One of the trends in modern medical practice is the idea that docs are merely technicians, that scientific treatment is the only way we treat people, and that human beings are like a machine, pop in the drugs, pop out health.

And this mechanical view of medicine fits in well with the beancounters, who don’t see why docs can’t memorize 3,280 CPT codes and spend ten minutes out of a fifteen minute visit “documenting” –and the best “documentation” is filling in little boxes for a computer print out so a secretary with a high school education can decide if it was a reasonable charge.

Yet those of us old enough to remember tradition see medicine not merely as a science but as a profession.

There is piety and reverence in the idea of a profession.

Yes, piety and reverence are old ideas, but it means a deep respect for those who went before us, and a knowledge that we are not the apex of truth, but are both over others (for whom we are responsible) and under heaven. (The Apollo of the Greek oath, the Godhead of the Christian ideal, or the Deep Heaven of Confuscian ethics). This piety lets us see our profession not as “ME ME ME” but as one of a line of thousands of years of healers who seek to heal, never to harm.

This piety goes against the brash “I know everything” of pseudoscience but is the essence of true science: the humility that we are truth seekers, and if the evidence goes against our initial ideas, we follow the evidence.

So when you read a medical school is replacing an ancient oath with a politically correct one, it makes one wonder if they fail to impress this piety and professionalism on their students, and instead are molding them into doctors who will be willing to cooperate with the latest social planning by “experts”.

You see, medical ethics is being molded  by economic factors to stop giving life saving care to the elderly simply because they are old and a bit senile…or when someone at your hospital decides your care is “futile” or “inappropriate”.

Well, as a doc, I often have tried to encourage my patients to stop “futile” care, but as a doc who has worked with a lot of developmentally disabled clients, I can assure you that there are just too many doctors out there who wouldn’t even give simple treatment to a person with retardation or cerebral palsy.

So why am I cynical about this report? Let’s “fisk” it.

Dr. Kathy Faber-Langendoen and other faculty found the previous oath’s archaic and often ambiguous language an impediment to being understood by students.

Let’s see. The average IQ of doctors is probably 135. Yup. They are just too dumb to understand old fashioned language. Sure.

The medical school said concepts in the new oath that derive from Blackwell’s writings include the importance of preventive medicine and the need for collaboration between women and men in the medical profession.

To devise an oath deciding doctors must “prevent” sickness twists the profession into something is is not, and was never meant to be: a profession to keep healthy people healthy, not a profession to treat the sick.Doctors diagnose, and devise a treatment plan. We do some preventive education, but with our limited time, most of us send a patient to a nurse, physical therapist or dietician for the “preventive” part of preventive medicine.

But the dirty little secret of medicine is that our offices are full of people who are not heathy, and never will be. We need an oath to remind us that caring for the sick, treating them with a professional courtesy, and doing our best is the reason for our profession, not an oath saying we will follow a bureaucratic schedule of preventive maintanance.
As for that part in men and women collaberating, this is a pc version of Hippcrates, who said that doctors saw their fellow physicians the same as a brother (sibling) and their teachers as parents. Nah, double non p.c. Sexist language AND praising the patriarchal family.

The problem being, of course, that families are forever, but the latest pc fad will be gone in ten or twenty years.

The new oath retains some elements of the Hippocratic Oath, written about 400 BC, and a widely accepted revision penned by Tufts University medical school administrator Larry Lasagna in 1964, as well as the Prayer of Maimonides, a Jewish physician from the 12th century.

Well, this sounds fine.

But did you ever actually read Dr. Lasagna’s oath?

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 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.

Yup.

We’re right back to  the start of my essay.
This is an oath that changes the practice of medicine from a noble profession to treat the sick person and never harming him or her (including the unborn) into a technician who sees people as machines, where doctors talk about humility while saying they are the ones wise enough to decide who should live or die, and that our responsibility is not only to care for that sick person, but we need to be reminded that treating that sick person might cost money. So if grandmom costs to much, we’ll humbly become her executioner.

If you think I am too paranoid about this, maybe it’s because I’ve worked with the elderly and retarded, and know of humble humane physicians who thought that the best thing to do for my patients was to kill them off.

Part of medical training is an inculturation into a profession that deals with life and death. And combining the idea that economics is more important than life with the idea that doctors can kill has an ominous history that can’t be shrugged off as an anomalie.
When those who are supposed to teach the young deny the long experience and history of the profession, when they destroy the reverence and piety in the name of political correct fads, and when they include phrases that have broad implications on the way medicine should be practiced, then it makes me glad I am retired.

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Nancy Reyes is a retired physician living in the Philippines. She has published articles on medical ethics in the past, and writes essays on medicine at Hey Doc Xanga Blog

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