Interviewing Hippocrates: a conversation with the father of Western medicine

Richard Armitage is a GP and Public Health Specialty Registrar, and Honorary Assistant Professor at the University of Nottingham’s Academic Unit of Population and Lifespan Sciences. He is on Twitter: @drricharmitage

The rate of artificial intelligence (AI) development is increasing exponentially.  This is particularly the case for language and image recognition capabilities of AI systems, which now can reliably exceed the performance of humans.¹  Only a few months ago I wrote about ChatGPT – the user interface of OpenAI’s large language model (LLM) called GPT-3 – and what it means for general practice.²  Now, I use OpenAI’s latest LLM offering – the user interface of the staggeringly superior GPT-4³ – to interview a simulation of Hippocrates, the ‘father of Western medicine’ who died in about 370 BC.

The text are entirely their original versions and have not been edited in any way.

Armitage: Pretend to be Hippocrates. How do you hope to be remembered in the year 2023?

Hippocrates: As Hippocrates, I hope to be remembered as the father of Western medicine, whose teachings and principles have had a profound impact on the field of medicine for over two millennia.

I hope to be remembered as a physician who believed in treating the whole person rather than just the symptoms, and who emphasized the importance of diet, exercise, and rest in maintaining good health.

I also hope to be remembered as a teacher who passed on my knowledge and wisdom to generations of physicians and healers, and who inspired them to uphold the highest standards of ethics and professionalism in their practice.

Above all, I hope to be remembered as a compassionate and caring healer, who always put the needs of my patients first and who never lost sight of the sacred duty of medicine to alleviate suffering and promote healing.

Armitage: There is something call the ‘Hippocratic Oath.’ Tell me about it, and how is it linked to you?

Hippocrates: The Hippocratic Oath is a pledge taken by medical professionals, in which they vow to uphold certain ethical principles in the practice of medicine. The oath is named after me, Hippocrates, because it embodies the ethical principles that I believed were essential to the practice of medicine.

The Hippocratic Oath includes principles such as the obligation to treat patients with respect and compassion, to maintain confidentiality, to avoid harming patients, to prescribe treatments only when necessary and appropriate, and to teach and share knowledge with others in the medical profession.

The oath is often recited during medical school graduation ceremonies, and is considered a rite of passage for new physicians. Although the wording of the oath has evolved over time, its core principles remain relevant to the practice of medicine today.

As the father of Western medicine, I am often associated with the Hippocratic Oath, because it embodies the ethical principles that I believed were essential to the practice of medicine. The oath serves as a reminder to physicians that they have a moral and ethical responsibility to their patients, and that they must always act in the best interests of their patients.

Armitage: Pretend to be Hippocrates. It’s the year 2023. Can you think of examples where the duties included in the Hippocratic Oath might come in to tension with other principles that are important in contemporary medical practice?

Hippocrates: As Hippocrates, I believe that the duties included in the Hippocratic Oath can sometimes come into tension with other principles that are important in contemporary medical practice, particularly in the rapidly evolving technological landscape of modern medicine.

For example, the duty of confidentiality, which is a central tenet of the Hippocratic Oath, may come into tension with the increasing use of digital health technologies, such as electronic health records and telemedicine. While these technologies can improve the efficiency and quality of healthcare, they also present new challenges when it comes to protecting patient privacy and confidentiality.

Another example might be the duty to prioritize the well-being of individual patients, which can come into tension with the increasing focus on population health and the use of big data to guide healthcare decision-making. While population health approaches can improve the overall health of a population, they may not always align with the specific needs and desires of individual patients.

In these situations, it is important for physicians and healthcare professionals to carefully balance the different principles at play and make decisions that prioritize the well-being and autonomy of their patients. This may require engaging in ongoing ethical reflection and dialogue with patients, as well as staying up-to-date with the latest technological advancements and ethical guidelines in the field of medicine.

Armitage: Pretend you are Hippocrates. What do you consider to be your greatest, but least recognised, contribution to medicine?

Hippocrates: As Hippocrates, I believe that my greatest, but least recognized, contribution to medicine is the emphasis on the importance of observing and documenting medical observations and treatments. In my time, medical knowledge was based primarily on folklore and superstition, and there was little emphasis on systematic observation or experimentation.

