OATHS HAVE POWER
Lawyers take oaths. Jurors do as well. In Philadelphia, where I try cases most often, jurors pledge to “well and truly try the case”. I can tell you that jurors take this oath very seriously. Medical malpractice cases almost always involve extremely sympathetic plaintiffs. They’re injured, sometimes catastrophically. Often the injured are children. And yet part of the instructions to jurors in my cases includes the admonition that they can’t allow sympathy to play any role in their deliberations. I’m not sure that’s possible–jurors are human, and when there’s a child who will never live a normal life sitting before them asking for justice, sympathy comes with the territory of humanity. But putting that sympathy aside is part of the oath to “well and truly try” a case. In my closings I often remind my jurors of the oath, and many times I see nods in recognition of the gravity of the pledge. There’s something about the solemnity of a promise that seems to make people feel more accountable.
A DOCTOR’S PROMISE
Doctors take oaths at the beginning of their careers. Traditionally it was the Hippocratic oath, but that has changed. Currently most medical schools do use some sort of oath but less than half of those are Hippocratic. If you read the Hippocratic oath you can see why other alternatives are used more often. It includes a pledge to give your teachers money if they need it, and not to participate in assisted suicide. It omits the pledge to serve all races and all sexualities. And to correct a common misconception, it does not include a pledge to do no harm. (It doesn’t make sense to pledge to do something that is impossible, and most medical interventions have some risk of harm.) For many, the Hippocratic oath doesn’t apply to their practice.
A number of different oaths have replaced the Hippocratic oath. What seems to be most common is an oath written by Dr Luis Lasagna, and it includes pledges to respect patients’ privacy and to be willing to say “I don’t know“. Other schools allow doctors to write their own oaths, which makes for a pledge that may be easier to keep. But I wondered whether lawyers, jurors and doctors really keep their oaths. Do oaths really have any power? My friend Rabbi Brad Hirschfield says yes. He says that oaths have the power of ritual, tradition and presence. If every doctor who takes an oath when starting their career believes it has that kind of power, it certainly does. And that kind of power can be magic.
PATIENTS’ POWER-AND RESPONSIBILITY?
Doctors aren’t the only members of the healthcare team who have power. I just got back from the American Association of Hip and Knee Surgeons meeting, and I was struck once again by the power of the patient. Some of the factors that most influence knee and hip replacement surgery results are whether the patient is obese; whether they smoke; whether they take narcotics; whether they are malnourished; whether they have social supports; whether they are anxious; and whether they are depressed. All of these are factors that a patient can influence. So the question is whether there’d be any value in patients taking oaths as well.
Rabbi Hirschfield believes there’s the potential for real value here. He thinks that the energy a patient and their family bring to the healthcare relationship is vital to the outcome, and I agree. This is true physically, emotionally and even more deeply. The ultimate example of that is Peter DeMarco. When his wife died this year, he wrote a letter to the doctors and nurses who cared for her. When you change the way you look at things, the things you look at change. In the depths of his horror and grief, Peter was able to look at the men and women caring for his wife and see compassion, empathy, and professionalism. Many others in his place may not have been so gracious.
There is power in being a patient. If taking an oath makes us more aware of that power, I think that’s reason enough to consider it. The specifics of that oath would depend on the patient, their condition and their goals. Rabbi Hirschfield offers three tenets he’d include. Honesty. Curiousity. Gratitude. Those three things are the hallmarks of any good relationship, and since the relationship between healthcare giver and patient is one of the most personal, they seem worthwhile pledges to me.
I’d love to know what you think of this idea. Do you think pledges are just words, and actions are what matters? Do you think this is a ridiculous notion and patients shouldn’t have to promise anything? Or do you see value in oaths and have some ideas for what doctors and patients should pledge? Come over to www.h2spark.com and share your ideas.