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Harjit: Welcome to the Bundle of Hers. Coming up for the first-years is the White Coat Ceremony. Do you all remember that day?

Margaux: Yes. It was, like, right before our test or something for us. They put it on an odd day, I think. So I remember it being a little stressful for no reason. It was fun.

Harjit: Yeah, it was fun. I was really, really stressed out. But I thought it was really cool that, you know, we were celebrating us even getting into medical school. I thought that was really cool point.

Margaux: Yeah, definitely. It's very empowering to finally get your white coat and know that somebody out there somewhere trusts you.

Harjit: Yeah, definitely.

Bushra: For me, I think with the White Coat Ceremony, it was kind of cool because we get to play doctor for a minute. But also, it was a little weird because I don't know any medicine at that point. I don't know anything about medicine. And so it's like, "Why am I getting this coat in the very beginning?" rather than, I don't know, like, third-year or . . . you know what I mean?

Harjit: So one thing that we all have to do when we get our white coat is read the Hippocratic Oath. So today we really wanted to kind of discuss that, our thoughts and feelings on this oath and what is basically the point of it and, you know, just go around and talk about what we feel about it.

Margaux: I honestly had never read the Hippocratic Oath before we took the oath. I didn't even look at it until it was on the pamphlet and we were sitting in the hall getting our white coats. So it was very interesting that they have you recite this oath, essentially, without any prior knowledge. That might have been my own fault, but . . .

Bushra: I've heard of the Hippocratic Oath before, and I passively had read through it, and I knew the importance of it. And it's kind of tradition to read it at White Coat Ceremonies. So I just thought it was another step towards, you know, medical school in general.

Harjit: Yeah. I just remember basically the only point that as a person not in medical school I knew about it was that "Do no harm." That's the phrase I think of when I think of the Hippocratic Oath.

Margaux: Right. That's kind of the Hippocratic Oath cliché. But today, we thought it would be a good idea and interesting to read through the Hippocratic Oath and kind of talk about what we actually think about it now, a year later, and as you guys are about to take the oath yourself.

Bushra: We're going to do the original Hippocratic Oath, the one that Hippocrates actually wrote, so . . .

Margaux: It's on Wikipedia too, if you're interested in reading along with us.

Bushra: So it starts out and it sets the scene, I think, very well by saying, "I swear by Apollo the Healer, by Asclepius, and Hygieia, and Panacea . . ." these are all . . . I want to say they're Greek gods.

Margaux: I think so. That's safe.

Bushra: "And by all the gods and goddesses making them my witnesses that I will carry out according to my ability and judgment, this oath and this indenture."

Harjit: I feel like that very first line we're already focusing on one group of people, you know? That whole idea of the gods and the goddesses, and then having a very, like, Greek terminology.

Bushra: I think that it's interesting because if you put yourself in that time, he starts out by saying Apollo the Healer, right? That's what physicians are. They're the healer. And he says, "I swear by Apollo the Healer." So I think that's intent right there.

And then he says, "To carry out according to my ability and judgment." So it's like, "I want to . . ." how do I verbalize this?

Margaux: I think it's kind of like you want to interpret what this God, Apollo the Healer, has defined as medicine, and we as mortals . . . is that what . . . can interpret from what their healing is. Because back then and I think even now, we don't have all the answers and we don't know everything, and we do have to use our best judgment. I just think it's kind of hard to swear to some deities that are not relevant in my life. It doesn't make the oath special, in my mind, by leading off to swear to these people.

Bushra: I think that's why in the modern version, you don't really see a reference to any religious figures at all. Because I feel like back then, and even now sometimes, things that are right and wrong, morality is kind of intertwined with religion. But I think that morality . . . people can be moral without having to have belief in a higher power. Human beings are capable of that regardless of whatever they believe.

Harjit: I completely agree with that.

