Physician Character and Integrity

Posted on 16 August 2015 by Lester Liao (Meds 2016)

Our last post discussed the significance of the oath in Hippocratic medicine and the importance of governing deities to ensure its terms were held.  While colleges serve a similar role in today’s world, the question remains: what if physicians can get away with things without the college noticing? This is where the content of the Hippocratic Oath begins to reveal much of the physician’s character.

Theoretically, in today’s society, if the college does not know you are somehow doing something unlawful and patients never complain, you can get away with anything.  This differs from the Hippocratic worldview that believed in gods that would certainly know what you were up to.  Embedded in the oath was a sentence of punishment for failing to uphold the oath.  Today this punishment may be losing the right to practice medicine.  Yet the college is not omniscient, and doctors today can certainly get away with small, “under-the-radar” practices that could relate to increasing financial gain, poor treatment of patients, and so on.  How is this to be prevented?  Hippocrates, on top polytheism, believed the solution was character.

As mentioned in previous posts, the Oath highlights a serious devotion to medicine and practicing it a certain way.  This assumes already that there is character compatibility between the practice of medicine and the person.   What is less obvious, however, is that this character is to be pervasive.  It is not what we would call “professionalism.”  Physicians were not to act all proper with patients but then to engage in all sorts of shenanigans on their own time.  Physicians were to be proper all the time.  Consider that the physician was to be “pure and holy both [in] my life and my art.”  This was hardly what we call professionalism.  This was integrity.  A physician was always to be a certain kind of person, never fragmented by circumstance or setting.  Regardless of surveillance, monetary gain, personal reputation, or simple convenience, physicians with integrity would act the same way.

The Oath further offers a practical example of how this integrity is supposed to manifest.  Regardless of whether the physician heard something inside or outside of the medical setting, he or she was never to divulge “what should not be published abroad.”  This was an early sort of confidentiality, but it was a confidentiality that developed not as an external restraint but as an internal disposition.  In today’s setting, if a physician is a terrible gossip but maintains patient confidentiality, there are no issues.  The Hippocratic worldview, however, did not hold such a disjointed view of the person.  The activity of the physicians developed from their fundamental characters.

When we consider today how to expect physicians to practice ethically, there are two things we can consider.  First we can ask if the person believes that there are true and real consequences to all his or her actions (even if they can somehow eschew human authorities).  Secondly we can ask what the physician is like as a person.  Surely it comes more naturally to a righteous person to act righteously in the professional and personal settings than for an unrighteous person to act righteously in the professional setting (presumably due to external rules and regulations) while acting unrighteously in all other domains.

We would do well today to learn this lesson from Hippocrates.  The human is a cohesive being that cannot arbitrarily be split into two personalities.  For all actions stem from a person’s heart or core.  Certainly we still have high aspirations and character qualities we laud in theory, but to the average patient seeing a community physician with little surveillance, integrity could be all the difference.   Perhaps recognizing the importance of a high devotion to medicine paired with personal integrity would change the way medicine is practiced today.

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