A Quadruple Aim update for the Hippocratic Oath

Posted by Dike Drummond MD


A Quadruple Aim update for the Hippocratic Oath

The Declaration of Geneva is the modern successor to the ancient Hippocratic Oath. It was first adopted by the World Medical Association (WMA) at its second General Assembly in 1948.

In the subsequent 70 years there have been only minimal amendments until just two weeks ago - October 14th, 2017 at the WMA General Assembly in Chicago.

For the first time the pledge adds a requirement for doctors to attend to their own health, well-being and abilities in order to provide the best care to our patients.

This language was added:

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

This new wording is meant to acknowledge the impact of physician burnout on patient care and be a tangential mention of the Quadruple Aim. But just hold on a second ...

Is this also a form of blaming the victim?=

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doctors-are-canary-in-the-coal-mine-of-medicine-1.jpgRemember the Canary and the Coal Mine?

This new addition to the declaration lays all responsibility for physician health and wellbeing on the physician/canary.

What about the Coal Mine?

How about a parallel version of the Hippocratic Oath - for Healthcare Organizations !

Each healthcare organization pledges to care for the patient AND the providers & staff equally -- before they are allowed to open their doors.

Hmm ... feels right to me.

Please leave a comment with your thoughts below. 


Additional Changes to the Declaration as of 10/14/2017

  • Specific reference for the first time to respecting the autonomy of the patient - included now for the first time.
  • A new obligation for respect between teachers, colleagues and students. Previously this was a one-way traffic of respect of the student for the teacher.
  • A new obligation on physicians to share medical knowledge for the benefit of their patients and the advancement of healthcare.  



[ New amendments are highlighted ]


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 PRACTISE my profession with conscience and dignity and in accordance with good medical practice;

I WILL FOSTER the honour 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 honour.


Here is the WMA announcement of the changes in the Declaration of Geneva.

Here is JAMA commentary on the new oath.



What difference do you think these changes make?
What are your thoughts on an Institutional Hippocratic Oath?


Tags: quadruple aim