Medical oaths offer markers to otherwise invisible elements of a medical career.1 These rites of professional passage highlight individual aspirations and social solidarity in the practice of medicine.2 Oaths make explicit a physician's ethical responsibilities. The Hippocratic oath helps to guide physicians in their aspirations and behaviors, whereas a personal medical oath can weld the individual experience of medical practice to contemporary ethics.3 In response to significant economic intrusion from managed care, the “patient-physician covenant” makes it clear that the fulcrum of medical practice lies at the patient-doctor relationship.4
One important juncture in a physician's career is standing down from the insistent flow of daily clinical practice. The act of ending an active practice lacks an explicit moral marker. I suggest “A physician's oath on retirement” to address the moral, psychological, social, and cultural responsibilities that a physician assumes when voluntarily relinquishing the responsibilities of active medical practice.
The Oath
Recognizing that a life well lived is a debt well paid, there is yet a time for direct accounting. On my inner sense of rightness, expressed as a sacred honor, I retire from active medical practice, solemnly pledging my continuing strength of mind, body, and resources toward repaying real and current debts accrued in the course of a full and rewarding physician's life
To my family, I owe years of time they granted with forbearance and understanding while sustaining me in patience and affection despite my absences in mind and body
To my teachers, I acknowledge an obligation of knowledge and skill that calls for return, however modest, through continuing teaching and reflection. Their wisdom in showing me how the art and science of medicine are never connected by “either or” but always by “both and” is treasure beyond recompense
To my community, for directly and indirectly providing for my medical education, I owe considerable sums only partially repaid through charity services to the poor and duty to the nation in time of war and peace. Greater than money has been society's gift of personal respect bestowed on me and my profession with generous allowance for more than life's necessities
To organized medicine, I am indebted for warm welcome in foreign lands, unexpected honors, and the opportunity to share in making a difference, measured in diminished human suffering
To patients, I owe countless debts for transgressions of time, ignorance, and inadvertent arrogance. But most important, the balance is wanting in matching patients' abiding trust in sharing their pain, suffering, and their very lives, to the secrets of their hearts
With keen awareness that remaining life is short and time is precious, as mind and body permit, I dedicate myself to a sustained sense of humanity expressed through the spirit of medicine. Though I can never repay my accumulated debt, I am proud to be known by it.
Competing interests: None declared
Author: Ralph Crawshaw, a retired psychiatrist, continues to pursue the human enterprise from a clinical perspective under the aegis of the Foundation For Medical Excellence.
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References
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