Oath of Hippocrates (extracts)
swear by Apollo the physician, and Aesculapius, and Health, and All-heal,
and all the gods and goddesses, that, according to my ability and
judgment, I will keep this Oath. I will follow that system of regimen
which, according to my ability and judgment, I consider for the benefit of
my patients, and abstain from whatever is deleterious and mischievous.
With purity and with holiness I will pass my life and practice my art.
Into whatever houses I enter, I will go into them for the benefit of the
sick, and will abstain from every voluntary act of mischief and
corruption; and further, from the seduction of females or males, of
freemen and slaves.
in connection with my professional practice or not, in connection with it,
I see or hear, in the life of men, which ought not to be spoken of abroad,
I will not divulge, as reckoning that all such should be kept secret.
While I continue to keep this Oath unviolated, may it be granted to me to
enjoy life and the practice of the art, respected by all men, in all
times! But should I trespass and violate this Oath, may the reverse be my
was an influential Greek physician circa the fifth century BC. His
writings both influenced Greek medical thought, and formed the ethics of
of us will need a doctor at some time or another in our lives. It is the
nature of our highly complex anatomy, as a species, that something or the
other will go wrong. As nature will have it, with time, with age, the
machinery begins to rust, falls apart more. Ears stop hearing, eyes grow
dim, the heart weakens, kidneys malfunction, livers are corroded. Even in
the young, cancer sets in, unpronounceable mysterious and complicated
diseases spread. Eventually all of us will die. Most of us are afraid of
death. The only barrier between us and the enemy of sickness and death is
the physician. No wonder he is often seen as a demi-god swathed in a halo:
conferring health and life in his voice and touch. We will gladly reach
deep into our pockets, mortgage our homes, get into debt for his divine
gift of healing, of life itself.
we have niggles of doubt over our treatment, we squash it or complain in
private, partly because there is little recourse, and partly because we
don’t know enough about medicine to be sure. The unsaid fear is that if
we dare question the doctor’s authority, exorbitant fees (in the case of
private practitioners) or terrible conditions (in the case of public
health care), we will remain untreated.
the years, I have heard a hundred hushed conversations about how various
doctors nearly killed this person or that either with their fees,
negligence, testing when not required, not testing when required, not
diagnosing correctly, going into tantrums when another opinion is
solicited; about the way they guard their territory; how, more often than
not, they openly brawl with their peers rather than collaborate - even at
the expense of the patient’s life.
private practice especially, many have described that let-down feeling
(almost that of exploitation) after being summarily and quickly looked
over, given a prescription and ushered out kindly but firmly to the
practitioners, for whom medicine is a business rather than a vocation, are
alchemists turning sickness into gold with supreme detachment and betrayal
of their vocation. Had I not met several practitioners who embody the
essence of the Hippocratic Oath, of a vocation, who are on call 24 hours a
day (and sometimes work for all 24 hours), who put the patient first, with
humour and skill, who work primarily “for the benefit of the patient”
and only secondarily for their due financial rewards in this demanding
profession, I would have completely lost faith in the medical profession
in this country.
interviewed one such young doctor on the condition of anonymity.
the Port-of-Spain, San Fernando, Sangre Grande, Caura and Mount Hope
hospitals should handle acute illness and emergencies and the Regional
Health Authorities (RHAs) are supposed to provide the bulk of service in
primary health care. But I haven’t seen any real changes with the
establishment of the RHAs since rural health centres, which could play a
vital role in small communities, are not generally well staffed or
are several recurring problems: nurses are being recruited by hospitals
abroad with better salaries and perks. The ones left behind are overworked
and morale is low. The ICU (Intensive Care Unit) is inadequate and
patients often die while waiting to have operations done. Both the RHAs’
and hospitals’ complaint has always been shortage of funds for
equipment, staff, drugs and administration. (But the ministry has hired
consultants who are paid exorbitant fees.)
that to mediocre management and you get a system where hospitals have the
same number of beds they had 30 years ago for a growing population.
Patients lie on chairs until they can get a bed, scrape around for funds
for private care or they just don’t come. The problem is more acute in
San Fernando Hospital.
problem with private practitioners is that of accountability. Unlike
America, for instance, they operate without fear of being sued, their fees
are random and often exorbitant, and they don’t explain to patients
exactly what is wrong with them. Patients, too, are at fault. They place
complete trust in doctors, fail to ask questions, are intimidated by them,
and rarely seek second opinions.
is not a profession but a vocation, but when the money comes rolling in,
it colours their vision. There are exceptions: doctors who will treat poor
people, and who maintain a balance between financial gain and vocation.
health care fees are not exorbitant when compared to developed countries
but are too high for a small developing country such as ours.
Medical Board is ineffective. There is little policing and practitioners
are rarely disciplined for negligence. In some countries, medical
practitioners have to be re-certified after a certain number of years but
that’s not done here.
Medical Board’s lecture series are optional, and many doctors don’t
keep up-to-date. The Board has not set any guidelines with respect to fee
structuring, ball-park figures for specific operations, for instance. That
leaves the door wide open for exploiting the public.
people who end up in the public health care system are afraid to complain
since it is their last resort, so politicians don’t see it as a big
issue since nobody is making a big fuss about it.
care is extremely expensive. It is impossible for the state to subsidise
treatment for complicated diseases such as Aids, renal failure, or open
heart surgery. In these cases if you’re poor, you may as well be dead.
if drugs, personnel, equipment are badly managed, the system is bled dry.
Few countries can afford health care without health insurance, which we
don’t have. To improve, it needs more funds and better management.
we must strike a balance. There are many dedicated health care
professionals in this country. Even under a trying public health care
system, much is done. More than a hundred people pass through Casualty and
Emergency everyday and are treated. Operations are being performed not
fast enough to cope with the load but it’s done.
vocation is not about just saving lives or cures but giving care, comfort,
relieving distress, and managing pain, and also helping to improve the
health care system itself. If somebody could say they did all that, then
at the end of their careers they can confidently say they have kept the
will go into them for the benefit of the sick, and will abstain from every
voluntary act of mischief and corruption’.”