What Hippocrates knew (and I forgot)

It is somewhat ironic that much of what I learnt about medicine (the real kind of medicine) was already taught by a seriously stale pale male some 2,400 years ago. Hippocrates utterly revolutionised the practise of medicine not by inventing a cure for cancer, but by doing something radical, yet surprisingly simple: he promised not to harm his patients, ever, in any way, no matter what. And then he kept his promise. Perhaps not so surprisingly, patients voted with their feet (and their purses) and a disreputable trade became one of the most honoured professions. This impertinence so upset the Greek elite that he was imprisoned for 20 years!

As a medical student, I didn’t know much about Hippocrates. We had no lectures about him (or maybe I was windsurfing at the time). Only while preparing to take the Hippocratic Oath at the end of my final year of medicine, did I take some interest in the bearded, balding dude. Two things stood out for me then: (1) this was going to be tough and (2) the oath I was about to take in the name of Hippocrates (courtesy of my medical school) bore little resemblance to the original version.

Hippocrates knew that the doctor-patient relationship was primarily a covenantal relationship, not a commercial one. In a covenant, both parties admit they are subject to a higher, divine authority. The doctor-patient relationship should thus be treated as a sacred space where both parties can learn and grow. In the townships where I was working as a medical student, there was little sanctity (or sanity) in the trenches of emergency medicine. Indeed, life was cheap, blood was everywhere and death… Well, death became as familiar as a close friend. Did I harm my patients? Never intentionally, but my heart was bitter and there was no kindness. War zones are not good places for contemplation.

It took a very special little hospital to heal my heart. In 1993, I began my internship at McCord hospital*, a mission hospital in Durban, focused on serving the poor and underserved. Here was a whole hospital dedicated as a sacred healing space. Don’t get me wrong, things weren’t perfect here, either. But they were sufficiently different for my stony heart to be softened. I began to learn and to grow again. When I left a year later, I better understood what Hippocrates knew and I had forgotten: for my patients to grow (and grow well), I had to shrink. And the more I shrunk, the more I grew (a bit like Alice in Wonderland, come to think of it). My first task as a doctor was not to heal, cure or even to alleviate. My first task was to respect.

Primum non nocere – First do no harm. Why is it so difficult for us humans to accept our limitation to help and to heal? The French thinker, Voltaire, quipped cynically but truthfully, “The art of medicine consists in amusing the patient while nature cures the disease.” Truth is, one human cannot heal another. Out of my hubris, I had to learn to enter the doctor-patient relationship with bare feet, on my knees, as an apprentice to the only Healer. I also had to learn to gently redirect my patients’ expectations in the same direction, away from me. And then, as two broken humans in the presence of the Divine, healing could begin.

“Ha! Airy-fairy!” I hear you say. “When I step in front of a bus, I want a competent doctor looking after me, regardless of all this sentimental sacred stuff.” On the face of it, there is no difference. But what if your competent, heartless doctor chose investigations and treatments to pad his pocket (or resume)? Would you know the difference? Probably not. But do you still think there is no difference? One mystery of healing is that it gently grows even in the presence of great evil. That fact should, however, not numb us into accepting unkind medicine as a necessary evil. Intuitively, we rebel against unkind medicine, no matter how competent the physician.

If life is sacrosanct – as Hippocrates knew – then touching the other has metaphysical consequences. There are no “mere” human beings. Stepping into a cathedral, you lower your voice and raise your eyes. Touching the infinite mystery of the other should be no different.

The least you can promise is to do no harm.

Kind regards,

Doc Frank

  • McCord Hospital recently had to close its doors – largely due to lack of funding – after 104 years of faithful service. The state is attempting to re-open it as a government hospital.

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