In a recent conversation with colleagues, we reflected on some of the challenges within and between members of the medical profession. After reminiscing about great teachers and mentors, conversation drifted, inevitably to the not-so-great ones. We were struck by numerous recent examples of poor, unethical, bullying, even immoral behavior by trusted colleagues and superiors. One of us summed it up succinctly: “It’s either Hippocrates or hypocrisy”.
The stories flooded out like vomitus in an unfortunate lady with hyperemesis gravidarum.
We are held to high moral, ethical, and behavioral standards. How we treat our patients and colleagues is therefore mission critical to being a “good” doctor. We started to think: “why?”. Why do smart, hard-working dedicated, caring, and (normally) compassionate people do this? And what can be done about it?
Few of us swear by Apollo the physician, and Asclepius, and Hygieia and Panacea. But all of us know, “First do no harm.”
The Hippocratic Oath (Ορκος) is a traditional oath taken by physicians in which they pledge to practice medicine ethically and to do no harm to their patients. It requires a new physician to swear upon a number of healing gods that they will uphold a number of professional ethical standards.
While very few modern medical schools require graduating doctors to solemnly recite the Hippocratic Oath , it remains important in medical culture and ethics. Few of us swear by Apollo the physician, and Asclepius, and Hygieia and Panacea. But all of us know, “First do no harm.” (This is a myth, though! Technically, the wording is, “…and I will do no harm or injustice to them [my patients].”)
Many of the Oath principles underlie professional standards to this day – confidentiality, honesty, non-malfeasance.
In summary, the Oath says:
The Oath does not expressly say things like “Don’t be a bully”, “Don’t sleep with your students”, or “Don’t treat only patients who can afford your fees”, but these, we think, are implied.
Particularly in modern medicine, physicians often experience extremes of stress, moral injury, conflicts of interest, the lure of high financial reward, and competition. We also have high rates of burnout, mentall illness, addiction, and suicide. Altogether these tensions can lead to a disconnect between our actions and the principles of the Hippocratic Oath.
One reason for this disconnect may be the increasing pressure on physicians to prioritize the financial bottom line of the healthcare system over the well-being of their patients. This can lead to a sense of moral dissonance among physicians, as they may feel that they are not able to provide the best possible care for their patients due to financial constraints.
Another reason is that, in the current healthcare system, physicians are often overworked and under-resourced, which can lead to feelings of burnout and emotional exhaustion. This can make it difficult for physicians to maintain the level of compassion and empathy that is necessary to adhere to the principles of the Hippocratic Oath.
The Oath does not expressly say things like “Don’t be a bully”, “Don’t sleep with your students”, or “Don’t treat only patients who can afford your fees”, but these, we think, are implied.
Hypocrisy in relationships between physicians can manifest in a number of ways. One example is when physicians fail to practice the same level of self-care and self-compassion that they advise their patients to practice. This can lead to feelings of burnout and emotional exhaustion among physicians, which can in turn negatively impact the quality of care they provide to their patients.
Another example is when physicians put the financial bottom line of the healthcare system above the well-being of their patients. This can lead to physicians providing unnecessary treatments or procedures, or to a lack of availability of certain treatments due to financial constraints. This can also lead to neglecting patient needs and not providing the best care possible.
The most extreme examples are where physicians abuse their positions of power in inappropriate relationships with patients, inappropriate tests or treatments, or financial misbehavior. Thankfully rare, these behaviors tend to be strongly criticized by licensing authorities, and rightly so.
Hypocrisy can also be evident in the way that physicians interact with their colleagues. For example, when physicians engage in unprofessional or unethical behavior, such as bullying or harassment, they are not adhering to the principles of the Hippocratic Oath, which calls for them to behave in a professional and ethical manner.
There are several examples of how physicians may engage in unkind, unprofessional, or lacking compassion behavior when dealing with colleagues. Some examples include:
Another example is when physicians engage in competitive behaviors that prioritize their own success or status over the well-being of their colleagues. This can include withholding information or resources from colleagues, or engaging in back-stabbing behaviors such as spreading rumors or gossip. This can create a culture of mistrust and can lead to a lack of teamwork and collaboration among physicians.
Despite evidence to the contrary, I still believe that most humans have good hearts, they are just a bit messed up. Physicians are no different – or perhaps they are a bit more messed up.
I believe true evil is rare and most people make mistakes, even bad ones, within a context.
Of course there are sociopaths and narcissists in medicine. I’m not talking about the diagnosable who walk among us. I mean the mostly good, honest, hard-working colleagues who mess up.
Call me a softie liberal if you like. I’ve also seen WAY too many “good” colleagues fall afoul of their own issues. Careers, marriages, businesses ruined. And always within a context.
I would like to understand why.
I honestly think that modern medicine is the main culprit.
The above examples of unkind, unprofessional, or lacking compassion behavior among physicians can be linked to the pressures of modern medicine. The increasing pressure on physicians to prioritize the financial bottom line of the healthcare system over the well-being of their patients can lead to a sense of moral compromise among physicians.
Additionally, the high workloads, long hours, and lack of resources often seen in modern medicine can lead to feelings of burnout and emotional exhaustion, which can make it difficult for physicians to maintain the level of compassion and empathy that is necessary to interact with their colleagues in a professional and ethical manner.
Finally, stress brings out our worst personality traits. Cutting corners, impatience, intolerance, are present in all of us. The stresses of industrial medicine amplify these, and sometimes we end up doing stuff we regret later.
In this article, we have explored the principles of the Hippocratic Oath which underlie much of medical ethics and professional standards. We have seen how otherwise “good doctors” can end up behaving badly, hurting others, and themselves. We lay the blame not at individual moral weakness, but at the systemic issues forcing us to cut ethical corners and compromise our principles.
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What can be done to resolve the hypocrisy? Read Part 2 next week for more…
