GOALS AND PURPOSE OF MEDICINE

 MISSION AND VISION: GOALS AND PURPOSES OF INTEGRATIVE MEDICINE

J.C MEEROFF MD, Ph.D.    Clinical Associate Prof of Medicine, FAU 

SUSANA MEEROFF            Director of Health Services and Administration

 

                     South Florida Institute of Integrative Medicine

 

 “Medicine is a sociopsychosomatic professional discipline or is not Medicine”

“The practice of medicine is a trained art based on science, technology, and philosophy”

“To be efficient, all contemporary Medicine should be integrative”

“Those who consult with the doctor will get something good and will go back home healthier. The virtue of Medicine is to help not only those who practice Medical Arts but also all individuals who are in touch with Medicine”

 

INTRODUCTION

 

Medicine is one of the oldest professions in the history of the world.  Medicine is a field of knowledge related to healing and other aspects of health and disease. There are documents from ancient Egyptian times (from around 3000 BC) indicating the existence of doctors’ or healers and in this context, the medical practitioner Imhotep (circa 2600 BC) produced a written work chronicling over 200 different medical conditions. The Hippocratic Corpus (circa 400 BC) contains the principles of medical knowledge from the golden era of Greek advanced knowledge.

Despite that seniority, it is still not clear what Medicine is, nor do that contemporary practitioners of Medicine have a well-defined concept of what are the purpose and goals of Medicine. As A Einstein emphasized may be that  “the problem involved is too vast for our limited minds” so we can’t put light on the issue yet. Nevertheless, since Medicine is a vital activity in most present-day human societies, it is important to find some sort of approximation and/or compromise to try to understand what medical practitioners can and should do with their profession(s).

Philosophers, scientists, sociologists, technocrats, and others have different views of the mission and vision of Medicine.  A very popular teleological-and pragmatic approach indicates that Medicine is an art based on science. Contrarily, for economists and politicians, Medicine is a hands-on everyday service that can be used to tackle social undesirable situations (the so-called medicalization of sociopolitical problems).

 

We adhere to the teleological position that Medicine has particular intrinsic goals focused on outcomes that we inherently value. We also believe that the contemporary Pragmatic Integrative Model of Medicine interprets those goals better than any other model of Medicine

 

Integrative Medicine is a contemporary approach to wellness that combines all forms of conventional and non-conventional medical practices provided that they can be effective, properly tested, verifiable and reproducible.

 

VISION AND MISSION OF MEDICAL PROFESSIONS

Following a stoic-pragmatic viewpoint, we can argue that Medicine has multiple, different intrinsic goals. We estimate that such a view is compatible with most modern medical models.  Unfortunately, Medicine does not have clear-cut boundaries, and, as Schamme said, it is impossible to conceptually separate Medicine from other practices solely by referring to its “alleged goals, because these goals are shared with several other disciplines”. What we shouldn’t due, is restrict Medicine to a simplistic and narrow clinical encounter between a patient and a doctor as Cassell proposed some time ago. We argue that the role of a physician is as follows: 1. Skilled at individual patient care; 2. Engaged in research to advance knowledge; 3. Educate individuals and communities about health and disease and 4. Keep patients and communities from harm and injustice.

In our view a partial list of goals for Medicine ought to include the following:

      Improve the content and value of medical ontology, epistemology, and phenomenology

Gain advanced knowledge of the nature of human life and the structure and functions and dysfunctions of the human organism

Better understand the concepts of health and disease

Introduce more  precise diagnostic tools and more  efficient medical treatments

Teach and assist individuals, families, and communities to recognize and go by the different stages of life and to withstand the distress of human existence

Diagnose, prevent, treat and heal injuries, illnesses, and diseases

Help people regain functional allostatic balance leading to restoration of health

Relief and comfort ill individuals, families, and communities

Assist people to live longer,  more productive, and more enjoyable lives

THE HIPPOCRATIC OATH: AN HISTORICAL RELIC OR AN INVALUABLE ETHICAL GUIDE?

The Hippocratic Oath is an ancient historical ethical/moral code of conduct used for centuries as a universal pledge of medical ethical conduct. Its origin is attributed to a mysterious figure known as the great Greek physician Hippocrates of Cos. Nobody can ascertain if such an individual was a real person or a mystical creation. Possible, the oath was written by a follower or a learned scribe from Pythagoras’ philosophical school. The fact is that under Hippocrates' name the principles of Greek Medicine were written and passed to further generations. The Hippocratic Corpus contains textbooks, lectures, research, notes, and philosophical essays on multiple medical subjects. These works were written for different audiences, both healers and laymen, and were sometimes written from opposing viewpoints therefore significant contradictions can be found between works in the Corpus.

Ever since the oath was created, health care graduates all over the world have sworn to some version of it. The oath addresses two important principles: benefitting the ill and protecting patients against personal and social harm and injustice.  The oath has been, modified over the centuries to fit the opinions of the time, ranging from the pale, legalistic original version of the Greeks, and to Maimonides’ poetic prayer, to the more scientific contemporary versions. Curiously, the old version of the oath involves the healer, the patient, and God, while the modern versions involve the physician, the patient, and the community.

We argue that the oath (or code of ethics or pledge as some want to rename it) is of great value and must be preserved. It must also be upgraded to fit into contemporary thinking, but without sacrificing the essential values contained in the original version.  We suggest that an attempt must be made to generate a universal consensus for a common oath/pledge/code that is flexible enough to accommodate most of the conflicting beliefs about Medicine.