Leen: I think it's interesting that they're including religious figures in a science . . . I mean, if you go even . . . if after a little bit later than that period, we start saying, "Science is against religion," and so we start having all those issues. But it seems like, you know, the Greeks, they look to their gods as healers, as the art makers, or the makers of this art, and so I thought that was interesting.

Harjit: Also, I feel like maybe at that time they were just speaking to their people, you know? I don't know if it was something that was a universal thing. So I guess it maybe makes sense why it was modified.

Bushra: The next paragraph says, "To hold my teacher in this art equal to my own parents, to make him partner in my livelihood, when he is in need of money to share mine with him, to consider his family as my own brothers and to teach them this art, if they want to learn it, without fee or indenture." Oh, that's interesting, without fee or indenture. That just spoke to me for a second there.

"To impart precept, oral instruction, and all other instruction to my own sons, the sons of my teacher, and to indentured pupils who have taken the physician's oath, but to nobody else."

I feel like part of this is very patriarchal and very hierarchical because it's, like, saying, "I'm going to teach my sons this art and then to nobody else," right? Because it just seems like the same of group of people are the only ones that are learning medicine. It's not open to anybody else. And it's like the cycle of producing physicians from the same, I want to say, class. And also it makes me feel like it's more catered to men.

Margaux: Well, I mean, it explicitly only says he and him, right?

Bushra: Brothers.

Margaux: And I don't know if in the modern version how they address that. I can't remember actually if the one that we read says "they" instead of . . . like a more gender-neutral term. But that's something that stands out to me too. That is very different in our modern practice of medicine.

Harjit: Right. One thing that I think really comes up is the language, that our language is very gendered. And I think that's kind of something that we've been noticing for a long time. And it isolates certain groups of people. And I think that's kind of a way that, you know, these kind of systems keep on going. They keep on getting perpetuated, is because of this language. How can you change language from books written thousands of years ago, you know? How can I learn from an old book or an old art piece when all their . . . if you can see this type of language perpetuated there?

Bushra: I think you get to see kind of the mindset of the time that this was written, right? I don't think it's you have to necessarily learn from it, but learn about it because historically, medicine is a patriarchal profession, right?

Harjit: It's male-dominated.

Bushra: It's male-dominated. And so I'm not surprised that some of the language being used is the same. And I think that even today, you see remnants of that lingering. But in the one we read of that paragraph, I think the only thing that they kept was the part about respecting your teacher. But the rest of it, I don't remember reading.

Margaux: But that brings about an interesting point too, of if you remember reading "The Emperor of All Maladies," and the Halstead . . . is he the one who made the radical mastectomy and all of his students were too afraid to tell him that they thought it was wrong because he was revered as this really great physician and surgeon? But it ended up being really not the right procedure at all and very damaging to these women's lives.

So it's interesting you have to find the respect with balance. And I think the professors have to or your teachers have to take that too, as we all need to grow together and that's where the respect is, not a hierarchical system as it's outlined here.

Harjit: Actually, that brings up a really good point because I always thought of learning in that way, you know, the teacher is above the student. But I remember being in my ethnic studies class and they were talking about how that type of model of learning is very oppressive because you really want a collaborative environment even with your teachers because there are so many things that every person knows that the other person doesn't know. Like I could learn a million things from my professor. A professor could learn a million things from me. So I feel like that whole point, in itself, is also very one-way learning.

Bushra: I don't know. I don't know if I agree with that 100%, because I feel like the respect for the teachers thing is because the field that you're studying in is so sensitive. People are going to live or die by what you learn. And so I think the respect towards your teachers is because they're endowing this knowledge on you. Not necessarily not caring about what you have to say, but you actually getting . . .

We study evidence-based medicine. We choose treatments and diagnostic measures based on the information that we gather, right? And so learning all those things and taking, I guess, the flowchart of how you would diagnose the patient and how you would treat a patient is based off of things that have already been studied. And so, in that case, we have a lot to learn from them, right?

Harjit: We definitely do. And I totally agree with that you're saying. I guess my point was more in the sense that students also can understand things that maybe one person can't. I do agree that they obviously have this knowledge, this skill that they are passing down. So I agree with that point.

