In this series of articles, medical students from across the country will discuss a range of topics from medical ethics to the NHS to public health to medical conditions to clinical governance.
These articles give you a basic overview of the principles; we have attached videos and useful websites to develop a more detailed insight.
The Hippocratic Oath is one of the oldest binding documents in history, being thought to originate from the 4th Century BCE by historians. One of the reasons people have heard of the Oath is through the tradition of it being spoken by medical students upon their graduation, this could hint to how ingrained the principles of it are in the architecture of modern medical practice. The document is most commonly credited to Hippocrates, a Greek physician who is regularly viewed as beginning the practice of medicine as a rational science. This however, is also debated, as historians do not know definitively who the Hippocratic Oath was written by, or even if it was written by a single person or a collective of the time.
The Hippocratic Oath and its principles focus on treating the ill to the best of one’s ability; preserving a patient’s privacy and teaching the secrets of medicine to the next generation.
There are of course other principles within the document, of which there are “classic” and “modern” versions. The Classic Version is a translation of the original text from Greek, more or less done word for word, whereas the Modern Version was written in 1964 by Lois Lasagne, Dean of the School of Medicine at Tufts University and it is the most commonly used and applied version of the text. The opening lines of the Hippocratic Oath traditionally focus on swearing to Greek Gods, and the removal or keeping of these within the Modern Version is a widely debated topic, as are some of the statements within the original text. These refer to topics including; euthanasia, abortion, and a surgeon’s role within the realm of medical practice. There is the question of relevance of these statements to modern medicine, as well as the viewpoints and moral standing of today’s doctors, patients, and wider society in general. However, this is not to say it is known how widely these principles were adopted at the time of the writing the text either.
Whatever I see or hear in the lives of my patients, whether in connection with my professional practice or not which ought not to be spoken of outside, I will keep secret, as considering all such things to be private ~ Hippocratic Oath
This belief in the ethics of confidentiality, spanning from the documentation of it in the Hippocratic Oath to laws formed now, by both doctor and patient have shaped doctor-patient relationships and made medical practice a safer space to share information. As done in the Hippocratic Oath, confidentiality has been made more than an ethical issue by laws being put in place and it being an integral part of modern medical education.
The General Medical Council (GMC) have documents outlining good practice in handling patient information, including confidentiality, clearly highlighting the conduct expected of doctors in knowing when confidentiality is expected and when the sharing of patient information is crucial.
Some exceptions to the confidentiality of the doctor-patient relationship exist of course, such as, when a patient has consented to the sharing of their information, if the patient is at risk or even, when they are putting themselves at risk with their behaviour. Confidentiality therefore cannot be viewed as an absolute within healthcare, and there are some other exceptions in addition to these listed. (Check out our other articles on Medical Ethics for more information.)
“It is a doctors’ duty strictly to observe the rule of professional secrecy by refraining from disclosing voluntarily to any third party, information which has been learned directly or indirectly in his professional relationship with the patient. The death of the patient does not absolve the doctor from the obligation to maintain secrecy” - BMA Handbook on Medical Ethics in 1974
Leading principles of the Hippocratic Oath focus on beneficence and justice, and it is neither within the realms of justice to disclose patient information (of course apart from exceptional circumstances) nor is it acting in the benefit of the patient to break their trust. Confidentiality is so integral to the doctor-patient relationship, and viewing the Hippocratic Oath, has been for a long time. It is fundamental to good medical practice.