Sharon Clark discusses the relationship of the Hippocratic oath to the potential for physician burnout. Her paper examines the potential conflict between this widely used oath and today’s practice of medicine.
Clark Sharon A. The Impact of the Hippocratic Oath in 2018: The Conflict of the Ideal of the Physician, the Knowledgeable Humanitarian, Versus the Corporate Medical Allegiance to Financial Models Contributes to Burnout. Cureus. July 30, 2018;10(7):e3076. doi:10.7759/cureus.3076.
Much of the understanding of the Hippocratic Oath is based on myth and is inaccurate, but the reality is that almost all physicians take some oath at the end of their training. A key element is to put the patient’s needs first. As an example, the recently graduated physician agrees:
Much of the discussion of burnout focuses on behavioral explanations for burnout, that is, those related to actions and situations. The article highlights a more ethical/philosophical basis for burnout due to the challenge of two ideals that cannot both be met. Specifically, the need to put the patient’s needs first versus the need to address economic models associated with a movement toward more corporate based healthcare delivery.
She argues that the Oath does indeed place the physician at odds with the increasingly business-focused, financially constrained, health care system. Physicians who perceive that a patient’s needs are being subordinated to other requirements are placed in a conflict that potentially contributes to burnout. Unfortunately, the article does not present data demonstrating that such a conflict actually exists nor that the conflict causes burnout.
One interesting potential solution is agreeing to the Hippocratic Oath (or an equivalent) at the beginning of training rather than at the end. Waiting until the end is similar to an agreement at matriculation to submit work as only one’s own. One might also argue that such an Oath should at least be considered before applying to medical school or even earlier, say before considering becoming a pre-medical student. Early inspection of the future role of a physician would help the individual start to resolve conflict at an earlier stage, or at least to acknowledge and process two conflicting requirements.
It’s easy to write off such dissonance as being irrelevant. However, conflicting moral standards are certainly a potential cause of longer lasting stress that is difficult to resolve. This is a topic without a simple solution but one which will gain from reflection. One way of addressing this potential cause of burnout would be to present different scenarios that operationalize the conflict and to ask users to take an action. One can then determine if this is potentially a problem and then consider ways that the conflict can be resolved.
We are looking into this issue, and we will incorporate it into the simulation scenarios on the Clinical Encounters Platform that mirror the conflict between the Hippocratic oath (or its equivalent) and the practice of medicine. In the simulation, we can identify ethically challenging situations where the process of care limits the ability to act in the patient’s best interest due to reimbursement problems, time constraints, insurance requirements, hospital expectations, or other financial-based requirements. We can both assess if a conflict exists and offer means to resolve the conflict or simply acknowledge it.