So this next part comes in the third paragraph of this oath. And I will actually just read one line. I think this is kind of one that really jumped out to me. It says, "Similarly, I will not give to a woman a pessary to cause abortion."

So I actually didn't know what pessary meant. So I looked it up using Google. You know how we find everything from Google. So it says, "a small soluble block that is inserted into the vagina to treat infection or as a contraceptive." So at first, I thought maybe this was saying, "We will not provide abortions." But it seems like they're also saying, "We will not provide contraception." Is that kind of what you all get from that, too?

Bushra: I guess, if that's what the definition of pessary is.

Harjit: Yeah. So I guess now there's kind of like a double . . . now there's a double explanation that I have to do for this one. But I feel like that's really . . . you know, honestly, in my beliefs, I feel like it doesn't align with my beliefs, because I feel like both those things are very important. There are things that are needed. And again, this is all my opinion. And if I was reciting that . . . I don't think the modified version has that because I don't remember saying that. I think I'd have a big problem with it.

Leen: So is it also to treat infection? Is that what you said was part of the definition?

Harjit: So pessary says, "A small soluble block that is inserted into the vagina to treat infection or as a contraceptive."

Leen: So it almost seems like it doesn't matter what it is, infection or not, we're not approaching that region to treat.

Bushra: You know what the crazy thing is? We have this conversation of women's health and women having the right to choose whether to use contraception, to get an abortion, just things related to women's health. That conversation was still being had centuries ago. I just think it's interesting that even today, we kind of still see the same topics being raised.

Harjit: But also, the whole point being that . . . again, this is said by . . . I think he identified as a male, right? Hippocrates? So this is being said by a man, and not having any experience of being a woman.

Bushra: Yeah, and things being decided by men for women is kind of interesting too.

Margaux: If you actually read the next line, it says, "But I will keep pure and holy both my life and my art." And I kind of see that as he's the . . . in the oath, you're putting yourself before that patient, that woman who may need that treatment to keep your own life pure. And that, I don't agree with.

Bushra: It was like a boundary that he wouldn't cross because it would seem bad or impure or whatever.

Leen: In honesty, it kind of almost seems like he's self-assuring himself saying, "I won't treat anything in the women health aspect, but I will still stay pure."

Harjit: Right.

Leen: So it's like, "Oh, yeah, I didn't treat you, but I'm going to feel bad, so I'm still going to call myself pure," is almost what it seems like.

Harjit: Right. And so that line really, really spoke to me because I was just thinking that, you know, we are going to be physicians, but we're going to be treating individuals that make a million different choices, right? And even their choice to come seek help from us, in a way, is a choice.

Leen: Whoa, wait.

Harjit: What?

Leen: I just read this again. So it says, "I will not give to a woman a pessary to cause abortion." So even if she did have an infection while she was pregnant, I mean, that kind of sounds like, "Now we're not treating group B strep or anything at this point."

Harjit: Yeah. Well, I hope that pessary definition is correct. But you can kind of get a sense of what he's saying with that line. And I find . . .

Leen: "Cause abortion." That's so weird.

Harjit: I know.

Bushra: It also says, "I will not use the knife." So surgery, I guess, wasn't a thing back in the day.

Margaux: Well, actually, I kind of like this next part that you're referring to, Bushra. It says, "I will not use the knife, not even verily on sufferers from the stone, but I will give place to such as are craftsmen therein." And I think in a different version, it's written more clearly too. My understanding is he knows his limitations as not being able to perform the surgery.

Bushra: Oh, I see.

Margaux: And so it is somebody else's responsibility, who has that knowledge to do this . . .

Bushra: Subspecialty.

Margaux: Right. That's how I interpreted that, anyway. And it's kind of "know your limitations and who's on your team," and it's for the best interest of the patient.

Bushra: Interesting. I actually kind of like that.

