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Freedom from disease is the first blessing.
—Siddartha Gotama
Reverence for good health has been documented since the beginning of recorded history. Siddartha Gotama (563 BCE–483 BCE), the great spiritual leader from India and the founder of Buddhism, inscribed his philosophies on the importance of good health as far back as 500 BCE. Historically, many cultures have allowed the medical practitioner to enjoy a distinguished—even holy—place in society, respected in the same manner as spiritual or religious leaders and philosophers. Medicine is truly one of the greatest vocations a man or woman can devote their life toward. It creates opportunity for individuals to provide service to society as healers, teachers, and respected role models. Many cultures recognize the special and complex part medical practitioners play in directly affecting the health of their people. Physicians are rewarded for a job well done, yet are held responsible when their work is acknowledged or perceived as less than satisfactory. This theme has threaded itself throughout time, with origins as far back as known recorded history.
Societies have held physicians accountable for their conduct since well before the time of 6th Babylonian King Hammurabi (ca. 1795–1750 BCE). The Code of Hammurabi represents perhaps one of the earliest of recorded laws, consisting of a total of 282 edicts carved in to a 6-foot tall stone monument for all to see. Prominently displayed is the code of patient care, which reads:
If a physician make a large incision with an operating knife and cure it, or if he open a tumor (over the eye) with an operating knife, and saves the eye, he shall receive ten shekels in money. ... If a physician heals the broken bone or diseased soft part of a man, the patient shall pay the physician five shekels in money.
This concept rings true to the modern understanding of the physician–patient interaction. A health service is provided and upon completion is compensated. Today there are many expectations about what constitutes a successful interaction, which stem from both objective rules of proper procedure established by decades of scientific research and subjective ideals, values, and thoughts unique to each patient. Completing an “unsuccessful” health encounter certainly has consequences today; however, if you did harm in the era of the Babylonian empire you would suffer an extremely severe punishment. Also included in Hammurabi’s rules are the consequences for an unsatisfactory job:
If a physician makes a large incision with an operating knife, and kills him, or opens a tumor with an operating knife, and cuts out the eye, his hands shall be cut off...”
Whether we like it or not, society continues to hold us accountable for all interpretations of unsuccessful care. Of course, avoiding mutilation or reprimand is not why we want to be excellent healers; however, current thoughts about punishment or consequences for a physician who has not fulfilled his or her expectations often echo this sentiment. It is important to remember that we have been granted special rights by the people whom we serve. We are fiduciaries to a wealth of knowledge, services, and information that will directly affect our patients’ health, and because of this we wield an incredible power. How do we harness and channel this power toward the good of our patients?
In this blog, we will look at some of the earliest lessons, the soft heart of medicine, handed down by teachers from as far back as more than a century ago. We are privileged to make our way down a road that is well traveled by those who have come before us, those who have truly learned the intricate and sometimes obscure secrets of patient care. To begin this story, we must start with the Greeks.
(To be continued… look for Dr. Colgan’s next blog: "The Father of Medicine")
Richard Colgan, MD, is associate professor of family and community medicine at the University of Maryland School of Medicine in Baltimore, Maryland. He was the School's nominee to the Association of American Medical Colleges for its Humanism in Medicine Award, the recipient of numerous faculty teaching awards including the School's Golden Apple Award for excellence in teaching. Dr Colgan is the author of Advice to the Young Physician: on the Art of Medicine. For more information, go to www.advicetotheyoungphysician.com
