This material is presented to first year medical students prior to small group sessions in which they develop their own version of the Hippocratic Oaths. For further information contact lnixon@hsc.usf.edu.

Oaths:The Hippocratic Tradition

Lois LaCivita Nixon, PhD, MLitt, MPH College of Medicine University of South Florida

Purpose of Class • To review characteristics associated with the medical profession. (theology, medicine, and law: the

“learned” professions)

• To consider the symbolic nature of an oath, specifically the Hippocratic Oath, USF’s revised version, and excerpts from various other oaths.

• To meet in small groups to draft a “working declaration, affirmation, or oath” for presentation at the White Coat Ceremony.

Professionalism

His report (Flexner Report) led to the standardization of medical education. Considered to be the most important change event in modern medicine.

Seven characteristics described by Abraham Flexner in 1910.

1. Essentially intellectual—or “learned”

2. Special body of knowledge continuously expanded by research

3. Practical end (service)

4. Specialized training of techniques

Characteristics -Flexner-

Characteristics -Flexner-

5. Moral commitment, a brotherhood (sic)

6. Self-organization and self-regulation

7. Altruistic motivations (unselfish regard for welfare of others)

Project Professionalism: ABIM

• ALTRUISM• DUTY• EXCELLENCE • HONOR

• INTEGRITY• ACCOUNTABILITY• RESPECT FOR

OTHERS

John Stone, MD, cardiologist, poetFor the heart will lead For the head will explain but the final common pathway is the heart whatever kingdom may comeFor what matters finally is how the human spirit is spent.

In recent years additional attention has been given to the following concerns:

•Maintenance of trust by managing• conflict of interest

•Improved access

These suggest a shift from physician-to-patient and patient-to-physician concerns to a broader physician-to-society focus.

•Just distribution of finite resources

Class of 2006

integrity

respect/courtesycompetent

communicator

empathy

open/honest

committed to learning

listener

maturity non-condescending

accountability

considerate

culturally sensitiveteaching skills

humility

confidentiality

current knowledge

generosity of spirit

humor

tolerance for difference

Bonding Declarations/ Commitments

• Promises

• Codes

• Oaths

Oaths

• Performative utterance (before others)

• Solemn declaration

• Validated by transcendent appeal, something sacred

• Moral weight, never trivial

• Extended timeframe (or lifetime)

• Involves relationships with other

and………..

•Proscribes consequences for failure

Cross my heart and hope to die……..

Oath breaker?!

Curtains!!

I solemnly declare…

I swear…

I hold these truths…

Examples or illustrations of the range of sworn oaths:

The Oath of the Horatii by David (French painter)

Maimonides, Rabbi, Physician, Philosopher RaMBaM, 1135-1204

Mecca

On my honor, I will do my duty to God and my Country….

Consecration of Bishops

West Point

So help me God….

Film excerpt Extreme Measures Two physicians *Hugh Grant…good *Gene Hackman…bad

•An oath is not universal, it is not a legal obligation, and it does not guarantee morality.

•Affirmations work to strengthen resolve to behave with integrity in extreme circumstances.

•An oath encourages examination of core values.

•An oath is a declaration of commitment and intention.

College of Medicine Graduation

Life is short, the art of medicine is long, experience difficult.

Film clip: Extreme Measures (Gene Hackman as arrogant physician who uses homeless and others to harvest organs for more “worthwhile” members of society. Hugh Grant provides the challenge)

http://hscvideo2.hsc.usf.edu/asxroot/hsc/jkeats/xmeasure.asx

Slides

Film Excerpt

Small Group Discussion

Apollo, Dionysus, Proteus The Staff of Aesculapius

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