Is the Oath the Real Culprit in Burnout?
A recent Medscape poll of more than 2600 physicians asked whether the focus of the oath to put patients first contributes to burnout. More than one-third of respondents (34%) said it did, 45% said it did not, and 20% were unsure.
Many of the physicians who offered comments said it is not the Hippocratic Oath that fosters burnout, it is the intrusion of business into patient care.
"I do everything I can to put patient issues and concerns at the fore," one respondent, an anesthesiologist, noted. "Sadly, though, since I do not work in a vacuum, I am forced to consider many non-patient-centered, nonclinical, and often even irrelevant matters that may ultimately have an impact on my care of the patient. Does upholding the Hippocratic Oath lead to physician burnout? No. It's trying to do no harm in an environment where many other physicians do not honor their commitment to the Hippocratic Oath."
"Putting patients first is not the problem in burnout," a psychiatrist observed. "Rather, it's the intrusion of the federal bureaucracy and the emergence of corporate-driven (read 'profit-driven') medicine—systems that purport to measure quality and improve efficiency, all in the name of dollars. Doctors are now treating the templates in the EHR and documenting for payment. There is little room left for listening—the cornerstone of effective communication and patient-centered care."
Family physician Dike Drummond, MD, says he thinks that many physicians are framing the problem of burnout the wrong way. As the author of Stop Physician Burnout, Dr Drummond serves as a coach for burned-out physicians, lectures on the subject, and holds retreats for burned-out doctors.
"You are looking for the solution to a problem, when this issue is an obvious dilemma, a never-ending act between the two roles the physician plays: the role of doctor and the role of individual human being," Dr Drummond explains.
"You can't solve a dilemma," he insists. Instead, "you create a strategy to maintain the balance you seek."
"The challenge is when no one shows you the 'off switch' on your doctor programming, and you live as if the saying, 'The patient comes first,' applies 24/7," Dr Drummond elaborates. "This is extremely common because of the conditioning/programming/brainwashing of our medical education."
For some doctors, locating the off switch begins with revising the Hippocratic Oath to acknowledge that doctors are human too.
"We all agree that when you are with a patient, the patient comes first," Dr Drummond says. "But it is impossible to put patients first 24/7/365 and be a healthy human being. This prime directive, and its closely related cousin—'never show weakness'—are two of the root causes of burnout."
In acknowledgement of this, Dr Drummond proposes his own version of the oath:
I promise to put the patient first when I am practicing my craft as a physician.
I promise to attend to my own needs and the needs of my family when I am not practicing medicine for a simple reason: My health, well-being, and energy levels are the single most important determination of the quality of care I provide to my patients. This balance is crucial to the well-being of my patients, my family, and myself.
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Any views expressed above are the author's own and do not necessarily reflect the views of WebMD or Medscape.
Cite this: Neil Chesanow. Does the Hippocratic Oath Promote Burnout? - Medscape - Mar 29, 2017.