Modern Day Hippocratic Oath Essay

The personal health of the individual appears to be the stereotypical focus of the physician in the eyes of many. Often times, this can even be the focus of the physicians themselves. Though a duty to each and every individual patient exists and is important, their health is determined by so much more than the one-on-one care provided in a doctor's office. How can the physician hope to keep their patient well, if the environment they exist in is inherently unhealthy or harmful to them? The modern day Hippocratic oath, charges physicians to do the following (Lasagna, 1964): I will prevent disease whenever I can, for prevention is preferable to cure. I will remember that I remain a member of society, with special obligations to all my fellow
human beings, those sound of mind and body as well as the infirm.
Similarly, Winslow (1920) defined public health as "the science and art of preventing disease, prolonging life and promoting health through organized efforts and informed choices of society, organizations, public and private, communities and individuals". With this information in mind, it becomes relatively simple to identify the physician's duty to promote public health. Duty does not identify specific courses of action however, so in what ways might the physician best serve their patients from a public health standpoint? People seem to generally put a lot of faith into what physicians have to say.
Patients oftentimes seek out their doctor's opinion on any number of health and societal issues. How educated the physician is on the subject matter and how they respond to these inquiries can have a direct and significant impact on how the patient proceeds, and their long-term health. A study by Stein et al. (2004) illustrated this point by showing that how the patient's physician responded to advice given by public health officials impacted adherence to the advice. The study involved a public health suggestion to a group of postal workers and Capitol Hill employees to take a 60 day regimen of antibiotics to combat potential anthrax exposure. Of the group, 37 people got specific advice from their personal physician about taking the medicine. When the physician suggested they take the medicine, 14 of 15 did. When the physician wasn't certain or did not recommend the medicine, only 4 of the 22 actually used it. Though this study is relatively small, it shows that a physician merely supporting public health recommendations has a synergistic effect on patient compliance, and hopefully, overall public health. If one-on-one personal recommendations from a doctor can have such an impact, how else might the physician support public health in their community or even the
nation? Another way the physician can influence and promote public health is to actually become publically involved. Gruen, Campbell, and Blumenthal (2006) identified three public roles that physicians should ideally be involved in, which were community participation, political involvement in health issues, and collective advocacy through professional organization. The survey that Gruen et al. (2006) used to measure physician participation in these areas received 1,662 responses, and found that while 90% of physicians felt that these roles were important, only 65% had actually served in one of these roles in the previous three years. There is obviously much room for improvement in this area. By using their voice on a larger scale than just in the office or hospital, physicians may be able to not only emphasize the gravity of some public health concerns, but also encourage action. A good example of a current issue where this can be applied is vaccinations. Many pediatricians and family practice doctors struggle with parents who are afraid of vaccinating their children. A little bit of very sensationalized misinformation and some fear led to a dip in childhood vaccinations, which in turn negatively impacted some of the benefit of herd immunity. This has culminated in outbreaks of preventable diseases that were all but eradicated in this nation for decades. It is now up to the voices of research, public health, and physicians to better educate parent's and encourage vaccination. A classic example of where a physician went public for the greater good comes from Dr. John Snow. Lockwood (2004) sums up the situation well: Snow's observations of the distribution of cholera cases led him to suspect that 1 source of the disease was the Broad Street public water pump. After he appeared before the city's Board of Guardians to make his case, the pump handle was removed—and the epidemic ended. Thus, Snow became an activist.
More than 500 people in the vicinity of this pump had already died, and once the pump was removed, the epidemic almost immediately stopped (Gunn & Masellis, 2008). His actions undoubtedly saved lives and paved the way for the likes of Lois Pasteur and his germ model of disease transmission. In this vein, I feel that physicians need to take a more public and community based stance, instead of trying to handle it on a patient to patient basis. To do this, doctors need to remain educated and up to date on these matters and many others. This leads to a final way doctors can influence population health deals with furthering their education in areas regarding public health issues and practices. Though awareness of and education in public health concerns were alluded to previously, actually learning more about public health and even obtaining advanced education in it may add weight and potency to the physician's efforts. I was first significantly introduced to this concept though the Air Force's Aerospace Medicine Primary courses. The military, and the Air Force specifically, recognizes the impacts of population and force health. So much to the point that the Residency in Aerospace Medicine program actually incorporates obtaining a Masters of Public Health from a selection of top universities into the three year curriculum (Residency Programs, n.d.). The importance in this training is elucidated when you consider the austere and harmful situations military personnel are expected to operate in. From beyond the atmosphere, to well below the ocean's surface. From sub-Saharan Africa to the Arctic. All of these environments have different dangers and require different force protection measures. It is up to the physician and the public health officials to ensure fitness of the force, or face a very real possibly that people could die from preventable causes. Beyond the military, there are a multitude of other courses and even degree programs available to help with furthering public health education. This course and the MHSA are great examples of how a physician can supplement their education to be a more effective weapon against the barriers to health, and was one of the reasons I chose to undertake the challenge to complete them. In summary, through supporting public health initiatives, being publically active and vocal in regards to promoting public health, and through continuing education in the matter, physicians can better serve their patients and the population as a whole. Another area that this is vitally important is in controlling the costs of healthcare. Chronic illnesses that are largely preventable have dire impact not only in the United States, but also in the world. A study that looked at 23 low to middle-income countries and determined that "if nothing is done to reduce the risk of chronic diseases, an estimated US $84 billion of economic production will be lost from heart disease, stroke, and diabetes alone in these 23 countries between 2006 and 2015" (Abegunde et al., 2007). If you consider the world-wide economic impact that diseases like this have, the results could be even more staggering. This and many other reasons are why bridging the gap between preventative and interventional care is of the utmost importance. That is why in all of public health's benefits and challenges, physicians must be intimately involved for the greatest effect to be attained.