Harjit: We just realized that this is translated. So a lot can be lost in translation. I speak a second language, so I know that it can be really difficult to translate things directly. So, again, this is based off of our opinion on the translated version.

Bushra: This is the James Loeb translation, if anybody is wondering.

Leen: So, in the next part . . . I'm going to read this. It says, "Into whatsoever houses I enter, I will enter to help the sick, and I will abstain from all intentional wrong-doing and harm, especially from abusing the bodies of man or woman, bond or free.

"And whatsoever I shall see or hear in the course of my profession, as well as outside my profession in my intercourse with men, if it be what should not be published abroad, I will never divulge, holding such things to be holy secrets."

It's really wordy, but again, parts of that, you know, it's even . . . for instance, especially abusing the bodies of man or in bond or free, it's absolutely . . . I mean, the intention to not do wrong is there. But why even bring that up in the first place, is kind of my question with that.

Harjit: Yeah. That's an interesting perspective.

Leen: In another version I was reading, it was saying how from entering houses, you won't abuse men or women of that house. It's like I just don't understand where that's coming from, from the first place. Was it a problem back in ancient Greece or something? I don't know.

Harjit: I wonder what they are defining as abuse, as well.

Leen: I know some cultures, it's whatever . . . like, the culture of the house is a very, very private, very secretive thing that only the family members know of. And so to see someone from outside coming into that is kind of . . . it's almost seen as impolite in that sense. So I don't know if maybe that's how that mindset was back then. I'm not sure.

Harjit: Yeah. I actually wonder that. Because like you said, there are cultures that they're very like, "This is my private space and only certain people can come in." So that could be the thing behind that.

Bushra: I wonder if they had hospitals.

Harjit: Yeah.

Bushra: I think that it was mostly, yeah, home visits.

Harjit: Google it.

Bushra: I don't know.

Harjit: Okay. So I think we kind of discussed some parts of the original. And I also do remember that this was not the one that we read. So it definitely was modified. So I kind of almost wonder . . . I feel like, you know, people notice these things. So they did try to change it and update it. What do you guys think about that?

Leen: I wonder how, when the first women entered into the profession, the oath was like. I mean, yeah, of course, they might have revised it to be more modern to that time. But I don't know if they completely changed every aspect of it. So, when women became more and more in Western medicine, I wonder what kind of oath that they were reading. I wonder if we can find a timeline of revisions.

Harjit: Yeah. And I also wonder . . . I don't know what you guys think about this, but I always think that things that are originally made with a certain intent, be it patriarchal, be it exclusive, anything branching out of that, how do you erase the original intent from it?

Bushra: This is just my interpretation. I don't think the intent was to be patriarchal, sexist, whatever. I think the intent was to set an ethical boundary for the practice of medicine, right? This is a very sensitive thing that you're practicing and there needs to be some guidelines. I think that was what the intent is.

So the revisions that you make around that, you can take out the patriarchy, you can take out the abortion stuff, you can take out all these other things, and it still works. And the reason why it still works is because ethics is the purpose of this.

Harjit: The main . . . okay.

Bushra: That's my opinion.

Leen: Here's another thought. There have been throughout history many oaths in regard to medicine throughout various cultures. So why did we take the Hippocratic Oath? Why did we use maybe the most, I would say, closest to Western European historical medicine oath in a field that includes or encompasses all human beings?

Harjit: Yeah, because I feel like this oath is actually recited throughout the world. I feel like I've heard it be a part of other countries as well.

Bushra: My understanding is medicine, the way that it's practiced today, evidence-based . . . I guess I don't really know. I can't speak to that. But that's what I think. Hippocrates was considered the father of medicine. And so I think that that's why it was taken from that . . .

Leen: Even though medicine goes back way before Hippocrates? I think that's always interesting. It's just kind of thought provoking.

Bushra: I don't know. Maybe if we searched, there'll be another code of ethics from other cultures. But I've never actually heard of it, to be honest, yeah.

Leen: Exactly, and that's kind of why I'm wondering.

