promising togetherness

Hello Sibley!  Happy October!  Congratulations on the opening of the new building, I can only imagine what an exciting and exhausting time it must be.  I am truly honored that the Hubsters have invited me to write remotely from NYC.  Medical school has been exciting so far—there are endless amounts to learn about science, culture, and people.  The weeks seem to be flying by, even though I am awake the vast majority of the time.  I look forward to continue hearing about the things going on at Sibley, and I hope that you are all well and enjoying what feels like the true beginning of fall!          

Since arriving in NYC, I have quickly resumed my pursuit to understand what it means to join the medical profession (along with a new pursuit to try all the different foods in the city).  In the first week of school, we began to have conversations around this very topic, and much to my delight, we explored the Hippocratic Oath—the pledge that all medical students will take when they graduate (see full text at the end of the post).  Taking this oath marks the joining of the profession and becoming a part of something that is bigger than any individual.  It tells us to honor tradition, to represent those who have come before us, and commit to “preserve [medicine’s] finest traditions.”  Before this conversation, I don't think I have ever considered what it means to take an oath.    

Have you ever taken an oath?  It is such an impactful word in itself, regardless of the actual definition of the word.  The phrase “take an oath” just feels heavy.  I think the most common oaths are probably those that come in the form of wedding vows or in the military.  Maybe one would consider the Pledge of Allegiance a form of oath?  Joining a fraternity or sorority?  I am surely missing other things.  

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So, what has the Hippocratic Oath meant to medicine?  For some fun facts, the Hippocratic oath wasn’t formally used in all medical schools until recently.  It was actually only first used in the last couple centuries, with most medical schools joining to use some form of it in the last few decades.  For something written in the B.C. era, it seems odd to me that the oath is one of the more notorious aspects of the medical profession even though its use has only peaked recently.  Another fun fact, the exact phrase “do no harm” is not actually in the original oath—even though most of us sum up the oath with those three words.  The Hippocratic oath has evolved over the years to reflect the changes in views on abortion, lethal injection, and euthanasia, but much of the original sentiment remains the same.    

It excited me to have a chance to explore what the oath means for us as medical students.  I enjoyed seeing how my peers and some current physicians view the “why” of medicine.  How they use the oath to protect, guide, and define medicine and their actions.  It is the foundation of the culture of a community—a contract in its own way.  With my design thinking hat, however, my mind quickly drifted elsewhere.  Who is the user of this oath?  Who does it affect?  Why is it important?

The oath gives a broad outline of how physicians should act, how they should serve, and what they should value.  Surely these are things that are for physicians to know and use, but embracing these traits changes the way one interacts with the world.  It makes me think that, although the users are the physicians and medical professionals, the people affected by this oath are the patients and the community. I just have to wonder if anyone outside of medicine has ever been a part of defining this oath?  What would they want it to say?  What would a patient or community want their doctors to pledge?

One aspect I think is missing is the sentiment of being with patients—of togetherness.  The oath seems to constantly put physicians on a higher or lower level than patients—never the same.  Using “patients” in 4 of the 11 statements, the verbs of those statements are about serving, advocating, and protecting.  The other 7 statements speak to the need to uphold the tradition and integrity of the profession.  Thus, the physician’s role is to always either be serving the patient or be working to sustain something that is larger than any single person, which doesn’t seem to leave much space in the middle.  It doesn’t highlight being with someone—connecting with a person where they are and committing to joining them on that level.   

I thought more strongly about the oath just last week when I found out a high school teacher of mine passed away this summer due to cancer.  She was young, and it really broke my heart to hear the news.  My normal evening quickly turned blue.  I hadn’t been particularly close to this teacher since high school, but we had known each other well during that time.  I looked up to her, and she was one of those beautiful humans who would sacrifice themselves for each and every student, never letting anyone settle for less than their best.  She would always be able to tell when something was wrong.  She would see it on my face and wouldn’t let it go.  She would ask me and hear me.  Those were some of the first moments where I started to appreciate the way that sharing burdens can help someone not feeling alone or embarrassed or trapped—how seemingly individual challenges can be approached together.  She changed my journey, and I am sad for the loss of such a positive influence in this world.    

For some reason, I found a connection between the oath and my sadness from this news.  I find sadness in thinking about those that we lose, because they have all affected and influenced somebody else.  Every single person has changed the journey of others in some way.  I find some internal struggle at the thought that the physician's role (according to the oath) focuses on serving, advocating for, and protecting a person—not to begin by appreciating, connecting with, and valuing them. 

Maybe I am toeing a line, but I am not trying to say that the first set of verbs are bad, instead that they feel a bit incomplete and impersonal.  In moments of duress, why do we have to pledge to be either subservient or protective?  Do we assume that those are the best methods to help people when they are in need?  People are people.  My teacher’s mission was not to serve or protect me—her mission was to be with me and help me grow.  She saw me as me, no matter what, and that is what made her so amazing.  She joined me in whatever place I happened to be.  Do relationships naturally have moments of sacrificing for one another?  Yes.  Do they sometimes have moments of protectiveness?  Of course.  But, they aren't based on those sentiments first.  What if we pledged to be a team?  What if we pledged to always meet someone where they are and build from there?          

Oaths are the baseline for a culture and its expectations.  They are meant to be forever.  They help to explain motivations and objectives.  But, they also affect other people—not just the pledge takers.  They have effects outside of the professions, the institutions, or the nations in which they are made.  They surely change your outlook on the world, but they also change the way the world looks back.  

So, back to where I started—have you ever taken an oath?  Has that oath affected you? How about those around you?  Who does the oath serve?  What do you want your oath to be? 

Andrew Yin

Please feel free to share any thoughts or ideas, thanks for reading!

ayin4@jhmi.edu

 

The Oath as taken at Weill Cornell Medical College:

I do solemnly vow, to that which I value and hold most dear:

That I will honor the Profession of Medicine, be just and generous to its members, and help sustain them in their service to humanity;

That just as I have learned from those who preceded me, so will I instruct those who follow me in the science and the art of medicine;

That I will recognize the limits of my knowledge and pursue lifelong learning to better care for the sick and to prevent illness;

That I will seek the counsel of others when they are more expert so as to fulfill my obligation to those who are entrusted to my care;

That I will not withdraw from my patients in their time of need;

That I will lead my life and practice my art with integrity and honor, using my power wisely;

That whatsoever I shall see or hear of the lives of my patients that is not fitting to be spoken, I will keep in confidence;

That into whatever house I shall enter, it shall be for the good of the sick;

That I will maintain this sacred trust, holding myself far aloof from wrong, from corrupting, from the tempting of others to vice;

That above all else I will serve the highest interests of my patients through the practice of my science and my art;

That I will be an advocate for patients in need and strive for justice in the care of the sick.

I now turn to my calling, promising to preserve its finest traditions, with the reward of a long experience in the joy of healing.

I make this vow freely and upon my honor.