The Hippocratic Oath

Focus on the individual patient and their immediate need can conflict with community welfare, conserving economic resources, supporting the criminal justice system or simply making money for the physician or his employer. Is a doctor is almost obliged by his/her vows as a doctor to ignore Public Health priorities or the strategic objectives of the health economy to serve the immediate needs of the patient in front of them?

What does this mean in practice?

Διαιτήμασί τε χρήσομαι ἐπ' ὠφελείῃ καμνόντων κατὰ δύναμιν καὶ κρίσιν ἐμὴν, ἐπὶ δηλήσει δὲ καὶ ἀδικίῃ εἴρξειν. I will prescribe regimens for the good of my patients according to my ability and my judgement and never do harm to anyone. Further, in GMC's "Good Medical Practice (2006) - Good Doctors" Patients need good doctors. Good doctors make the care of their patients their first concern: This focus on the individual patient and their immediate need can conflict with community welfare, conserving economic resources, supporting the criminal justice system or simply making money for the physician or his employer. This means that a doctor is almost obliged by his/her vows as a doctor to ignore Public Health priorities or the strategic objectives of the health economy to serve the immediate needs of the patient in front of them.

What does this mean in practice?

Management of resources, and treating immediate need, are difficult bedfellows. The bridge between them is Public Health, or a proactive attempt to prevent ill-health through resolving the environment that will ultimately (and probably already causes) cause poor health. Actions to reduce smoking can be perceived both by physician (improved health) and the economist (reduced future cost, reduced lost production) as beneficial to society. Finance managers can see the long-term benefits, but sadly this year's budget has to provide both for this year's clinical needs (last year's smokers), and extra resources for the proactive programme that will reduce next year's bill. It's a difficult decision and it emphasises the importance for doctors to recognise the legitimacy of public health targets and the need for planning, and of course for managers to understand the constraints under which doctors work.