Margaux: So Wikipedia might have some insight into that. It says that one of the first significant revisions of the Hippocratic Oath was in 1948 by the World Medical Association. And that was during World War II, immediately after the foundation of the World Medical Association.

And they were concerned that the state of medical ethics across the world was in shambles and needed some revision. And they felt that by revising the Hippocratic Oath and giving it to all doctors worldwide, it would help set up responsibility and guidelines for everybody to follow in a universal way.

But that still doesn't help us understand why they chose specifically the Hippocratic Oath. But I'm not aware of any other medically-oriented oath.

Harjit: So I think that, again, ties back to, like Bushra said, he was considered the father of medicine. So that's maybe why it was chosen. I mean, again, we also need to consider that people choose things that call to them. But the people that get to choose the things, they're usually in a certain position of power. So I guess that maybe just spoke to the person who was in charge.

Also, what I found interesting is . . . you just mentioned that's when it started. But people actually use this oath, others actually use this oath, to kind of tie it into malpractice. So this is a big deal. It's not just something that we just say, but actually, people utilize this. So the oath is almost like . . . it's almost like we're making a promise, right?

Margaux: Right. So are you saying is it legally binding? Is that what you're saying, or . . .

Harjit: I don't think it's . . . but they use it to make cases against or . . .

Bushra: I think it's interesting the fact that "First do no harm" doesn't actually . . . it's not a part of the Hippocratic Oath, but that's what people . . .

Margaux: That's how they know it.

Harjit: I mean, that's how I knew it as.

Bushra: That phrase is from the 17th century. It's not even from the same time that the Hippocratic Oath was written.

Harjit: But they named . . . Okay, but is "Do no harm" in the modern version of the Hippocratic Oath?

Bushra: I don't know.

Margaux: I don't think it was. I think I remember that sticking in my mind when we read it last year, that it actually did not say, "Do no harm."

Harjit: Yeah. And actually, on Wikipedia . . . I love how we're looking on Wikipedia. But on Wikipedia, it says that this phase does not appear in the oath.

Margaux: Yeah. Just a side note, Wikipedia is really great for medical school.

Harjit: I know. We triple check all our knowledge.

Leen: Do we though?

Harjit: First aid.

Bushra: Up to date.

Harjit: Up to date.

Margaux: Pathoma, first aid. Sketchy. That's enough. That's credible.

Bushra: The holy trinity.

Leen: Also, is there any other place that we actually say the Hippocratic Oath besides White Coat Ceremony?

Bushra: We say it during White Coat Ceremony and we say it on graduation.

Leen: Oh, we do say it at graduation?

Bushra: I don't know if we say it again between those two timelines. But that's all I know, is White Coat Ceremony and graduation.

Harjit: Yeah. So I find that interesting that, you know, we're taking this oath and then like we don't really revisit it. And to be honest, I'm kind of a little bit like, "Why didn't I look more into this oath?" When we were talking this topic came to be about, we were really thinking about it. And I was like, "Oh, I don't know much about this, but I did make this promise." And I think it's really interesting that we're only saying it here and graduation.

Bushra: I used to think that every single doctor has the Hippocratic Oath memorized.

Margaux: Do they?

Bushra: That's what I used to think growing up in high school. I was like, "Oh my gosh. Every single doctor has this oath memorized because everybody always refers to the Hippocratic Oath." I don't think that's true. But I feel like the principles within the Hippocratic Oath, the modern versions at least, I think that's something that most physicians follow, right?

Harjit: Yeah. I agree. I agree. Like we were discussing the intent of the Hippocratic Oath, I think if it's from that basis, like we're here to provide for our patients, they are our number one priority, I do think that it's something that's important.

Margaux: Yeah, So, as you approach your White Coat Ceremony, if this has spiked you interest, we hope you read the oath that you're about to take and think a little bit about the promise that you're making and choosing to follow. And maybe at some point, we'll revisit it during our next four years because I think that's important, too, that we take this oath, and we need to revisit it.