Tuesday, May 15, 2012

White Coat Ceremony Remarks

Tonight we are here to celebrate the transition of our new students from pre-med to medical school. They are now on the path to becoming physicians, and with this comes the specific moral and ethical responsibilities that all physicians must follow. In recognition of the moral foundation of medicine, in a few minutes we will take the Hippocratic Oath.

Hippocrates was a Greek physician born in the 5th century BC. He is widely known as the father of medicine because of the great advances he made in both the science and ethical practice of medicine. He was the first to separate medicine from mythology. He was the first to believe that disease was the result of natural causes, and not a supernatural punishment from the gods. He taught his students, for the first time ever, to focus on taking a thorough history and physical before deciding upon a course of treatment.

Hippocrates was also the first to practice auscultation, by placing his ear directly on the patient's chest, and his descriptions of the significance of pulmonary rales and friction rubs are still valid today. He also was the first to perform endoscopy in the form of a rectal speculum. His influence was so great that Hippocratic methods were practiced up into the 19th century, and by no less than Sir William Osler, one of the founders of Johns Hopkins Hospital. Perhaps the biggest contribution of Hippocrates, however, was his establishment of a moral foundation for the practice of medicine.

The original Hippocratic oath begins with the invocation “I swear by Apollo the Physician and by Asclepius and by Hygieia and Panacea...” But why did Hippocrates choose to begin the oath in this manner, and just who where these people?

Apollo was the Greek God of Medicine and son of Zeus. Although Apollo was a physician healer, he also used his knowledge to bring about ill-health and the plaque Apollo's son, Asclepius, represented strictly the healing aspect of the medical arts. Hippocrates was a descendant and follower of Asclepius. During his time, non-venomous snakes were often used in healing rituals, and this is the origin of the rod of Asclepius, the snake-entwined staff, which remains a symbol of medicine today.

Hygiea was a daughter of Asclepius, as was Panacea. From her name we get the word “hygiene”, as she was associated with the the prevention of sickness, the continuation of good health, and social welfare. Panacea was the goddess of the universal remedy. It was said that she carried around with her a potion that would cure the sick, and this brought about the term “panacea”, a remedy for all disease or ills.

Although we no longer recite this version of the Hippocratic Oath, it is instructive to understand its original roots. Apollo had the power to heal and was the origin of medical knowledge, but also the power to destroy, and he used both. Asclepius descended from Apollo, but represented strictly the power to heal. Hippocrates chose to include Hygiea in his oath, because he understood the fundamental principles of disease prevention. His inclusion of Panacea perhaps could represent the medical principle that while physicians cannot always heal, they can always provide comfort. Although not a panacea, this compassion and comfort is given to all patients.

The Hippocratic Oath at the time represented a true revolution in medicine, and was given to all of his students. For the first time, physicians swore to treat all patients, regardless of background, social status, or ability to pay. Physicians were to uphold patient privacy, and to practice within their area of expertise. They pledged to first, do no harm. They made an oath to respect education, and to pass on their knowledge to others. And finally, the Oath recognizes that medicine is not only a science, but also an art.

The anthropologist Margaret Mead summarizes the revolution brought about by Hippocrates this way:

“For the first time there was a complete separation between killing and curing. Throughout the primitive world, the doctor and the sorcerer tended to be the same person. He with the power to kill also had power to cure. These physicians, the followers of Asclepius, were to be dedicated completely to healing under all circumstances, regardless of the patient's rank, age or intellect."

So as we recite the Hippocratic Oath tonight, let us keep in mind the great dedication Hippocrates had to the medical profession, not only to the science, but also to its morality. As Hippocrates himself said,

“Wherever the art of medicine is loved, there also is a great love of humanity.”

Given at the IAU College of Medicine 20th White Coat Ceremony, May 11, 2012, Vieux Fort.