Reflections on
Hippocrates
An Editorial by K. Christopher McMains, MD
Recently, a medical student rotated on our clinical service
in otolaryngology who set me to thinking a good
bit about part of the Hippocratic Oath. Not about one
of the really controversial, juicy bits about pessaries or intentionally
doing harm, rather about the following:
“To consider dear to me, as my parents, him who taught me
this art; to live in common with him and, if necessary, to
share my goods with him; to look upon his children as my
own brothers, to teach them this art.”
As it turns out, this student’s father had been the most
influential physician of my medical school years. He taught
me to estimate anemia and bilirubin levels from the sclera
and conjunctiva.
Moreover, he taught me the courage of challenging those
things for which there is not convincing evidence. His
courage in maintaining this high standard spilled over from
science into self-analysis and spiritual belief. No dark corner
was safe from scrutiny or protected from examination.
Nothing short of the truth would do. In the years that
would follow, my approach to self-examination, spiritual
development and medicine were shaped by him.
Historically, this intimate mentorship has been the model
in medicine, whether in the pre-Osler days of individual
apprenticeships or the post-Osler days of bedside education.
Knowledge as well as values were passed down, incorporated
and continued.
Graduates from West Point speak of “The Long Grey
Line,” knowing that they bear the expectations of those who
came before and owe an obligation to those who come
after.
At its best, medical training transmits not only medical
knowledge and diagnostic skill, but also a culture and an
understanding of similar inheritance. Each physician carries a debt of gratitude to those who invested
in our lives, philosophies and
practices, as well as an obligation to
share our knowledge and, perhaps
more importantly, to share ourselves
with those who will follow.
American individualism is a
two-edged sword when it comes
to the practice of medicine. Each
of us probably heard from a senior
during training, “You can call,
but it’s a sign of weakness.” True,
this proud dynamic forced me to
reach the absolute limits of my
resources and into the exclusive
and personal relationship of
patient care.
Individualism also serves as the
wedge driven between us by the
economics of modern medical practice.
Time is the currency we hold,
devalued by decreasing reimbursements,
leaving little time for teaching
and less for collegiality.
However, it is our duty and our
honor to invest in the lives of students,
whether as full time academicians,
as adjunct
faculty, as summer
preceptors or as significant
adults in
the life of young
men and women
who aspire to be
doctors.
A decade later, I
reflect on the new
roles. This student,
a reflection of a
younger me, excited,
a bit naïve, and
earnest to his core.
He represents extra
effort, inefficiency
and lost time. He
also represents the
challenge of my
debt, an understanding
of what I owe to
his father.
I find myself in the role of his father, in the position
to choose, hoping that I am worthy of the mantle.
K. Christopher McMains, MD serves as Assistant Professor in
the Department of Otolaryngology/Head and Neck Surgery at
the University of Texas Health Science Center at San Antonio.
He also shares his valuable time and talents as a member of
the BCMS Public Health and Patient Advocacy committee.
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