Move over Hippocrates

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The Independent Online
Hippocrates was a 5th-century Greek physician and, in his name, doctors were once obliged to make an oath affirming their obligations and proper conduct. The British Medical Association still makes much of the Hippocratic Oath, deciding at its conference this week to produce an updated version - apparently to guard against slipping ethical standards brought about by commercialism in the NHS.

Like so many matters the BMA makes much of, the foundation for the fuss is poor. Hippocrates is probably not the author of the document. Of the 70 works ascribed to the Hippocratic Collection, Hippocrates might have written only six of them.

The fact that some doctors cling to the oath is fascinating. The promise makes the doctor's first duty to the person who "taught him his art". Indeed, it calls upon a doctor to "consider [his teacher] as dear to him as his parents". Translated into the language of today: "Listen boys, doctoring is not a science, it's an art. We are not sure what we are up to; if we get it wrong don't blow the whistle on each other."

The Oath goes on to promise that doctors will not have a bit on the side with their patients [men or women]; not "procure an abortion"; neither to prescribe anything that may "cause harm". The time has probably come for the BMA to ask its members to sign up to a new set of values that reflects the sorry state of their "art" in the 20th century.

Professor Alan Maynard of York University tells us that 90 per cent of healthcare interventions are based not on evidence but on tradition and judgement. A worthwhile way to start might be to get doctors to promise not to do anything to us that they cannot prove will work. The Evidence Based Medical Unit of Oxford University's Nuffield Department of Medicine tested half a sample list of 226 manoeuvres carried out in obstetrics. It found that 40 per cent were beneficial and 60 per cent were useless or did harm.

In a recent trial, researchers sat in with GPs for half a day and found that in 16 cases the doctor did not have the latest information, which would have been important to the diagnosis or treatment. If looking after patients produce these kinds of risks, no wonder Hippocrates thought doctors should look after each other first.

A doctor's oath of allegiance to his employer may not be a bad start. John Yates of Inter-Authority Comparisons claims that, on average, consultant surgeons only have an NHS knife in their hands for 10-12 per cent of the week.

A new set of values might more appropriately encompass patients, their safe treatment, using methods that are proven to work, with skills paid for by the taxpayer, focused exclusively on the NHS. And it might be a touch less hypocritical.

The writer is at the Centre for Health Services Management, Nottingham University.