Responsibility in the Medical Profession, and a Word from Hippocrates

Hippocrates 460BC – 370BC

by Mary W Maxwell

This article contains a speech given to medical students by their teacher when he was age 37. It was presented many years ago at the University of Adelaide, and though it will sound pretty “far out,” there really is no reason for it to be past its use-by date. Here it is, and below it is the Hippocratic Oath. Please share it around:

“As I have a captive audience, I propose to discourse on responsibility as it affects our profession. It should be said forthwith, that a sense of responsibility is the fundamental characteristic of the good physician, be internist, surgeon or pediatrician.

You will recall that Dr. Eric Sims commented upon some of the problems of home-visiting. Clearly, however, the urge which drives the physician to visit a patient in his home, often in the full expectation of a false alarm, is not clinical immaturity or fear of lawsuit, but a sense of responsibility.

It is this sense of responsibility that, I hope, motivates you in your learning, since you learn not simply to pass exams, but for the longer view of your career as a physician.

This sense of responsibility is a tender plant, easily bruised by materialist considerations, and fatally marred by unseemly motives. Knowledge without responsibility is often futile, and occasionally dangerous.

We of the medical profession too, are applied scientists, we may do basic research. More often perhaps we apply the results of research in a multitude of ways. In so doing, many of us see a  dilemma — for example, should we eradicate malaria so that the survivors die of starvation?

Should we persistently treat a child with leukaemia who will die sooner or later? Should we treat a senile patient, who has pneumonia, knowing that alive he is a burden to himself and his family, and a drain upon the resources of Society?

Do we nowadays believe Osler’s dictum that the physician should not strive officiously to keep alive? These are only a few examples of the questions which many of you — I hope all of you — will ask yourselves.

The answer ultimately will have to come from yourselves, and the questions will be more searching than any you will be asked in your undergraduate career.

The nature of these dilemmas are such that they can only be answered by knowledge out of responsibility. Knowledge you can acquire simply – although you may not at this time think the process simple.

Responsibility you will have thrust upon you, a sense of responsibility you all have, but must sharpen by usage and frequent application.

Non-Responsibility

There’s also a disease, not confined perhaps to this country, which I call the “She’ll be right Syndrome.” This syndrome is universal, and endemic, but occasionally assuming epidemic proportions. The etiology is multiple, sometimes specific, occasionally idiopathic.

There is some evidence that it is contagious. The gross pathology is variable, but necrosis of the intellect and autolysis of the psyche are constant findings, sometimes obscured by non-specific degenerative changes.

Microscopic examination reveals, in most cases, blunting of motivation, some encrustation with bitterness, and eroded areas of over-confidence.

The clinical features are readily recognizable, lethargy and anorexia are usual. Then anorexia takes a peculiar form of lack of relish for the daily diet of a job well done.

He then embarks upon a long and rambling rationalization of his difficulties, personal, connubial, and financial.

A variant in this is to attempt to hoodwink us by the assumption of an air of superiority, an unwillingness to discuss basic principles, and a retreat into the scientific jargon of his trade or profession.

The differential diagnosis is usually straightforward; principal among the problems to be considered are ignorance, illness, and being in a position above the patient’s ability. All of these deserve sympathy and understanding.

The treatment of the full-fledged case is difficult, but lies principally in the appeal to a latent sense of responsibility. This and frequent appeals to the sense of intellectual honesty – closely related to the sense of responsibility — are the main lines of treatment.

I have not mentioned prophylaxis; I shall now do so. “She’ll be right” is a dangerous doctrine for the individual implying as it does nowadays, a lower standard than the best; for our profession, no standard less than the best in compatible with our history and motives.

The emergence of the “She’ll be right Syndrome” in a society signifies a rottenness in that society. We must – you principally, be on guard against it.

We must battle it wherever it emerges, regardless of charges that we are “rocking the boat” and “sore-heads” and vitiating professional solidarity and so-on.

To maintain and advance the standards of our profession is one of the solemn obligations to which you are called; you will maintain and advance these standards through a sense of personal, professional, and social responsibility.

Through this sense, too, you will examine in no superficial way.”

— The speech-maker, George Morrison Maxwell, MD, was born in Scotland and came to Australia in 1959.

Hippocratic Oath

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 which 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. 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.