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The Dean’s Charge to the Graduates And The Hippocratic Oath

M.D. Diploma Ceremony – May 21, 2017
The Dean’s Charge to the Graduates And The Hippocratic Oath

Jeffrey S. Akman, M.D.,
Vice President for Health Affairs,
Walter A. Bloedorn Professor of Administrative Medicine,
Dean, School of Medicine and Health Sciences

 “SEEK TRUTH AND PURSUE IT STEADILY.”

Graduates, do you recognize those words? Everyone entering Ross Hall passes these words on the gate above the west bench on the “Eye” Street corridor.

“SEEK TRUTH AND PURSUE IT STEADILY.”

As we move to the conclusion of our ceremony, it is a GW tradition for the Dean to make brief remarks to the graduates, a charge as it were, prior to the recitation of the Hippocratic Oath.

This afternoon I want to talk about truth, integrity and honor —fundamental, core values for a physician. 

As Dean Haywood reminded you, the signing of our Honor Code at the White Coat Ceremony was for each one of you the last official act that you performed before beginning medical school.

Every ancient and modern version of the Hippocratic Oath and every unique oath that medical schools create for their own schools (such as the one that you recited at the White Coat Ceremony) speak to the fundamental importance of truth, integrity, and honor in medicine and in the health professions.

In our version of the Hippocratic Oath, you will recite these words:

“THAT I WILL LEAD MY LIFE AND PRACTICE MY ART IN UPRIGHTNESS AND HONOR.” 

I believe that this is the most important line in the Hippocratic Oath. There is so much packed into this brief sentence to take with you into your career as it speaks to ethics, morality and moral behavior, integrity, principles, and honesty. 

Our patients expect their physicians to tell them the truth. That a physician would purposefully mislead or provide false information to a patient would be considered unethical. Conversely, we require honest information from our patients to successfully diagnose and treat our patients.

Yet, sometimes truth is blurred in the context of the doctor-patient relationship. Consider the patient who is embarrassed or ashamed about contracting a stigmatizing disease such as HIV/AIDS and omits information that might be helpful in making the diagnosis.

Consider the patient with alcoholism who purposefully minimizes the amount that he or she drinks leading you to under-medicate a potentially deadly withdrawal syndrome.

Or consider the physician who has bad news to give to a patient. The art of medicine requires the physician to think about how to be truthful yet compassionate. What I call “truth dumping” is rarely good medicine. Understanding how to dose out information gradually but truthfully might be the best approach for some patients rather than telling the whole truth at once. 

Recently, I was at a dinner party and the guests around the table were talking about the great care they had received by GW docs and at GW Hospital. One guest told a story about his father who was diagnosed with cancer and who received his care at GW. His father was an internationally acclaimed artist and architect who had made it his mission in the latter part of his life to draw the most significant historic mosques of the world. Unfortunately, his cancer and his cancer treatments repeatedly interrupted his travels and his artwork. However, following each of his numerous bouts of chemotherapy, he would invariably take off to another part of the world to draw another mosque. 

At a certain point his cancer was no longer responsive to any treatments.  His doctor knew he needed to tell his patient the ultimate truth - that he had no additional treatments to offer. So, to help his patient deal with the bad news, he asked the patient’s son to join him for the appointment to provide additional emotional support. 

However, when given the difficult news of his terminal condition, the patient was paradoxically optimistic and cheerful seeing this news as a gift for him to be able to continue his work, drawing historic mosques without the interruption of the chemotherapy treatments.

Sustaining hope is a complex but important skill for any physician. And the art of medicine requires truthfulness on the part of the physician. For if a patient learns that you are not being truthful, even for what you believe are good intentions, then you have violated the social contract and, potentially, the trust between you and the patient.

Recently, Dr. Darrell Kirch, president of the Association of the American Medical Colleges, mentioned while giving a speech at GW that the oxford dictionary word of the year for 2016 was “post-truth.”

Yes, post-truth.

You’ve undoubtedly heard that we are living in a “post-truth” world.

Post-truth is defined as “relating to circumstances in which objective facts are less influential in shaping opinion than appeals to emotion and personal belief.”

Consider how living in a post-truth world affects medicine. Beliefs such as “vaccines cause autism” become alternative facts for some and influence public health. Extensive research has repeatedly demonstrated a lack of causation between childhood vaccination and autism; yet, look at what’s happening in Minnesota where unfounded autism fears are fueling Minnesota’s measles outbreak.

