THE HIPPOCRATIC OATH
AS A MEMBER OF THE MEDICAL PROFESSION:
I SOLEMNLY PLEDGE to dedicate my life to the service of
humanity; the health and well-being of my patient will be my first
consideration; I will respect the autonomy and dignity of my patient; I will
maintain the utmost respect for human life; I will not permit considerations of
age, disease or disability, creed, ethnic origin, gender, nationality,
political affiliation, race, sexual orientation, social standing, or any other
factor to intervene between my duty and my patient; I will respect the secrets
that are confided in me, even after the patient has died;
I will practise my profession with conscience and dignity and
in accordance with good medical practice; I will foster the honour and noble
traditions of the medical profession; I will give to my teachers, colleagues,
and students the respect and gratitude that is their due; I will share my
medical knowledge for the benefit of the patient and the advancement of
healthcare;
I will attend to my own health, well-being, and abilities in
order to provide care of the highest standard; I will not use my medical
knowledge to violate human rights and civil liberties, even under threat;
I MAKE THESE PROMISES solemnly, freely, and upon my honour.
©2017 World Medical
Association Inc.
Every year, across medical schools in Kenya, newly graduated
doctors take the Hippocratic oath before they are released to the public to use
their knowledge and skills for the good of humanity.
The oath binds doctors to protect the patient by upholding
professional integrity at all times. In summary, the oath binds one to first do
no harm. To care for the patient and to maintain the utmost level of confidentiality
even in death. To attend to the patient without consideration of their age,
race, religion, colour or walk of life; yes, even if the said patient is a
murderer or rapist, one cannot compromise the quality of care provided.
Yet, despite such a stringent declaration, doctors are always
on the receiving end of medical malpractice. In the face of bad medical
outcomes, the finger is always pointed at the doctor. Why do the doctors
shoulder such a huge burden of blame?
As is the case in any other profession, there is a hierarchy
of responsibility. In the medical profession, the buck stops with the most senior
doctor in the room. This is the reason why complaints arise in largely in big
hospitals and rarely in the small dispensaries and health centres that refer
complicated patients to them. These patients’ fate could go either way.
So how does a doctor who left the house in the morning to go
save a life end up on the front pages of the dailies with accusations of
malpractice? Is there a mentally stable doctor who leaves their house in the
morning with the intent to harm a patient?
Dr. Salim* is an anesthesiologist who lost a patient on the
operating table because she developed a nasty allergic reaction to one of the
anesthetic drugs used on her. Despite the fact that both the patient and her
spouse signed consent for general anesthesia with all its attendant risks, the
spouse is currently suing Dr. Salim for negligence leading to death.
Dr. Daudi* is a paediatrician. Baby Jonathan* was admitted
under his care in critical condition. Despite a careful history and examination
and numerous investigations, the cause of Baby Jonathan’s illness remained
elusive as he deteriorated in the ward. He was put on various treatments
broadly targeting possible causes of his condition but after 48 hours, he
succumbed. During a post-mortem requested by Dr. Daudi himself, Jonathan is
found to have a rare condition whose test results were not yet back from the
lab as they took three days to be ready. Jonathan’s parents intend to seek
legal redress.
Dr. Kaluu* was off duty on a weekend. He received a call from
the junior doctor in the hospital asking for expert help. The labour ward had
received a mother from a peripheral facility who was bleeding torrentially. The
other senior doctor on call was already in a different operating room trying to
save the life of another mother. Dr. Kaluu jumps off his couch and in a race
against time to save a mother’s life, the battle is lost as the facility does
not have enough blood to transfuse her to replace her loss. The patient’s
family is infuriated that the doctor was in his house instead of being in the
ward and hence the delay in getting to the patient caused death, terming him
lazy and uncommitted to his patients in comments made on social media.
The reason there are regulations about the practice of
medicine is not for the 95% of doctors who wake up every morning to give
service in accordance with the Hippocratic oath. It is for the 5% rotten apples
whose actions result in preventable mortality and morbidity. And just like in
any other profession, these type of people will exist. These are the doctors
who will be unavailable when on duty; careless with procedure; disregard the
contribution of their peers and the rest of the care team in the patient’s
management; fail to call for help in a timely manner; fail to update themselves
on the current practices; or take on procedures outside their skill set with
disastrous results. For this reason, the law exists to deal with them.
For the other 95%, in their daily struggle to save life,
errors of commission will happen such as in the case of Dr. Salim, errors of
omission will happen like in the case of Dr. Daudi, both of which may be beyond
human control. This is the reason why institutional protocols exist to minimize
these errors.
The court of public opinion is extremely harsh especially
with the advent of social media. In cases such as Dr. Kaluu’s, the harsh
judgement has robbed us many great doctors with a human heart as they walk in a
dark tunnel wondering why they got involved in the first place when they had
every reason to stay out of it. Many have opted to immerse themselves in
non-clinical medicine such as research, policy and administration to avoid such
mishaps.
As the consumers of medical services, we must remain vigilant
at all times to ensure this lifesaving profession maintains the highest
standards of care at all times. However, we must be careful not to break the
very people with the skill set we require when we are the ones lying on that
bed and they are the only person between us and the grave.
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