The America Medical Association (AMA) has one code that can serve as the basic starting point of the suggested universal new version. The post-1980 AMA code reads as follows

Preamble: The medical profession has long subscribed to a body of ethical statements developed primarily for the benefit of the patient. As a member of this profession, a physician must recognize responsibility not only to patients, but also to society, to other health professionals, and self. The following Principles adopted by the AMA are not laws, but standards of conduct that define the essentials of honorable behavior for the physician.

 I. A physician shall be dedicated to providing competent medical care, with compassion and respect for human dignity and rights.

 II. A physician shall deal honestly with patients and colleagues, and strive to expose those physicians deficient in character or competence, or who engage in fraud or deception.

III. A physician shall respect the law and also recognize a responsibility to seek changes in those requirements which are contrary to the best interests of the patient.

IV. A physician shall respect the rights of patients, of colleagues, and of other health professionals, and shall safeguard patient confidence within the constraints of the law.

V. A physician shall continue to study, apply and advance scientific knowledge, make relevant information available to patients, colleagues, and the public, obtain consultation, and use the talents of other health professionals when indicated.

VI. A physician shall, in the provision of appropriate patient care, except in emergencies, be free to choose whom to serve, with whom to associate, and the environment in which to provide medical services.

VII. A physician shall recognize a responsibility to participate in activities contributing to an improved community.

 VIII. A physician shall, while caring for a patient, regard responsibility to the patient as paramount.

IX. A physician shall support access to medical care for all people.

Also, the World Medical Association currently has a code (2017 Declaration of Geneva) that reads as follows

AS A MEMBER OF THE MEDICAL PROFESSION:

·         I SOLEMNLY PLEDGE to dedicate my life to the service of humanity;

·         THE HEALTH AND WELL-BEING OF MY PATIENT will be my first consideration;

·         I WILL RESPECT the autonomy and dignity of my patient;

·         I WILL MAINTAIN the utmost respect for human life;

·         I WILL NOT PERMIT considerations of age, disease or disability, creed, ethnic origin, gender, nationality, political affiliation, race, sexual orientation, social standing, or any other factor to intervene between my duty and my patient;

·         I WILL RESPECT the secrets that are confided in me, even after the patient has died;

·         I WILL PRACTICE my profession with conscience and dignity and in accordance with good medical practice;

·         I WILL FOSTER the honor and noble traditions of the medical profession;

·         I WILL GIVE to my teachers, colleagues, and students the respect and gratitude that is their due;

·         I WILL SHARE my medical knowledge for the benefit of the patient and the advancement of healthcare;

·         I WILL ATTEND TO my own health, well-being, and abilities in order to provide care of the highest standard;

·         I WILL NOT USE my medical knowledge to violate human rights and civil liberties, even under threat;

·         I MAKE THESE PROMISES solemnly, freely, and upon my honor.

There are many similarities between the two codes presented here. We argue that they can be easily unified for universal usage among health care professionals all over the globe.

 

SELECTD REFERENCES

Bailey I. (1991) Who wrote the Hippocratic oath? NEJM 106:91-92

Boorse C. On the distinction between disease and Illness. Philosophy & Public Affairs. 1975; 5(1): 49- 68.

Cassell EJ (1991) The Nature of Suffering: And the Goals of Medicine. DOI:10.1093/acprof:oso/9780195156164.001.0001

Clark SA  (2018) The Impact of the Hippocratic Oath in 2018: The Conflict of the Ideal of the Physician, the Knowledgeable Humanitarian, Versus the Corporate Medical Allegiance to Financial Models Contributes to Burnout. 2018 Jul 30. doi: 10.7759/cureus.3076

Lockwood AH (2004), The Physician's Role in Society: Enhancing the Health of Individuals and the Public. AMA J of Ethics Virtual Mentor. 2004;6(4):189-190. doi: 10.1001/virtualmentor.2004.6.4.msoc2-0404.

Meeroff JC & Meeroff S (2020). Doctor-patient relationship in the modern  world.  https://www.meeroffmedicine.com/articles/The Doctor-Patient relationship

Meeroff JC. (2018). A pragmatic model of health and disease under the integrative paradigm. https://www.meeroffmedicine.com/articles /The contemporary pragmatic model of health and disease.

Pellegrino, ED: “The ‘Telos’ of Medicine and the Good of the Patient,” in Clinical Bioethics: A Search for the Foundations edited by Corrado Viafora, Springer, Dordrecht, The Netherlands, Vol. 26 International Library of Ethics Law, and the New Medicine, 2005: 21- 32.

Schramme T(2017)  Chapter . 9 The goals of Medicine in The Handbook of the Philosophy of Medicine, Thomas Schramme & Steven Edwards Eds

Weil A. (2022) What is Integrative Medicine  https://integrativemedicine.arizona.edu/about/definition.html

World Medical Association. Declaration of July 9; 2018 https://www.wma.net/policies-post/wma-declaration-of-geneva/

 Copyright 2022 © JCMeeroff, MD, PhD.                                                          All rights reserved.

 

 How to cite this article:

 

MEEROFF JC & MEEROFF S (2022). MISSION AND VISION: GOALS AND PURPOSES OF INTEGRATIVE MEDICINE.   

https://www.meeroffmedicine.com/articles/ Goals and purpose of medicine