|Year : 2019 | Volume
| Issue : 1 | Page : 1-2
Kalkunte R Suresh
Chief Editor,Director – JIVAS, Bengaluru, Karnataka, India
|Date of Web Publication||8-Mar-2019|
Kalkunte R Suresh
Chief Editor,Director – JIVAS, Bengaluru, Karnataka
Source of Support: None, Conflict of Interest: None
|How to cite this article:|
Suresh KR. Hypocritic Oath. Indian J Vasc Endovasc Surg 2019;6:1-2
A cursory look at this heading might lead the reader to think this refers to the “Oath” all physicians take as decreed by the Father of Modern Medicine – Hippocrates! A relook will tell you an altered story.
The title “Hypocritic” is a bit distorted derivative of Hypocrisy which has few related meanings (from dictionaries) – (a) It is the practice of engaging in the same behavior or activity for which one criticizes another. In moral psychology, it is the failure to follow one's own expressed moral rules and principles (b) behavior that contradicts what one claims to believe or feel. (c) The practice of claiming to have higher standards or more noble beliefs than is the case. The word hypocrisy comes from the Greek (hypokrisis) and Hippocrates hails from the same nation. It is unfortunate they sound similar and we can argue that it is easy for us, sometimes, to mistake one for the other!
The “Aphorisms of Hippocrates,” written sometimes between 460 and 370 BC, is the earliest known medical text. Hippocratic Corpus, a collection of his some 60-odd works, also contains the Oath taken by the physicians and his famed assertions. The first Aphorism states “Life is short; art is long; opportunity fugitive; experience delusive; judgment difficult. It is the duty of physician not only to do that immediately belongs to him but likewise secure the cooperation of the sick, those who are in attendance, and of all external agents.” How true even today, two millenniums later!
His other axiom has more relevance today, probably more than ever before in light of rapidly progressing technology where everything seems “doable.”
Primum non nocere(Classical Latin: ) is a Latin phrase that means “ first, to do no harm.” The phrase is sometimes recorded as primum nil nocere.
Non-maleficence, which is derived from the maxim, is one of the principal precepts of bioethics that all medical students are taught in school and is a fundamental principle throughout the world. Another way to state it is that, “given an existing problem, it may be better not to do something, or even to do nothing, than to risk causing more harm than good.” It reminds physicians to consider the possible harm that any intervention might do. It is invoked when debating the use of an intervention that carries an obvious risk of harm but a less certain chance of benefit.
A case in point, to illustrate the above, is the anterior tibial artery rupture after angioplasty (which has happened before and likely to happen again), post-fem-pop bypass, in the recently concluded superb EVL. The suggestion was to tamponade the popliteal artery with balloon to stop bleeding and the then rewire the artery. First point – how much does the ruptured, diseased anterior tibial artery bleed in a closed compartment? Likely about 15 to 20 CCs. The nature will tamponade and remodel the artery. Proximal balloon occlusion to stop this insignificant bleeding might cause thrombosis of other patent distal collaterals, in spite of adequate anticoagulation, thus harming the patient. Rewiring could cause more damage to the artery beyond repair. Primum non nocere – further intervention could be more harmful than beneficial. I am informed this patient had no compartment syndrome, no change in hemoglobin and had excellent distal signals, now with palpable pulse with ABI of 0.85! Superior surgeon is the one who knows when not to harm the patient further.
Let us peruse the Hippocratic Oath, in Greek, from the 1923 Loeb edition, and then followed by the English translation:
“I swear by Apollo Physician, by Asclepius, by Hygieia, by Panacea, and by all the gods and goddesses, making them my witnesses, that I will carry out, according to my ability and judgment, this oath and this indenture.” Though we may not invoke divine spirits in today's day and age we provide care to the best of our abilities and the corollary to this would be – if beyond us we should seek help from others better equipped than us to treat the diseases. Unfortunately this adage is frequently not followed – we all are aware of limb ischemias being treated by some even when it is beyond their abilities.
“To hold my teacher in this art equal to my own parents; to make him partner in my livelihood; when he is in need of money to share mine with him; to consider his family as my own brothers, and to teach them this art, if they want to learn it, without fee or indenture; to impart precept, oral instruction, and all other instruction to my own sons, the sons of my teacher, and to indentured pupils who have taken the physician's oath, but to nobody else.” The phrase “To hold my teacher in this art equal to ….” should perhaps should be rephrased to state “To hold my professional colleagues equal to myself….” Not infrequently one colleague derides the other and one of the definitions of hypocrisy comes in to play – “It is the practice of engaging in the same behavior or activity for which one criticizes another” – many professionals decree that a colleague who has done his/her best should not be criticized, but some may not apply this adage to themselves.! But there is also another meaning of hypocrisy in to play – “The practice of claiming to have higher standards or more noble beliefs than is the case.” We all are aware of some other specialists treating vascular diseases without acceptable proficiency in treating these patients!
“I will use treatment to help the sick according to my ability and judgment, but never with a view to injury and wrong-doing. Neither will I administer a poison to anybody when asked to do so, nor will I suggest such a course …. But I will keep pure and holy both my life and my art. I will not use the knife, not even, verily, on sufferers from stone, but I will give place to such as are craftsmen therein.” I doubt if any docotor harms his/her patient intentionally, but the last phrase written over 2000 years back clearly states that a patient will be handed over to more experienced person in that art – “but I will give place to such as are craftsmen therein.” This, unfortunately, does not seem to happen with many vascular patients.
“Into whatsoever houses I enter, I will enter to help the sick, and I will abstain from all intentional wrong-doing and harm, especially from abusing the bodies of man or woman, bond or free. And whatsoever I shall see or hear in the course of my profession, as well as outside my profession in my interaction. The phrase with men, if it be what should not be published abroad, I will never divulge, holding such things to be holy secrets.” This axiom is truly followed even today by nearly all the doctors.
“Now if I carry out this oath, and break it not, may I gain forever reputation among all men for my life and for my art; but if I break it and forswear myself, may the opposite befall me.”
I will conclude this editorial by again quoting, perhaps the most important maxim from Hippocratic Corpus “Primum non nocere(Classical Latin: ” is a Latin phrase that means “ first, to do no harm.”
| References|| |
Sokol DK. First do no harm revisited. BMJ 2013;347:f6426.
Hippocrates of Cos. The oath. Loeb Class Libr 1923;147:298-9.