients, keeping myself far from all intentional ill-doing and all seduction and especially from the pleasures of love with women or with men, be they free or slaves.All that may come to my knowledge in the exercise of my profession or in daily commerce with men, which ought not to be spread abroad, I will keep secret and will never reveal.If I keep this oath faithfully, may I enjoy my life and practice my art, respected by all men and in all times; but if I swerve from it or violate it, may the reverse be my lot.” {1} 

This oath has been changed, updated, and clarified several times throughout history. The most commonly used revised version of the Hippocratic Oath was produced by Dr. Louis Lasagna in 1964. Dr. Lasagna was the Academic Dean of the School of Medicine at Tufts University. The update oath reads as follows. 

“I swear to fulfill, to the best of my ability and judgment, this covenant: I will respect the hand-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 over treatment 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 must 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 my 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.” {2} 

The modern version of the Hippocratic Oath is typically used in graduation ceremonies for the graduating doctor.

My guess is that most people go to medical school for the correct reasons. Other’s, may go into the profession for less than admirable reasons. I will teach you how to weed out the doctors whose intentions are not pure. 

How to select a physician? Since the advent of Health Maintenance Organizations (HMO’s) this question has become a tad bit more complicated. HMO’s give doctor’s financial incentives for keeping the costs of health care down. Pepper that with the drug company’s gifts and incentives and you have a stew for greed.  

 So the question then becomes, how do you find a doctor who can effectively balance your health care needs while they keep costs down for the HMO’s? First, you will want to consider the doctor’s credentials. Where did he or she go to medical school? Now, keep in mind that a doctor may have graduated from a prestigious medical school but finished last in his or her class.  A doctor who is board certified becomes a stronger candidate for the type of doctor you are looking for. Word of mouth is another way to find a reputable and clinically sound doctor. This does not only include your family and friends, but it also includes the word of the medical insider. Once you have narrowed down your list to a few choices, call the “Charge Nurse” on the hospital floor the doctor typically works. Once the nurse picks up the phone, identify yourself and ask about the reputation and CLINICAL JUDGEMENT of the doctor. You may obtain mountains of information this way as most RN’s have definite opinions about the staff they work with. RN’s are ususally very busy, so keep your questions short and to the point. Remember there are 3 shifts in a day! (Day shift is 7am to 3pm, evening shift is 3pm to11pm, and night shift is 11pm to 7am.) You can gather your information any time of the 24 hour day.   

Once you have gathered information on your prospective doctor, make an appointment with him or her and tell the receptionist you want time for a short interview with the doctor prior to being seen for your medical issue. Before going to this appointment read everything there is to read on your diagnosis and your medications. Quiz the doctor on your newly obtained information. You can learn a lot about this person in this setting. Keep in mind one of the most important indicators a doctor is able to balance insurance companies and the patients health care is how much TIME he or she spends with you. If you come to the office visit prepared and the doctor answers your questions in an unhurried fashion, and gives you the respect you deserve, than you probably have a keeper. If the opposite is true throw the doctor back in the lake like you would a small fish! Bedside manner is important, but if the doctor displays a rotten bedside manner and is good at the balancing act with HMO’s and has sound clinical judgment, you may want to further evaluate this doctor. A little rudeness verses a doctor who does not have sound clinical judgment; I will take the rudeness any day! You have to weigh this out for yourself, however.  Remember any relationship develops over time. First impressions can be wrong. If you think the doctor you choose has potential, give the collaborative relationship time to develop. 

 If you want to find out more specific information on your new doctor you can contact your State’s Medical Board, the American Board of Specialty, the AMA (if you are a member), and copious websites which will usually cost money. You can find out about disciplinary action, malpractice suits, how many years experience the doctor has, where he or she graduated, if he or she was fellowship-trained, hospital affiliations (more is better here), teaching responsibilities, credentials, and board certification. 

Once the collaborative relationship with your doctor has developed, give your doctor the respect he or she deserves. Come to your appointments on time. Come prepared with an exact description if your symptoms. Come with a list of questions. And finally, display appreciation. You can send a card of gratitude of course, but the best way to show appreciation to your doctor is to adopt a healthy lifestyle. Stop smoking! Eat right! Exercise! Sleep enough! Loose any drug habits! Loose the weight! The effort you put into the suggestions your new doctor has given you will be valued not only by your doctor, but by you too. You will ultimately feel better.   

  References:

{1} October 1, 2007, Hippocrates, “Hippocratic Oath”, http://en.wikipedia.org//wiki/Hippocratic_Oath (comp) 2006  

{2} September 30, 2007, Lasagna, Louis, “Hippocratic Oath-Modern Version”, <http//www.pbs.org/wgbh/Nova/doctors/oath_modern.html> (comp) March 2001.

Tags: American Doctor, Dedication