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Dox Responds: The Updated Physician’s Pledge

Image: Luis Molinero/shutterstock.com

In October, a newly revised version of the Declaration of Geneva was adopted by the World Medical Association (WMA) General Assembly in Chicago.

The Declaration was first adopted by the WMA in 1948. Now, nearly 70 years later, the “contemporary successor to the Hippocratic Oath” has been updated to reflect issues facing clinicians today.

Here at Doximity, we wanted to know what doctors thought about the new Physician’s Pledge. So, we assembled a few of the perspectives about the newest changes. If you would like to read the updated pledge, please click here or scroll to the bottom of this page.

“I was there at the WMA conference and I participated in discussions over the previous 18 months on the Declaration of Geneva. I also served as the sole non-voting delegate to the General Assembly from one of the sections.

“The only substantive change to the Declaration (aka Hippocratic Oath) is near the bottom of the pledge where it deals with physician wellness. I will say that some of the African delegations wanted to modify it further to state that the government or other authority must provide adequate resources for physicians, because apparently physicians in many third world and/or war-torn countries are being blackmailed with the Declaration by their governments without being provided adequate resources. However, this modification was soundly defeated because this a pledge between the physician and patient. The Africans’ issue will be dealt with in other ways by the WMA and other nations.

“I really like this pledge because it states a) what our ancient duties are to our patients, and also to both our students and teachers, b) the vow of secrecy even upon death, c) no discrimination, including sexual orientation or gender identity, and d) recognizing that physician wellness is vitally important both for the sake of physicians but also for patients to be able to receive high quality care every time.”

Dr. Ankush Bansal

Medicine is steeped in tradition and history, however as medicine evolves and changes, it is important that physicians evolve as well. The new Physician’s Pledge addresses a few new important ideas while maintaining the integrity of what it means to be a physician.

“There are many wonderful traditions that exist in medicine. It is important for physicians to continue to practice the art of medicine with these types of important historical and cultural traditions incorporated into practice and training. Traditions such as the white coat ceremony and tenets like the Hippocratic Oath with the promise “to abstain from doing harm” have been adapted into the modern era to the well-known phrase “first do no harm” and have become a part of the foundation of medicine.

“But it is also important for physicians to grow and change as medicine grows and changes. In the electronic age, with paperwork, online obligations, prior authorizations and peer to peer reviews taking up significant amounts of our time, the addition of language addressing physician well-being in this new pledge is an important modification. Physician burnout is a commonly discussed topic of concern and self-care of the physician translates to better overall patient care. Including the reciprocal respect between students and teachers will foster and stimulate the traditional environment of constant learning. Overall, this pledge seems to be a modification that takes into account some of the modern challenges we face in medicine while maintaining the core values that were introduced thousands of years ago.”

Dr. Shikha Jain

“A modern re-tooling of the Hippocratic oath is welcome in my opinion. Rightly so, the first statement is that “the health and well-being of my patient will be my first consideration.” “Respect the autonomy and dignity of my patient” is a nice change from a more paternalistic practice of medicine. Contemporary concerns of patient confidentiality and non-discrimination are highlighted in this new declaration. The statement that providers “will not use my medical knowledge to violate human rights and civil liberties” and that there will be the “utmost respect for human life” should give pause to those physicians that participate in state-sponsored executions and torture. The pledge to respect learners should be welcome to all trainees and teachers alike. The oath states that the physician will “attend to my own health, well-being, and abilities in order to provide care of the highest standard”. In the past, care was seen as a zero-sum equation, from physician to patient without care given to one’s own health. A respect for self-care is welcome in this era of high burn-out. Overall, the new oath is a good one that modernizes and humanizes the medical mission.”

Dr. Heather Finlay-Morreale

“One can hardly disagree with the pledge. I think the pledge, like the Hippocratic oath, serves as a ritual of passage and, as such, merges physicians across both time and geography. I feel that in addition to one’s public attestation to peers, family (in the form of those increasingly popular White Coat ceremonies) and society, there is often an internal attestation of beliefs. With time and experience, our personal attestation will deepen and change. I think that there is some real value in renewing our vows, much like I did those of my marriage, after years of experience both good and bad, stressful and in the flow, rewarding and defeating. The renewal of my vows meant more in acknowledging my internal rite of passage than the simple public declaration made long before I had the experience to understand the oath’s real meaning.”

Dr. Chuck Dinerstein

“The most important change in the World Medical Association Declaration of Geneva, from my perspective, is how the new version — after nearly 70 years and more than a decade since the previous revision — places renewed emphasis beyond simply maintaining a narrow definition of medical health. What “being healthy” means can vary wildly among practitioners within a field, to say nothing about across subspecialties: I (as a neurologist) typically view protecting the brain to be of the utmost importance, but I suspect other specialists might offer differing perspectives.

“This new revision places emphasis not just on an individual physician’s narrow scope of practice, to be used to ensure medical health, but takes a step back to more fully acknowledge holistic well-being. It puts physicians in a position to act not only as custodians but to proactively foster well-being with the recognition we must support that vision of our patients — not necessarily our own more narrow view. Respecting autonomy, preserving dignity, and working with patients throughout life with THEIR goals in mind. I also appreciate the removal of “at the time of this pledge” by the WMA to help remind all this Is a lifelong goal.”

Dr. Aaron Nelson

“I am very much in favor of this statement, I found myself nodding throughout reading it. We can go into details about small things that may be changed, but overall it sums up our mission as physicians. We have an incredible gift given to us as docs and should show our gratitude by using this gift for the best of those around us.”

Dr. Robert Lamberts

The Physician’s Pledge

AS A MEMBER OF THE MEDICAL PROFESSION:

I SOLEMNLY PLEDGE to dedicate my life to the service of humanity;

THE HEALTH AND WELL-BEING OF MY PATIENT will be my first consideration;

I WILL RESPECT the autonomy and dignity of my patient;

I WILL MAINTAIN the utmost respect for human life;

I WILL NOT PERMIT considerations of age, disease or disability, creed, ethnic origin, gender, nationality, political affiliation, race, sexual orientation, social standing, or any other factor to intervene between my duty and my patient;

I WILL RESPECT the secrets that are confided in me, even after the patient has died;

I WILL PRACTISE my profession with conscience and dignity and in accordance with good medical practice;

I WILL FOSTER the honour and noble traditions of the medical profession;

I WILL GIVE to my teachers, colleagues, and students the respect and gratitude that is their due;

I WILL SHARE my medical knowledge for the benefit of the patient and the advancement of healthcare;

I WILL ATTEND TO my own health, well-being, and abilities in order to provide care of the highest standard;

I WILL NOT USE my medical knowledge to violate human rights and civil liberties, even under threat;

I MAKE THESE PROMISES solemnly, freely, and upon my honour.


Dox Responds: The Updated Physician’s Pledge was originally published in Op-(m)ed on Medium, where people are continuing the conversation by highlighting and responding to this story.
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