As they don their white coats for the first time, a new crop of medical students nationwide is taking an oath — but it may not be the one you think.
The Hippocratic oath has been out of fashion for a while. It doesn’t actually say, “do no harm,” but it does pledge allegiance to mythical goddesses, among other things. In its place are modernized oaths, which combine the idea of “do no harm” with vows to remember both the human beings on the other end of the stethoscope and their social and financial well-being when treating them.
“We see health as a much broader context than just the physical symptoms and diagnoses,” said Steve Smith, associate dean for student affairs at Dell Medical School at the University of Texas at Austin, one of three new medical schools opened in the US this summer.
Dell let its inaugural class select and revise their own oath earlier this month. The students decided to modify parts of a more humanistic oath written in 1964 by Dr. Louis Lasagna, a former dean at Tufts University School of Medicine.
“I will remember that I do not treat a fever chart, or a cancerous growth, but a sick human being,” the students vowed at their symbolic white coat ceremony. In these ceremonies, now common nationwide, students accept white coats, recite oaths, and commit to practice ethically as they begin their medical education.
Oath-taking has become nearly universal at US medical schools, and while oaths of all stripes are often called “Hippocratic,” hardly any schools use the original oath that Hippocrates, the Greek “father of medicine,” is said to have written over 2,000 years ago.
That oath has several problems, said Smith. For starters, he pointed to the Greek gods: “I swear by Apollo Physician and Asclepius and Hygieia and Panaceia and all the gods and goddesses,” the oath begins. The original oath also asks doctors never to “give a woman a pessary to procure abortion,” and to abstain from euthanasia (“I will neither give a deadly drug to anybody who asked for it”).
Lasagna’s oath is the most popular one used by medical schools: 33 percent use it, according to a 2009 survey of 135 US and Canadian medical schools. Just 11 percent of the schools use the classical Hippocratic version, researchers found.
“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,” Lasagna’s oath reads in part. Lasagna’s version also calls on doctors to admit when they don’t know the answer; prevent diseases; and to take responsibility not just for the patient’s health, but for the way an illness affects a person’s “family and economic stability.”
Other values influence a school’s oath. Dr. Robert Orr, a professor at Loma Linda, a Seventh-Day Adventist university outside of Los Angeles, surveyed medical schools in the US and Canada in 1993 about this practice. While oath-taking had become widespread, he and coauthors concluded the content of the Hippocratic oath had been watered down over the years. He joined a panel that rewrote the oath in 1995 at Loma Linda’s medical school, which had been using a secular version.
The school’s new oath doesn’t swear off abortion or euthanasia, as Hippocrates’s version did. But it brings back one thing Orr noted had gone missing — a pledge to God.
“This is not a code of ethics for providers,” Orr told students in a 2012 ceremony before they took the new oath, “but a professional oath sworn to God almighty.”
New York Medical College, Tulane, and the University of California, San Francisco, all have students vow not to discriminate against patients based on gender, race, religion, or sexual orientation.
Most schools stick with one of three main versions of the oath, often for the sake of tradition — Hippocrates’s, Lasagna’s, and the Declaration of Geneva, said Dr. B. Alex Foster, the coauthor of the oath survey and an assistant professor at UT Health Science Center in San Antonio.
But some medical school classes have revised their oaths to reflect their personal values.
Medical students at Creighton University, a Jesuit university in Omaha, Neb., revised their school’s oath last year to keep up with modern times, adding a pledge not to discriminate against patients based on sexual orientation, according to spokeswoman Cindy Workman.
At Harvard Medical School, each class of students now writes its own oaths, one at the white coat ceremony and another at graduation, when they take the oath as a newly minted doctor.
The latest version that incoming students at Harvard recited in August reads in parts like a fiery sermon. It calls on doctors-in-training to “wake up to the realities of the world” and “rise up.”
“We promise to bear witness to historical injustices that continue to unfold for marginalized communities,” the oath reads, in part. “… We must have the courage to act when we witness injustice.”