My Hippocratic Oath

On admission as a member of the medical profession, I solemnly pledge:

• To keep the health of my patient as my first priority, understanding that treating the disease is not the same as healing the patient;
• To treat patients with dignity and respect, regardless of their social group or status, and keep in confidence their private histories;
• To work collaboratively with other medical professionals, community and religious leaders, and family members and friends;
• To commit myself to lifelong learning and recognize when I become unable to care for patients due to personal handicap;
• To encourage healthy behavior within communities, remembering that preventing disease is preferable to curing it;
• To maintain my own physical, emotional, and spiritual health so that I am able to effectively serve my patients.

 

JUSTIFICATION:

My intent with this pledge is to address the patient first. The biopsychosocial model of health teaches us that patients are more than pathologic processes. I address this fact in the first line and again in the third line, as it pertains to collaboration with other important people in the patients’ lives. The second line addresses the importance of the patient’s trust in the doctor. They must feel accepted regardless of age, sex, race, or religion and must feel comfortable revealing private facts that are necessary for us to diagnose and treat the disease. In the fourth line I discuss the fact that medical knowledge is not static, but constantly growing and changing. In order to be effective physicians, we need to keep up with this expansion. We also must be aware of our physical, emotional, and intellectual limits so we do not hurt our patients. In the fifth and sixth lines, I wanted to step back and remind everyone of a duty to our community health and a duty to our own health, which seems neglected in many similar oaths.

I removed some of the lines in the Declaration of Geneva because they seemed self-evident or common to all professions (e.g., treat colleagues as siblings, respect teachers, practice with conscience) and not unique to the medical profession.

Stress

I started third year on triple block. On psych consult I worked 8am-6pm and on inpatient psych I worked 8:30am-3pm. On primary care I worked 10am-4pm three days per week, I went to lecture once a week with similar hours, and had three-day weekends. Neurology was the most time-consuming of the three, starting at 7:30am and ending around 4pm. I had plenty of time after I got home to study, hang out, and watch movies. Third year seemed manageable. But after triple block I started ob/gyn.

Most days this past month I have woken up at 5am and have gotten home around 7pm. Occasionally I would leave before 6pm and consider it a good day. On one lucky day I got to leave at 5pm. I relished the days we had 8 hours of straight lecture (including a lunch lecture) because it meant that I could go home at 5pm and study. Unfortunately, the lecture days weren’t quite the godsend I’ve made them out to be: even though the lectures started at 9am, I had to round on my post-op patients at 5:30am, write notes on them by 6:15am, and attend M&M conference at 7am followed by grand rounds at 8am. I also had to work a Sunday shift, meaning I only had Saturday to relax and recharge (i.e., study) followed by six more grueling days of work.

When I got home at 7pm, I would eat dinner and read up on the next day’s cases (the patient’s history, the disease process, the surgical procedure, and the relevant anatomy). I tried to get 6 hours of sleep each night, but it was never enough. As the clerkship went on, I found myself too tired to keep up with my studying. I would literally fall asleep at my desk with my head bent over my book. Before ob/gyn I thought people were just exaggerating when they said stuff like that.

For me, the most stressful part of medical school is how constant and unrelenting the workload is. I no longer have time to be the good boyfriend, the good listener, or the good son. I no longer have time to make my own breakfast or lunch. I no longer have time to exercise (no, speed-walking and retracting don’t count). I no longer have the time to enjoy my life in the carefree manner I used to. Every decision I make to take a break by watching TV or meeting up for dinner directly impacts the time I have to study and how well I do in the rotation. But that is precisely what I need to do to ensure my mental and spiritual wellbeing. I simply have to accept the fact that I cannot be the best medical student I can be while simultaneously being the best person I can be.

It’s not the amount of information we need to learn that is so overwhelming, although that certainly contributes. It’s not the fact that we’re being thrown from team to team every 2 weeks as soon as we start to feel comfortable with and confident in our fund of knowledge, interviewing efficiency, and clinical reasoning. It’s not the uncertainty we feel from learning every new attending’s special way of doing things. It’s not the isolation we experience from never seeing our friends unless they’re on the same rotation. It’s the fact that we have to do all of this while working 60+ hours each week, with fewer and fewer days to catch our breath and re-evaluate and reassess our situation. It’s the fact that we’re on an unyielding, terrifyingly fast treadmill without the safety cord to stop it if we falter or fall off. At some point, we all need to take our feet off the machine and rest for a little while. And we need to take control of the treadmill instead of letting it control us.