Youngest, Oldest Physicians Diverge on Hippocratic Oath

Marcia Frellick

June 02, 2017

Responses to a Medscape poll on physician beliefs about the Hippocratic Oath show that thoughts about the power of the oath and even whether physicians have taken it differ strikingly between the youngest and oldest physician groups.

According to the poll, to which readers began responding November 22, of those under age 34, 39% said it was very meaningful, compared with 70% of those 65 and older. Conversely, of those in the under-34 group (which had 267 respondents), 18% said it was not at all meaningful vs 10% of those in the oldest age group (836 respondents).

Total responses to the poll numbered 2674 physicians plus 134 medical students. Readers' comments numbered well over 200, and though commenters didn't give their ages, their responses helped describe the debate.

A commenter who listed his specialty as pain management wrote, "The Hippocratic Oath is quite relevant today as it gives our newly trained colleagues an idea of the principles our once noble profession espoused, when we served patients for their good, not bureaucrats for theirs."

Another commenter took a different view, writing that the oath is "sadly, irrelevant. Medicine has evolved from a profession into a huge service industry that involves many other players. These players, like the health insurance, hospital employers and pharmaceuticals, do not pray to the same god as the medical profession. Their priority is financial profit ― within or without the Hippocratic Oath."

Medical students' answers concerning relevance of the oath were similar to those in the under-34 group, with 41% finding it very meaningful and 16% saying it was not at all meaningful.

How Often Is the Original Form Recited?

The poll showed a large difference in age groups as to who recited the oath in medical school and, if they did, in what form. While 64% of those aged 65 and older recited the oath in its original form, only 39% of those under 34 did. Just 33% of current medical students recited the original oath.

Those under 34 were four times as likely as those 65 and older to say they recited an oath written by their medical school faculty members (17% vs 4%). The number was similar among current medical students, at 19%.

Here's the breakdown on which oath was recited for the youngest and oldest physician groups and medical students compared with the average for all physicians.

Table. Question: As a medical student, which version of the oath did you recite?

Answer 65 and Older (%) Under 34 (%) All Physicians (%) Med Students (%)

Hippocratic Oath (original version)

64 39 56 33
I didn't take an oath 17 14 14 19
An oath written by my med school faculty 4 17 9 19
Declaration of Geneva (1948) 4 13 6 11
Modernized oath by Louis Lasagna (1954) 3 9 5 7
Oath by Maimonides 5 2 3 1
Alternative written by med school class 0 2 1 6
Alternative version I wrote myself 0 0 0 1
Other 2 4 4 4

Keep It or Change It?

As to whether the oath should be kept, revised, or replaced, those 65 and older answered with more certainty that it should be kept, but still only 72% said keep it. In that age group, 8% said get rid of it and 20% said revise or replace it.

The poll told a different story in the younger age group. Fewer than half wanted to keep it (43%); 40% said revise or replace it; and twice as many as those in the older group, 16%, favored getting rid of it.

The Hippocratic Oath focuses on putting patients first. The poll asked two questions related to that aspect: whether that contributed to physician burnout, and how often physicians were able to put patients first in today's healthcare environment.

Does It Add to Burnout?

The younger group was much more likely to say that the oath's patient-first focus contributed to physician burnout. Almost half of those in the younger group (47%) said it did vs 27% in the 65 and older group. Medical students were split on the subject: 33% said yes; 32% said no; and 35% were unsure.

Asked how frequently they were able to put patients first, given the current healthcare environment, numbers were strikingly different by age. Only 12% of those under 34 said "always," whereas 40% of those 65 and older answered that way. Similarly, the younger group was more likely to say they "rarely" were able to put patients first (7% vs 2% for those 65 and older).

Some readers said unequivocally that the oath should rule the profession. One commenter wrote that it is "like constitutional law. It should be preserved."

Another said that it's taking any oath, not just the Hippocratic Oath, that is irrelevant: "We must do the right thing by the patient with or without taking an oath as it is implied when we decide to become doctors."

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