Thursday, July 29, 2010

The Hippocratic Promise

Richard P. Holm MD

Through ancient and modern history, there is a tradition in the medical profession that the graduating medical student publicly and formally takes an oath and promises to uphold high ethical standards. It is a med student rite of passage, which has been handed down from our ancestors.

Historically it has been the Hippocratic oath, which is to swear by Apollo the Physician, and Asclepius and Hygieia and Panaceia and all the gods, and goddesses, to preserve life and to care for all regardless of rank, age or intellect. This apparently represented a shift in attitude in ancient Greece, as earlier many had used the knowledge of medicines and herbs to poison. Also it asked that the life of a slave, the life of the Emperor, the life of a foreign man, and the life of a child with a disability should all be valued as equal in importance.

But this traditional oath is replete with modern controversy. For example if the old oath is followed, the children of physicians would have preferential admission into medical school; we could not cut out kidney or bladder stones, or do any surgery for that matter; physicians could not take payment for providing care to patients (except maybe room and board); and there would be conflict with how we presently give suffering terminal patients enough pain medicine. Indeed, the old oath was meant for another time.

At the Sanford USD School of Medicine as in every medical school graduating medical students still give a contemporary version of the Hippocratic oath. Although there is some variation between schools, every version promises to diminish suffering and enhance health; to do no harm; to search for truth through science; and to respect the freedom and right of self direction for every patient. Modern versions also speak to just distribution of care when resources are limited, avoiding over and under-treatment, asking for help when necessary, and the art of a warm, sympathetic, and caring bedside manner.

Every physician upon entering the medical profession has made an oath and covenant to uphold a worthy ethical standard. This is more than tradition. It is a promise.

Tuesday, July 13, 2010

Valuing Others

By Richard P. Holm MD

This week, in our little town in South Dakota, a young man in his twenties came into my office weeping and scratching his arms and legs. I was expecting a rash-type problem, when he blurted out that he was injecting methamphetamine two to four times a day. “It has destroyed my life,” he said. “I used to have a job, insurance, a house, and a life. Now I have nothing. Please help me,” he cried. I did my best for him.

By definition addiction is the state of physical or psychological dependence on a drug, which is liable to have a damaging effect. It’s a habit, a compulsion, or an obsession, which turns around and bites the user and everyone nearby. Alcoholism is the most pervasive and obvious addiction in our society. If it doesn’t directly affect you, most certainly it affects someone dear to you.

The potential for addiction is part of our collective human nature. I dare say that every one of us given just the right situation would be addicted to one drug or another, whether it be cigarettes, pain medicines, sleeping pills, marijuana, methamphetamine or a fine red wine.
What is it that separates the addict from normal happy people who are able to function in society? Some experts define addiction and, specifically, alcoholism with the four features of craving, loss of control, physical dependence, and tolerance. Others add that addiction means losing perspective about what has value in life. Vision of the surrounding world dims, and instead the addict obsesses on self and how to get another shot, pill, snort, drag, or drink. Addiction accelerates like a maelstrom into such selfness until nothing else exists.
It makes sense then that the opportunity for recovery comes with the sacred message of the Golden Rule: treating others with compassion and fairness. Valuing others is the key ingredient in order to sober- up the self-absorbed addicted individual. It is no wonder spiritual based programs for sobriety are the most successful.

No question, we are all at risk for the selfish cycle of addiction, and our best help comes by relearning how to care for others.