August 15, 2018

I have been on-call this weekend, covering for the group of private practice psychiatrists on the Seacoast. On these weekends of being on-call in particular, I have the time to listen by telephone to the suffering of patients that I will most likely never meet. Their stories are often so compelling and heartbreaking. As I respond to the varied needs of my colleagues’ patients, I am reminded of the principles upon which our profession is based and why we do what we do in our practice of medicine. 

In this day and age when physicians are struggling with incredible time-pressures and institutional pressures (“burnout”), it is most important for us as physicians to pay attention to the principles of our profession that are so well codified in the AMA’s “Principles of Medical Ethics.” Indeed, I would suggest rereading those “Principles.” I keep a copy close at hand myself to help clarify why we went into this profession of medicine, and what we need to do to keep those principles alive and operating for us as we confront the pressures patients and physicians are under today. 

The Preamble of the “Principles” starts with the following: As a member of this profession, a physician must recognize responsibility not only to patients but also to society, to other professionals, and to self.

As physicians we are well aware that our patients don’t live in isolation and we don’t practice in isolation either – but rather in a complicated and ever-changing social environment. By joining together physicians in specialty societies and professional organizations such as the New Hampshire Medical Society, we work to support our patients and our profession to make sure society is providing the appropriate supports that our patients need to facilitate their wellbeing and health.

As I reread the “Principles,” I am also struck by how applicable these principles are to our general society in the United States these days; and how unfortunately far we have come in today’s society from being consistent to those principles. Although the origin of the phrase, “First, do no harm” is not technically part of the historic Hippocratic Oath, the principle of “not doing harm” does probably stem from Hippocrates and his followers in about the third century BC.  This principle of “not doing harm” is central in our practice and our mission as physicians and is clearly part of each of the seven sections of the ”Principles.” It ought to be part of our society’s operating principles as well.  

Section 1 of the “Principles” states:  A physician shall be dedicated to providing competent medical service with compassion and respect for human dignity. 

As I extrapolate this principle to society in general, I think of the migrants at our southern border who have been subjected to so much harm, with no compassion, and with no respect for their human dignity. We certainly wouldn’t want such treatment for our patients, nor would we want it for our children and ourselves. We should treat migrants seeking asylum at our southern border who are escaping violence in their own countries with similar compassion and respect their human dignity. Our country, our government, has become callous to the principles of ethical treatment of others and that lack of humanity is shameful to say the least.

At the time of writing this blog post, there are still estimated to be more than five hundred children (559 by one account) still separated from their parents, and many of those parents have already been deported without their children.  There also does not seem to be anyone in the federal Administration in charge of this problem and apparently little or no effort to resolve this inhumane travesty. 

I plan to have other blog posts commenting on the “Principles of Medical Ethics” as it pertains to the practice of medicine in today’s world and to further extrapolations of those “Principles” to our society at large. As always, I would appreciate your comments and ideas on this and other issues. I can be reached at lenkorn.md@gmail.com.

Regards,

Len Korn, MD
NHMS President