Lee A. Resnick, MD, FAAFP
In the Hippocratic Oath it is written and we are bound: “To hold him who has taught me this art as equal to my parents and to live my life in partnership with him, and if he is in need of money to give him a share of mine, and to regard his offspring as equal to my brothers in male lineage and to teach them this art if they desire to learn it without fee and covenant.”
This section of the Hippocratic Oath is a reminder, albeit a chauvinistic one, of the brotherhood of physicians. It represents the bond we share and the respect we should show each other. I dream of the time when this was a more visible and apparent part of physician life. Images of the physicians lounge (now mostly gone), with cigarette-smoking surgeons sharing war stories come to mind. But this is certainly not my time (more on this later). I have not felt it since residency, when shared sacrifice and pain built strong fraternal bonds.
Through the oath we are also sworn: “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.” Yes, there is a history of secrets in medicine, necessary it was assumed to protect the profession first and fore- most. The secrecy of the profession, it was thought, was unequivocally in the best interest of its patients, as it protected the art from the frivolous scrutiny of laypeople that, it was felt, produced more harm than good.
Well, I don’t have to hyperbolize the end of those days. It is a new era for the profession for sure, and the self-governing control has been wrested, for better or worse. The scrutiny can at times feel insufferable, with the eyes of regulators, insurers, lawyers and administrators always glaring down. Yes, the demons of the profession are many, and yet, a new snake has overtaken the others, producing more venom than them all.
Our colleagues, our own brothers and sisters, our sworn comrades, are spewing more defamatory slander at each other than the sensationalized malpractice lawyers. An urgent care shift almost never passes without hearing a patient referencing another physician’s criticism of my work or the work of my colleagues. “The ER doctor said I didn’t need to be there. That urgent care is known for transferring patients who don’t need it.” “Why did that doctor put you on that medicine?” “Why didn’t that doctor put you on any medicine?” “That splint is terrible!” “That doctor misread your x-rays.” It goes on and on like that. I often wonder aloud: “Is it me?” “Am I incompetent?” “Am I an embarrassment to my profession?” Unfortunately, of course, these venomous communications are common to all of us now. No one is protected. And our exaggerated vulnerability drives more and more of it as we jockey for position.
Yes, our self-inflicted wounds are now one of the profession’s biggest risks and we simply must find a way to stop it. The path, however, is certainly unknown. How can we find a way to reveal the problem, and cut off the head of the snake? What is the forum for demonstrating the irreversible harm? With all the distracting noise in the profession, how will we elevate the issue above the fray? I am fearful, sad to say, that it will not, but I am committed to doing my part.
I have made a promise to represent the best care for my patients at the time I see them and from the lens that I view them. I will not diminish, slander or lay blame on my colleagues (this is, of course, not to say that I will remain silent in the face of illegal or unethical conduct). I will not participate in the pervasive fault-finding that has overcome the profession that I love…and to the detriment of us all. That is my oath. An addendum, perhaps to the one I took in medical school. The one worth revisiting from time to time for all of us.