Member Care and the Hippocratic Oath, Part 4

The "Hippocratic Heart":

Doing Good and Avoiding Harm

Diego Rivera, The Vendor of Lillies

Non hay tan buen tesoro
como el bien facer
nin tan precioso oro
nin tan dulce placer.
Sem Tob, 14th century, Spain

Translation:

Doing good is the greatest treasure,
Better than gold, better than pleasure.

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“I will prescribe regimens for the good of my patients
according to my ability and my judgment
and never do harm to anyone.”
Hippocrates, 4th century, Greece
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This portion of the Hippocratic Oath can be summarized in two words and also in two phrases: Benevolence—Do good and Nonmaleficence—Do no harm. So much of helpful and ethical health care practice is founded upon these timeless principles.
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Applications for the "Hippocratic Heart"
1. Memorize. A suggestion: Do you know other languages besides English? If so, get an accurate translation of these two words and two phrases, especially in your heart language. Memorize them.
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2. Competency. We practice within our level of competency (“ability and judgement”). We also acknowledge that we will be “stretched” at times in our practice, and may be called upon to help in ways that are not fully within our experiential, training, and certainly comfort zones. Is this OK? Consult with colleagues as much as possible in such situations. In addition and in general, get supervision as needed. Participate in peer supervision and group case consultations. These all help us in doing good (good practice) and avoiding ham (poor practice).
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3. Love. The foundational principles of benevolence and nonmaleficence are clearly reflected throughout the New Testament. They can be seen as core principles founded upon the bedrock of “love”. Here are some quotes.
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**Let love be without hypocrisy. Abhor what is evil; cling to what is good.
Romans 12:9
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*Love works no evil to a neighbour. Love therefore is the fulfillment of the law.
Romans 13:10
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**Let us not lose heart in doing good…let us do good to all people, especially those who are of the household of the faith.
Galatians 6:9,10
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Reflection and Discussion
1. Primum non nocere--first, do no harm. Sometimes this principle is used without the accompanying principle of “doing good” What are your thoughts about the possible sufficiency of nonmaleficence?
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2. Sometimes we are in situations when we are not sure of the best course of action or the best intervention/treatment. Nor are we able to foresee the consequences of our work. A classic example is if we help one person in a dysfunctional system, will that lead to positive change in the overall system as hoped or will it lead to greater problems for the healthier person and the system—e.g., the person may have to still reamain part of the dysfunctional system and may be dependent on the system as he/she tries to effect healthy change. Comment on such situations and give any examples in your life, practice, current international events, history.
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3. It is helpful to make organizational applications of the principles of Benevolence—Do good and Nonmaleficence—Do no harm. For example, what practices can organizations put into place to make sure that leaders, staff, the ethos, policies etc. do in fact reflect these core Hippocratic principles?

GP2: Good Practice by Good Practitioners

Growing as Good Practitioners:
Staying in Touch with Stress and Yourself

"Good" practitioners develop their character (virtues and resiliency) and competence (skills and knowledge), as part of their ethical commitments to do good and to provide quality services. Growing as good practitiners also means that we stay in touch with our inner world, stress levels, and the need to give/reveive feedback and support from trusted friends and colleagues.

Here is a tool that we have found uselful to help monitor our stress levels as well as the stress levels of mission/aid workers. It helps us stay in touch with how we are doing in the face of the demands of work, expecialy in "field" contexts. This tool is used by the International Federation of the Red Cross and Red Crescent Societies and many other organizations (from the booklet Managing Stress in the Field, 2001). The booklet is very helpful and available to download for free at:

http://www.ifrc.org/cgi/pdf_pubshealth.pl?stress.pdf

Short Questionnaire on Stress

Instructions: Rate each of the following items in terms of how much the symptom was true of you the last month.
0 = Never 1 = Occasionally 2 = Somewhat often 3 = Frequently 4 = Almost always
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___1. Do you tire easily? Do you feel fatigued a lot of the time, even when you have gotten enough sleep?
___2. Are people annoying you by their demands and stories about their daily activities? Do minor inconveniences make you irritable or impatient?
___3. Do you feel increasingly critical, cynical or disenchanted?
___4. Are you affected by sadness you can’t explain? Are you crying more than usual?
___5. Are you forgetting appointments, deadlines, personal possessions? Have you become absent-minded?
___6. Are you seeing close friends and family members less frequently? Do you find yourself wanting to be alone and avoiding even your close friends?
___7. Does doing even routine things seem like an effort?
___8. Are you suffering from physical complaints such as stomach aches, headaches, lingering colds, general aches and pains?
___9. Do you feel confused or disoriented when the activity of the day stops?
___10. Have you lost interest in activities that you previously were interested in or even enjoyed?
___11. Do you have little enthusiasm for your work? Do you feel negative, futile, or depressed about your work?
___12. Are you less efficient than you think you should be?
___13. Are you eating more (or less), smoking more cigarettes, using more alcohol or drugs to cope with your work?

Total Score: (Add up scores for items 1-13)
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Interpretation: No formal norms are available for this measure. Based on the content of the items, a score of 0-15 suggests the delegate is probably coping adequately with the stress of his or her work. A score of 16-25 suggests the worker is suffering from work stress and would be wise to take preventive action. A score of 26-35 suggests possible burnout. A score above 35 indicates probable burn out.

Based on “The Relief Worker Burnout Questionnaire” in Coping with Disaster (1999) by John H. Ehrenreich.

Reflection and Discussion

1. Based on the above tool, what are some of the main areas of stress for you?

2. What are a few things you could do to help deal with such stress?

3. Who do you know that would benfit from using this tool?