Journal of Medical Internet Research | Revised Hippocratic Oath for Digital Health

JMIR Publications published “A Revised Hippocratic Oath for the Era of Digital Health” in the Journal of Medical Internet Research, which argues that the Hippocratic Oath, which contains a set of ethical rules designed to guide physicians through their profession, should be updated to reflect the new realities of digital health and articulate updated principles that govern the practice of modern medicine.

The original Hippocratic Oath still embodies ideals that are timely and relevant even in the 21st century:

  1. To treat patients to the best of one’s ability
  2. To preserve a patient’s privacy
  3. To faithfully teach the art of medicine to the next generation

Despite the varying views about the Oath, most medical schools still ask their students to recite either the classic or modified form of the Oath.

Dr Bertalan Meskó, MD, PhD, Director of The Medical Futurist Institute, said, “The rise of digital health has dramatically changed the practice of medicine in a way that could not have been easily predicted at the time Hippocrates outlined his ethical principles of medicine.”

Together with Dr. Brennan Spiegel, MD, MDHS, Director of Health Services Research at Cedars-Sinai, the co-authors explain that digital health is a broad term that encompasses the use of digital devices and platforms, including electronic health records, patient-provider portals, mobile health apps, wearable biosensors, artificial intelligence, social media platforms, and medical extended reality, to improve the process and outcomes of health care delivery.

Remote patient monitoring, for example, affords patients and doctors a more complete and accurate picture of disease progression outside the walls of a hospital, clinic, or research center. The data from mobile technologies can now be shared between the patient and provider, allowing greater collaboration, stronger therapeutic partnerships, enhanced shared decision-making, and an increasing shift to preventive and proactive care in lieu of reactive care.

Extended reality technologies such as virtual reality and augmented reality provide opportunities to go beyond the traditional exam room and introduce new ways of blending behavioral and psychosocial care with traditional biomedical care.

In short, the cultural transformation enabled by digital health is rapidly changing the practice of medicine from a tradition of physician-driven decisions based on limited institutionally owned data to shared decision-making based on expansive data across platforms, owned and shared by patients, that reflect biopsychosocial well-being across broad disease trajectories and illness experiences along a range of geographies, demographics, and sociocultural communities.

Drs. Meskó and Spiegel conclude in their JMIR Publications Research Output that the Hippocratic Oath remains an important pledge that modern physicians should continue to honor, but that it is now justified to modify the Hippocratic Oath—even if modestly—to reflect the digital health revolution, advances in patient empowerment, and the evolving role of technology in the everyday practice of medicine.

The authors offer incremental but meaningful updates to the Oath to help prompt discussion and contemplation about the current Oath and its relevance to our changing times.

The World Medical Association may want to consider integrating the authors’ suggestions into an updated Oath, just as previous changes were adopted, to ensure the Oath remains relevant and impactful for all physicians and their patients.

A few examples from the upgraded oath, with the changed text in italics.

  •  “I will remember that there is an art to medicine as well as science, and that warmth, sympathy, and understanding may outweigh the surgeon’s knife, the chemist’s drug, or the programmer’s algorithm.
  • “I will treat my patients in an equal-level partnership, and I will not be ashamed to say “I know not,” nor will I fail to call in my colleagues when the skills of another are needed for a patient’s recovery.”
  • “I will respect the privacy of my patients and their data, for their problems are not disclosed to me that the world may know.”
  • “I will remember that I do not treat a fever chart, a cancerous growth, a data point, or an algorithm’s suggestion but a human being.”

DOI – https://doi.org/10.2196/39177

Full-text – https://www.jmir.org/2022/9/e39177

Free Altmetric Report – https://jmir.altmetric.com/details/135631904

Keywords – hippocratic oath, digital health, eHealth, future, automation, ethics, viewpoint, medical perspective, physician perspective, ethical, digital divide, artificial intelligence, moral 

JMIR Publications is a leading, born-digital, open access publisher of 30+ academic journals and other innovative scientific communication products that focus on the intersection of health and technology. Its flagship journal, the Journal of Medical Internet Research, is the leading digital health journal globally in content breadth and visibility, and it is the largest journal in the medical informatics field.

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