Is the Hippocratic oath still relevant to practising doctors today?

Meaningful, memorable, irrelevant?

Some clinicians see the oath as a rite of passage, others can’t remember taking it, and some think it is irrelevant. Whether doctors view it as meaningful or not, the oath still has the power to encourage debate, prompting them to consider what kind of vow would uphold the standards of their profession, or even if they should take a vow at all.

Medical students usually take an oath when they graduate but there is no standard approach across the UK. Some universities—like Aberdeen and Dundee—use a modified version of the original, while Bristol uses the “Bristol Promise,” which is said en masse out loud on the day of graduation (see box).

Different variations of the Hippocratic oath are taken by doctors around the world. A version created in the 1960s is used in the US, for example, while in Pakistan doctors adhere to the original oath.

Doctors’ experiences of taking an oath at their graduation ceremonies also vary. Some may not remember the exact words but can still remember how this rite of passage made them feel.

David James, chair of the Royal College of Paediatrics and Child Health trainees’ committee, qualified in 2006. While he doesn’t remember which version of the oath that he took, he does recall that it was “a serious and appropriate initiation into medicine.”

Deji Jaiyesimi, a paediatric specialty trainee year 3 based in Colchester, doesn’t recall taking the Hippocratic oath at his graduation ceremony five years ago. But he does remember talk during the ceremony of what was expected of doctors. “It was more than a ceremony—it made me feel I was entering into a special profession, and that I must do the best I could to support patients. The experience was inspirational,” he says.

Scarlett McNally, a consultant orthopaedic surgeon in East Sussex, didn’t take the Hippocratic oath when she graduated from Cambridge University in 1989, “because it wasn’t considered important at the time.” However, her work teaching at Brighton Medical School has highlighted why pledging an oath is a valuable experience for doctors.

“The graduation ceremony at the school is very moving. All the graduates who are about to become doctors say an oath together in front of their friends and family,” she says. “It’s lovely to have something that represents your move from one state to another, that shows that you need to step up to a different level, and that sets out your responsibilities and what’s expected of you.”

A moral compass

David Warriner, a clinical fellow at the Academy of Medical Royal Colleges, regards the oath as “a moral compass.”

“It helps you with circumstances you face where you’re not sure what to do,” he says. “It also gives you a sense of pride and purpose in terms of the wider scope of medical practice and the importance of putting patients at the heart of decisions you make, which we can forget sometimes.”

For Warriner, the original oath still resonates, particularly the phrase: “I will utterly reject harm and mischief,” which is commonly misquoted as “First do no harm.” He says, “For me that fits perfectly with not over diagnosing, not over treating, and sharing decision making.”

He finds the vow, “I will remember that I do not treat a fever chart, a cancerous growth, but a sick human being,” which was included in the 1964 version of the oath, particularly meaningful. “When I teach juniors about how to help patients I remind them these are not blood tests—they are people,” he says.

In the age of social media, the revised Hippocratic oath also seems valid when it asks doctors to pledge: “I will respect secrets confided in me.” Warriner cites examples of clinicians posting pictures of patients on social media. “This space is a public forum so respect patients and think about whether you would want that done to your parents—so don’t do it,” he says.

One of the difficulties with the original oath is that medicine is constantly changing—along with people’s values and beliefs—and some of the central tenets no longer seem to fit (see box). For some, the oath may still chime as a guideline for best practice. For others the General Medical Council’s (GMC) Good Medical Practice guidelines are more applicable.

While appreciating the historical value of the Hippocratic oath, Judith Harrison, a clinical academic training fellow and a specialty trainee year 4 in psychiatry in Cardiff, says that GMC guidance has superseded it. “The oath is a useful record of how medical ethics have developed. But the GMC’s good practice guidelines go into more detail, have evolved through case law and disciplinary hearings, and are regularly reviewed,” she says.

Doctors have different views about what professional oaths mean and it could be time to consider what they want their oath to say—or if they wish to take an oath at all.

Sue Bailey, chair of the Academy of Medical Royal Colleges, is a supporter of the oath. “It reminds you why you’re doing medicine, what you should be doing every day, and when dealing with work pressures it acts as a safety valve and mitigates risk should you feel you are going against your oath,” she says. But she says that it could be time to have “an informed conversation” about what a doctor’s oath should look like.

“While the oath is still relevant, we need to respect how things might change,” she says. “So it would be interesting to think about what the Hippocratic oath will look like in a hundred years’ time, and whether its basic principles will stand the test of time.”

Regulated by law and the GMC

Some clinicians do not believe that doctors should take an oath at all. “I don’t think any doctor should swear any oath,” Clare Gerada, a GP partner in London, says. “We are not royalty or priests, but health professionals doing a job, regulated by law and the GMC. That should be enough.” She would like to see “a new charter to take account of the changing and transformational times we are in.”

“We have to have more honesty about the roles and responsibilities and extent of these for health professionals,” she adds. “Doctors should not be expected to sacrifice their lives for their patients, or to make their patients their first concern. I am not saying that doctors abandon patients when their shift is up, but we must ensure that policy makers do not expect doctors to make all the sacrifices and be worked literally to death.”

She suggests a charter that both patients and doctors could sign together, pledging to use healthcare resources wisely, and to take care of their own health. “It would be a charter for not just doctors, but for all of us.”

Warriner suggests that experienced doctors could consider retaking an oath. “It would be like reaffirming marriage vows: an opportunity to reaffirm you belief in making your patient the first consideration,” he says. “That belief is still spot on.”