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David P. Smith: A return to the asclepeia: A physician’s enduring obligation
Thursday, April 10, 2014 10:43 AM

The straining loads being placed upon the backs of physicians are immense these days. We are being squeezed by hospital administrators, insurance companies, patients, and, for those in the shrinking numbers of private practitioners, add in all of those overhead costs that are onerous. It would be easy if we could just take care of the patient the way we were trained, and everyone else would help us to accomplish that worthy goal. However, the reality is that we have a multitude of non-health professionals, who believe they know what patients need, constantly not just suggesting to us what we should do, but outright now dictating how it should be done. I do not need to list the multitude of ways that this is occurring. All of us are very familiar with these stresses from the impossible task of pleasing everyone at once, although I think most of us do attempt to do so, especially for those of us who view ourselves as more than just “providers.”

There are huge financial pressures upon our hospitals right now, and physicians are being asked to be increasingly efficient to the point that the only person who could do it any better is God Himself. Governmental programs are notorious for one-size-fits-all approaches which do not allow for the individual variation in patient care that individuals who are all made a little differently should be allowed to have provided for them. Not everyone, especially the very elderly, can be discharged safely from a hospital at the prescribed number of days, assuming they even “qualify” for admission past observation.

We have to remember why we decided to practice medicine in the first place and do what is right for the patient whether others, who do not do what we do, understand or not. Of course, we should try to help administrators and bureaucrats to understand why another day is really needed before someone can go home, but in the end we have to do, and should only do, what we truly know is right for the patient. A good question to ask yourself might be what would you do if this patient were your parent, or maybe even better, what would you do for yourself?

In the waiting room of my clinic, I have hanging the framed copy of the Hippocratic Oath which was given to me by MBMC upon graduation from my family medicine residency at UMC. This oath calls us to a higher calling in the practice of our profession which cannot be allowed to transform us into cook-book technicians. Looking back in history around the time of Hippocrates, we also find another symbol that is commonly used today – the rod of Asclepius. Asclepius (or Asclepios) was the Greek god associated with healing and medicine. During that time, there were places which were called Asclepions which were built for people to visit who were ill. While at these temples, which were run by priests, patients could bathe, meditate, and were encouraged to get plenty of rest and sleep. While sleeping, it was thought that Asclepius and his two daughters, Hygeia and Panacea, would visit which would cure everything. The priest would dress as Asclepius while the Therapeutae entourage would make their rounds in the evenings to care for the patients.

For those who used the asclepeia, an offering, which for the poor was not much while for the rich a more generous contribution would be expected. It is interesting that many of the poor would bring a rooster, which was thought to ward off evil spirits, and sacrifice it to Asclepios hoping for a cure while in the temple. In the early days of medical practice in this country, it was widely practiced that those seeking treatment from a physician would bring a chicken for payment. Observing the way our country is heading presently, those days may not be completely in the past.

While we have greatly advanced modern hospitals, in many ways still though we can find similarities to those asclepeia of thousands of years ago. Let’s keep the modern advancements we have made, but let us also keep in mind the art of the practice of medicine which requires us to do what is right for the proper treatment of the patient first and put what is right for the finances further down on our list of priorities. If we do not do what is right for the patient first, we may find ourselves like Asclepius, who is said in mythology to have been killed by a thunderbolt from Zeus because Asclepius accepted gold for raising Hippolytus from the dead. If we get our eyes focused on the gold instead of on the patient’s best interests, everyone loses. None of us are gods, but patients do generally look to us to have a higher standard for how we lead our lives and practice our profession. Luke 14:11 reads, “For everyone who exalts himself will be humbled, and he who humbles himself will be exalted.” We have a responsibility to stand up for our patients first, and then all of the rest will fall into its proper place.

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