Fanfare, please. The World Medical Association has released a revised version of what’s known as The Physician’s Pledge (1) as outlined in the Journal of the American Medical Association (JAMA). It’s described as “the contemporary successor to the 2,500-year-old Hippocratic Oath”. And although only about 11% of medical schools still use the ancient “do no harm” Hippocratic version, oath-taking is still an important part of most med school training.(2)
But if you’re a patient instead of a physician, there are some surprises in this revised WMA document just for you.
As Berlin-based physician Dr. Ramin Walter Parsa-Parsi explained in JAMA, when doctors around the world reviewed previous professional and ethical pledge documents, one of the most important gaps identified this time was “the lack of recognition of patient autonomy”. For example:
“To address this lack of recognition – despite references to the physician’s obligation to exercise respect, beneficence, and medical confidentiality toward his or her patient(s) – World Medical Association members, ethical advisors and other experts recommended adding the following clause for the first time:
“I WILL RESPECT the autonomy and dignity of my patient.”
This modern version of the pledge is based on the Declaration of Geneva, adopted by the World Medical Association (WMA) back in 1948. It’s not universally used – especially in North American medical schools – but this exercise created by physicians from all over the world strikes me as a unique and earnest reflection of the changes afoot in doctor-patient relationships, no matter where they are experienced.
About one-third of U.S. and Canadian medical schools use a humanistic modified version of the Hippocratic Oath created in 1964 by former Tufts University School of Medicine dean Dr. Louis Lasagna that includes, in part, wording like this:
“I will remember that I do not treat a fever chart, or a cancerous growth, but a sick human being” and “I will remember that there is art to medicine as well as science, and that warmth, sympathy and understanding may outweigh the surgeon’s knife or the chemist’s drug”, and “I will not be ashamed to say ‘I don’t know’ nor will I fail to call in my colleagues when the skills of another are needed for a patient’s recovery.”
But for your reading pleasure, let’s review the changes in the newest MWA Physicians Pledge as compared with the previous version. Some of the changes that are of special interest to patients include:
♥ The words “and well-being” have now been added to: THE HEALTH AND WELL-BEING OF MY PATIENT will be my first consideration. (This is an important one, and reminds physicians to consider both the physical (health) and emotional (well-being) condition of each patient).
♥ The words “and in accordance with good medical practice” have been added to: I WILL PRACTISE my profession with conscience and dignity and in accordance with good medical practice. (This change reflects the standards of ethical and professional conduct expected of physicians by their patients and their peers).
Finally, another new addition is: I WILL ATTEND TO my own health, well-being, and abilities in order to provide care of the highest standard. This is a critically important nod to the growing awareness of mental health issues and burnout rates among our physicians amid increasing workload burdens, occupational stress, and the potential adverse effects these factors can have on physicians, their health, and their ability to provide the best quality care possible. The medical profession, in fact, consistently “hovers near the top of occupations with the highest risk of death by suicide.”)
1. Parsa-Parsi, RW. “The Revised Declaration of Geneva: A Modern-Day Physician’s Pledge.” Journal of the American Medical Association. 2017;318(20):1971–1972.
2. Foster, B. et al. “The Use of Medical Oaths in the Twenty-First Century”. The Pharos/Spring 2016
Q: What would you like to see included if YOU were rewriting the Physician’s Pledge?