6 Examples Of How The Hippocratic Oath Should Be Upgraded

Physicians have been taking the Hippocratic Oath for centuries. Originally written in 400 BC, it is one of the oldest known codes of ethics, attributed to Hippocrates, the ancient Greek philosopher and physician. In the “A Revised Hippocratic Oath for the Era of Digital Health” paper published in the Journal of Medical Internet Research by Brennan Spiegel and Bertalan Mesko (The Medical Futurist), we advocated how we should upgrade the millennia-old principles to reflect the 21st-century realities of medicine.

Amazingly modern for its age and timeless in its core principles, the Oath describes ideals that are timely and relevant even in the 21st century: to treat patients to the best of one’s ability; preserve a patient’s privacy and faithfully teach the art of medicine to the next generation.

Most physicians believe the Oath still has relevance today, although there are few empirical studies that have formally evaluated the sentiment about it. In a non–peer-reviewed survey, only 39% of physicians and medical students under the age of 34 years said the Oath was still meaningful, whereas 70% of respondents aged 65 years and older positively endorsed the pledge. Despite these varying views, most medical schools still ask their students to recite either the classic or modified form of the Oath.

Although the Oath has gone through several revisions, (most notably in 1948 by the World Medical Association) it does not reflect the dramatic changes in 21st-century healthcare. 

It is now justified to modify the Hippocratic Oath—even if modestly—to adapt the text to the digital health revolution, advances in patient empowerment, and the evolving role of technology in the everyday practice of medicine.

Let’s take a look at some of the 21st-century principles that should be included in a modernised version. 

1. Recognise a broader origin of scientific gains in medicine

The Hippocratic Oath entreats physicians to “respect the hard-won scientific gains of those physicians on whose steps I walk.” In the era of digital health and democratized care, research arises not only from physicians and nonclinical researchers but also from patients who both contribute their own data and meaningfully participate in research through patient-centered and patient-created models such as those supported by the Patient-Centered Outcomes Research Institute.

We suggest the following edits:

“I will respect the hard-won scientific gains of those physicians, researchers, and patients in whose steps I walk, and gladly share such knowledge as is mine with those who are to follow.”

2. Acknowledge both “Sick Care” and preventive “Health Care”

The Oath focuses on treating the sick but is silent on the role of preventive medicine for the well, yet modern medicine emphasises the importance of preventive care across physical, mental, and social realms of health, not just reactive “sick care” for the ill. Advances in digital health place an emphasis on predictive analytics using remotely collected data, while precision medicine aims to identify early signs of disease to inform timely preventive care.

This is our suggested version:

“I will apply, for the benefit of the healthy and the sick, all measures [that] are required, avoiding those twin traps of overtreatment and therapeutic nihilism."

3. Treatments don't only include medication and surgeries but algorithms as well

As advances in AI, robotics, virtual reality, mobile health apps, wearable biosensors, and portable diagnostic devices continue to expand, we believe the Oath should acknowledge the growing and permanent impact these technologies now exert on care delivery. In the 21st century, the Hippocratic Oath should reflect the foundational role of digital health in patient care. 

This is how we would include this principle:

“I will remember that there is an art to medicine as well as science, and that warmth, sympathy, and understanding may outweigh the surgeon’s knife, the chemist’s drug, or the programmer’s algorithm.”

4. Embrace an equal-level partnership between patients and physicians

The Hippocratic Oath encourages physicians to say, “I know not” when they are unsure how to treat a patient, and to “call in my colleagues when the skills of another are needed for a patient’s recovery.” These are laudable sentiments, however, the Oath should ideally acknowledge that patients, too, can help with diagnosis and treatment.

Patients now have expansive access to credible information about biomedical sciences, increasingly generate their own biometric health data through wearable biosensors, and monitor their own psychometric scores through apps; these data sources are now part of clinical practice. While physicians have experience prescribing treatments and monitoring a wide range of diseases, the Oath should recognise that patients are the experts of their personal illness experiences. When engaged collaboratively by their physicians, patients can deliver meaningful insights that shape diagnostic and care plans. 

In light of this paradigm shift, we suggest the following additions to the Oath:

"I will treat my patients in an equal-level partnership, and I will not be ashamed to say ‘I know not,’ nor will I fail to call in my colleagues when the skills of another are needed for a patient’s recovery."

5. Address the importance of physicians protecting patients' data as well

Respecting patients’ privacy is a primary passage in the Oath. However, the concept of privacy now extends beyond safekeeping conversations to guarding the “big data” generated in the care of every patient in modern health care. 

We suggest the following addition:

"I will respect the privacy of my patients and their data, for their problems are not disclosed to me that the world may know."

6. Therapies reflect on vital signs, data and algorithms

The explosion in big data surrounding healthcare is transforming how doctors care for and interact with their patients. A.I. in particular has a vast potential to automate processes and potentially overtake certain roles and responsibilities normally filled by clinicians. 

Nonetheless, physicians must always remain focused on their patients, including their personal stories and their biopsychosocial well-being beyond their digital fingerprints and big data analytics. A.I. will never replace medical professionals, although physicians who embrace A.I. may eventually replace those who do not. 

We propose the following additions to the Oath to reflect these considerations:

"I will remember that I do not treat a fever chart, a cancerous growth, a data point, or an algorithm’s suggestion, but a human being."

Not a definitive set of final recommendations

We offer these modest suggestions to help prompt discussion and contemplation about the current Oath and its relevance to our changing times. These are not meant to be a definitive set of final recommendations. Rather, we propose a new text that bodies such as the World Medical Association might consider integrating into an updated Oath, just as previous changes were adopted to ensure the Oath remains relevant and impactful for all physicians and their patients.

The Medical Futurist Institute is happy to give support or cooperate with healthcare institutions and universities open to introducing a revised version of the Oath. If you are in a position to facilitate the process, feel free to reach out!