Some states require physicians to provide inaccurate or untrue information to the patient when it comes to abortion counseling. For example, Texas law mandates the provision of information to a patient that includes the possibility of a breast cancer risk related to abortion, even though extensive research shows no causal link between breast cancer and abortion.

And in the ongoing health care debate to repeal the affordable care act, the statement that the substitute legislation called the American Health Care Act, will improve access to health care is, at its core, meant to mislead; leading people to believe that more individuals will be covered by health care through this legislation. Yet, almost every independent reviewer of this legislation states that millions and possibly tens of millions of people will lose their health care coverage if this legislation becomes law. 

For those of us on the front lines of medicine and health care, what is indisputable is that people who do not have health insurance have worse medical and health outcomes.  

Finally, as medicine is the application of science to prevent and relieve human illness and suffering, an attack on science may also be an attack on medicine—and, ultimately, an attack on truth and on the health of our nation.

What Steven Colbert calls “truthiness” or that something feels true or someone believes to be true, usually does not make for good medicine.

And, so I come back to my central point today and what I most want to leave you with. Despite what you see and hear in this post-truth world, you are nothing without your integrity and honor. Truth is the foundation for all that we do. It is the cornerstone of the doctor-patient relationship; and, science (or the pursuit of truth) is the foundation for modern medicine and biomedical research.

Today we complete your George Washington Medical School experience with the powerful reminder that ethical behavior, professionalism, service to our fellow man, and the courage to live these values are, and have been, at the core of the physician identity.

And so doctors, I charge you to seek truth and pursue it steadily. Conduct your lives with integrity. When you signed your medical school’s Honor Code, it did not have an expiration date.

I charge you to always put patients first. Altruism and a deep sense of our shared humanity forms the basis for your calling to medicine. Ultimately, our place among the healing professions is about our love for our fellow man and our capacity to care for one another.

I charge you to sustain your call to service and advocacy that brought you to GW for medical school. There is so much that needs to be done in our communities, in our country, and around the world. Strive to be the physician-citizen, the physician-officer, or the physician-activist that will make an impact beyond the exam room. 

And to our newest GW medical alumni, I charge you with continuing to pursue your dreams. Stay engaged with your alma mater. We want to know how you are doing and we want to take pride in your achievements. We want to stay involved with you.

And so the tradition continues; the inspiring tradition that new physicians recite the Oath of Hippocrates and publicly acclaim those values that remain as the foundation of our calling.

The GW tradition is that, in addition to our graduates, we invite all physicians in the audience to reaffirm their vows. 

Several groups of physicians in Lisner Auditorium were asked to rise to say the Oath of Hippocrates, including parents, grandparents, spouses and significant others of our graduates, any and all GW medical school alumni, all other physicians in the audience, as well as, the class of 2017.

All physicians who were invited to stand joined Dean Akman in affirming or reaffirming their commitment to the best in the practice of medicine.

The Oath of Hippocrates:

“I DO SOLEMNLY SWEAR BY THAT WHICH I HOLD MOST SACRED THAT I WILL BE LOYAL TO THE PROFESSION OF MEDICINE AND JUST AND GENEROUS TO ITS MEMBERS;

THAT I WILL LEAD MY LIFE AND PRACTICE MY ART IN UPRIGHTNESS AND HONOR;

THAT INTO WHATSOEVER HOUSE I SHALL ENTER,

IT SHALL BE FOR THE GOOD OF THE SICK TO THE UTMOST OF MY POWER;

I, HOLDING MYSELF ALOOF FROM WRONG, FROM CORRUPTION, FROM THE TEMPTING OF OTHERS TO VICE;

THAT I WILL EXERCISE MY ART SOLELY FOR THE CARE OF MY PATIENTS, AND WILL GIVE NO DRUG, PERFORM NO OPERATION, FOR A CRIMINAL PURPOSE,

EVEN IF SOLICITED, FAR LESS SUGGEST IT;

THAT WHATSOEVER I SHALL SEE OR HEAR OF THE LIVES OF PEOPLE WHICH IS NOT FITTING TO BE SPOKEN I WILL KEEP INVIOLABLY SECRET;

THESE THINGS I DO PROMISE AND IN PROPORTION AS I AM FAITHFUL TO THIS MY OATH, MAY HAPPINESS AND GOOD REPUTE BE EVER MINE; THE OPPOSITE IF I SHALL BE FORSWORN.”