Defending the Oath that I Took
I am a physician. I am also a refugee from the former Soviet Union and the granddaughter of Holocaust survivors. My parents were both physicians - something not easy to achieve as Jews in the USSR - but they gave up practicing medicine for freedom in America.
I grew up in San Francisco, watching my parents, as nurses, proudly caring for each individual patient, right in the thick of the HIV-AIDS epidemic of the 1980’s. They taught me that it is a privilege to care for human life, and becoming a physician always felt like a natural calling – an honor in line with my deeply cherished Jewish values.
My passionate concern is scientific, humanistic, and based on my clinical experience. I am a board-certified neurologist with a special interest in cognitive neuroscience (college research in implicit memory and role of emotions). I spent the past decade taking care of patients suffering from Parkinson’s Disease -- a disease that disconnects the brain from the body. In managing the many different symptoms this disease can present with, I learned the importance of understanding a dysregulated nervous system.
Dysregulation can occur for a variety of reasons and the most common in my experience is unprocessed trauma. No wonder our current civilization is exhibiting signs of “limbic hijack.” We are living through a collective trauma and any individual perceived threat reflexively strengthens our tribal instincts.
It is with sadness and dismay that I reflect on what’s become of my once-sacred profession. Even before the pandemic, moral injury spread throughout the house of medicine taking ~ 400 of my beloved colleagues’ lives each year to suicide. For over a decade, I witnessed corporate business influences destroy the sanctity of the doctor-patient relationship. Advocating for medically appropriate care has become nearly impossible. It’s no surprise that soaring costs and plummeting quality medical care have led to the morbid reality we are living through today.
We recently celebrated the Jewish New Year, and my Rabbi’s sermon was all about the importance of hope. Hope, after all, has guided the survival of my ancestors throughout time. I am grateful for the many inspirational physicians, who, over the past several years, have been replenishing my bucket of hope.
I have found the strength to fight back buoyed by my fellow healers who abide by the Oath of Hippocrates. In a variety of different ways, we have been exposing how conflicts of interests contribute to third-party intermediaries profiteering at the expense of our patients’ lives.
But this is only the beginning.
For hope to lead to profound transformation, we must strive to:
- Reveal the revolving door among media, academia, government, and corporate greed, and educate the public about how decisions are being made without regard to unintended consequences.
- Reaffirm medical ethics - those lessons from history we must not take for granted. Emphasize the merits of the scientific method without discounting the art of healing.
- Encourage civil discourse and honest logical debate in order to seek truth for the betterment of humanity.
At the start of the pandemic, I was encouraged by the hard work and achievements of my fellow practicing physicians when treating this “novel” coronavirus. Of unknown etiology and pathophysiology, we collaborated and took charge, just as our education and training prepared us to do and despite many “administrative suits” trying to get in the way. We found strength in knowing this was our calling and our chance to show why practitioners need a seat at the Healthcare decision table.
But just as the division in our country grew, so did division amongst ourselves. Ideology began influencing medical decisions and instead of focusing on addressing root causes of our problems, we began arguing amongst ourselves and taking out frustrations on our patients (e.g., refusing to provide medical care based on vaccination status). It’s against this backdrop of chaos that poorly designed “anti-racist” policymaking in medicine has begun to spread, which should be alarming to us all.
While acknowledging disparities in health outcomes is imperative to achieving meaningful change, the “equity” not “equality” goals adopted by the AMA, among a growing number of academic institutions, is counterproductive and will ultimately cause more harm and division. Fortunately, organizations like the Foundation Against Intolerance & Racism (FAIR) are working to address this cultural shift, and instead promote a shared culture of fairness and understanding, rooted in our common humanity.
The “anti-racist” approach currently gaining momentum ignores confounding variables and inappropriately generalizes to solutions, relying on observed correlations as a substitute for analyzing and addressing root causations of perceived differences. As a result, conclusions, and the corresponding policy prescriptions, are fraught with error.
Proper tracking and analysis of potential harm doesn’t appear to even be considered. Moreover, negative unintended consequences can take decades to fully be appreciated, so needless suffering is currently being overlooked.
The growing division among physicians today regarding what is ethical anti-racism is quite troubling. The discussions regarding “Whiteness” seem no different than how my 100-year-old grandpa describes his “Jewness” according to the Soviet and Nazi regimes, which he thankfully survived.
I understand the historical context differences, but respectfully argue that we are seeing a parallel dehumanization of the individual. It was wrong then, and it is wrong now, no matter the skin color or group identity to which a person is assigned.
Medical Ethics, especially those reaffirmed after the atrocities of WW2, must be reiterated.
Medical Standards including what constitutes informed consent ought to be reasserted.
Transparency and Accountability in medical decision-making, access, and cost should be demanded.
Trust in the doctor-patient relationship needs to be reestablished.
When we took the Hippocratic oath, we committed to putting each individual life we are caring for first, no judgements, only empathy and good will. The current version of our medical system is robbing our society by silencing its healers and denying what is bordering on basic human rights. Ignoring history and denying pain is driving fear, shame, and guilt, which further divides us into growing tribal silos of hate, resentment, and imagined superiority.
We must learn from the past, acknowledge and process our emotions, heal our wounds, and with kindness, proceed in repairing our sense of shared humanity, so our children don’t continue repeating our generational suffering.
Over the coming months, I look forward to drawing attention to the current barriers doctors face just trying to care for their patients. In doing so, I hope to inspire constructive dialogue on how we can deliver more humanistic, affordable, and easily accessible medical care.