Dealing with death, pain takes heavy toll on doctors as well

Taking the Hippocratic Oath is an important rite of passage for students in most medical schools.

Students recite the oath in various forms and at different stages – some in their first year during ‘White Coat Ceremonies’, and others at the beginning of their clinical rotations. Most do it again upon graduation.

Over time, the original Hippocratic Oath has been updated to  reflect changing societal beliefs and values; for instance, not many nowadays might be inclined to swear “by Apollo the Physician, and Asclepius... and all the gods and goddesses as my witness...”

Preventive medicine definitely requires the active education and participation of the individual and the community at large in their own health matters.

The Declaration of Geneva, according to the World Medical Association’s (WMA) website, is considered to be the Hippocratic Oath’s modern version. First adopted in 1948, it contains the age-old values of service to humanity, maintaining confidentiality, and concern for the patient’s health as the physician’s prime consideration.

The Declaration of Geneva has undergone six revisions since then, culminating in the latest version amended by the WMA’s General Assembly in Chicago in October 2017. In it, a little-known but critical addition was adopted – “I will attend to my own health, well-being, and abilities in order to provide care of the highest standard.”

For doctors who have been accustomed (and expected by society) to constantly put others before themselves, this pledge marks a significant step in recognising that doctors are, after all, human, and need to take certain steps in order to be well in body and mind.

Regularly encountering pain, suffering and death, as doctors do, certainly takes its toll on one’s health. One might however also note that in the Declaration of Geneva, the health of the doctor is encouraged “in order to provide care of the highest standard.”

The recognition that the health of the physician also matters is a commendable inclusion; after its absence over many years.

But it would be absurd to condemn someone for failing to partake of a nutritious diet without food to eat. For doctors expected to attend to their own health, well-being, and abilities, it is implied that they will get the time off to rest or seek medical advice and treatment.

They need enough time and proper funding to attend courses and training that enhance their medical skills, knowledge and practice. It should be the case that there will be sufficient human resource in healthcare in terms of numbers and expertise to effectively handle whatever physical and mental health challenges they may have; and that it case of admission, treatment will be in well-equipped hospitals without financial hardships.

For the wellbeing of doctors to become a reality, toxicity, cruelty, harassment, and discrimination in their workplaces must be rooted out and replaced with empathy and kindness.      

It is past time for the creation and adoption of physician health programmes (PHPs) that specifically offer care, confidentiality, treatment and follow-up to physicians impaired by physical, mental, addictive, and other conditions.

The USA’s Federation of State Physician Health Programs (PHPs) consider privacy and confidentiality to be paramount “to allow those in need of help to come forward without fear of punishment, disciplinary action, embarrassment, or professional isolation.”

For doctors trained to hold tight the secrets of their patients and others, any form of perceived ‘failing’ on their part – even due to illness – can be difficult to admit to. PHPs offer doctors a dignified way to get treatment and to continue practising, if they are able and willing to.

Dr Esther Muiruri is a Bioethicist, Advocate of the High Court of Kenya and a visiting course facilitator at Aga Khan University Medical College, EA