A tweet by Gavin Preston M.D. says: “Second law of medicine = No one cares how much you know, until they know how much you cared”. It implies that being caring is valued highly in medicine, if not higher, relative to being knowledgable. It encourages medical professionals to be caring just as much as they are knowledgable, if not more. I figured, his experience as a retired physician and a 39-years cancer survivor must mean that there is some truth to that which he wrote.
Second law of medicine = No one cares how much you know, until they know how much you cared
Gavin Preston, M.D.
But, I’ve never heard of this law before. I am not sure if anyone has too. Have you?As medical professionals, we are familiar with the Hippocratic Oath and the ever famous first rule – “Do no harm”. Honestly, nothing else comes to mind. So, is this second law actually written in the oath? Could it be that I’ve forgotten such a striking law of the oath? I decided to look it up. What I found were a few interesting points with regard to this second law, which also shed some light on its origins.
Apparently, there is nothing which resembles it in the original or earlier versions of the Hippocratic Oath. I am not surprised because it sounds too modern to have originated from such ancient scriptures. Besides, even “primum non nocere” was not found in the original document, only inferences. So, I search the modern versions of the Hippocratic Oath for any inferences made which vow similar intentions to the second law, hoping to find some clues.
Modern versions of Hippocratic Oath is more commonly known to us as Code of Medical Ethics, Good Medical Practice or Code of Professional Conduct. The laws or rules written in these various documents all originated from the laws or rules written within the original Hippocratic Oath. And true enough, there are many inferences made to the second law if you look closely in these more modern versions.
A modern version of the oath which was rewritten in 1964 and has been widely accepted and is still in use today by many US medical schools, made inferences to the second law as below:
I will remember that there is art to medicine as well as science, and that warmth, sympathy, and understanding may outweigh the surgeon’s knife or the chemist’s drug.
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 cannot recall which version of the Modern Hippocratic Oath I recited as I stood at my graduation ceremony many years ago. But, it is comforting to know that the second rule is most likely inferred to by many medical graduates as they begin their medical career. Although it is not as direct as the one Gavin Preston wrote, at least it is similar in its meaning and intentions. Most important of all, that it guides their actions in practice.
The second law doesn’t imply that it is okay to not seek knowledge. Rather, being caring medical professionals matter more than knowing everything there is in medicine. It is NOT okay to be the most brilliant mind in your field but to have little care for your patients. It is better to admit lack of knowledge, but have an immense sense of care for your patients as it will lead you to refer patients to one who has more knowledge, offsetting any possible weaknesses or gaps in your knowledge.
Personally, I have witnessed doctors at both ends of the spectrum when it comes to this law. All I can say is that I completely agree. Nothing feels worse to a patient than having an arrogant treating doctor who shows little empathy and then refuses to acknowledge that his or her knowledge may be limited. I much prefer ones that are empathic and humble enough to admit his or her shortcomings and then take steps to ensure patients receive the care that they deserve. What do you think?
- Medical Definition of Hippocratic Oath by William C. Shiel Jr., MD, FACP, FACR
- The Hippocratic Oath Today by Peter Tyson.