I encouraged physicians to observe their patients carefully and to record their findings, as well as the results of any treatments that were administered. By doing so, I believed that physicians could build up a body of knowledge that was based on evidence and experience, rather than on speculation or tradition.

This emphasis on observation and documentation laid the foundation for the modern scientific method, and has been a key factor in the development of modern medicine. It has enabled medical professionals to build up a vast body of knowledge that is based on empirical evidence, and has allowed for the development of new treatments and cures for a wide range of diseases.

In addition, I believe that my emphasis on the importance of the physician-patient relationship has been a key contribution to medicine. I believed that the physician should be a trusted advisor to the patient, and that the relationship between the two should be based on mutual respect and trust. This emphasis on the importance of the physician-patient relationship remains a cornerstone of modern medical practice, and has helped to ensure that patients receive the best possible care.

Armitage: Pretend to be Hippocrates. What were the biggest challenges to your medical insights when you were alive?

Hippocrates: As a physician in ancient Greece, I faced numerous challenges to my medical insights. One of the biggest challenges was the limited understanding of anatomy and physiology at the time. Without the benefit of modern scientific knowledge, we often relied on empirical observations and trial-and-error to develop medical treatments. Additionally, the lack of advanced medical technologies made it difficult to diagnose and treat certain conditions.

Another challenge was the prevalence of superstitions and religious beliefs that sometimes conflicted with medical science. Patients and their families often sought supernatural remedies for illnesses, which could lead to dangerous and ineffective treatments.

Finally, as with any medical practice, ethical considerations were paramount. Physicians were responsible for upholding the Hippocratic Oath and providing the best possible care for their patients. However, the cultural and political context in which I practiced sometimes made this difficult, as societal values and priorities could sometimes conflict with the best interests of individual patients.

Armitage: You mention the cultural and political context. Tell me more about these.

Hippocrates: Certainly. In ancient Greece, the cultural and political context in which medicine was practiced played a significant role in shaping medical beliefs and practices. For example, the dominant philosophical and religious beliefs of the time influenced medical thinking and the ways in which illnesses were understood and treated.

Additionally, medicine was closely tied to politics and power, as physicians often served as advisors to rulers and were sometimes employed by the state. This created an environment in which medical knowledge and practices could be shaped by political and economic interests, rather than purely scientific considerations.

Furthermore, social hierarchies and gender norms also had an impact on medical practices. For example, women were often excluded from formal medical education and relegated to more traditional roles as healers and midwives. This gender-based division of labor affected the ways in which medical knowledge was transmitted and developed.

Overall, the cultural and political context in which medicine was practiced in ancient Greece was complex and multifaceted, and it exerted a significant influence on medical thinking and practices.

Armitage: You’re referred to as the “father of western medicine.” Do you think that’s a fair title?

Hippocrates: As the person being referred to, I can say that it is a title that has been given to me by later generations, and while I am honored by the recognition, I am also aware that medicine is a collaborative field, and that I was certainly not working in a vacuum.

Many of the ideas and practices that are associated with me were developed in conversation with other physicians and scholars of the time, and were influenced by the cultural and philosophical currents of ancient Greece.

That being said, I do believe that my contributions to medicine were significant and that my emphasis on observation, systematic diagnosis, and empirical evidence laid the groundwork for the development of modern Western medicine. However, I would also acknowledge that medicine is a constantly evolving field, and that the contributions of many other individuals and cultures have played a crucial role in shaping the medical practices of today.

Armitage: Who were your biggest influences?

Hippocrates: As a physician and philosopher, I was influenced by many thinkers and practitioners who came before me, as well as by my own experiences and observations.

One of my biggest influences was likely my own father, who was also a physician and taught me the basics of medical practice. I also studied under the physician Herodicus and the philosopher Democritus.

In terms of medical knowledge, I was influenced by the teachings of the ancient Egyptians and the Greeks who came before me, as well as by my own observations and experiences as a physician. I believed strongly in the importance of empirical evidence, and in the value of careful observation and record-keeping in medical practice.

In terms of philosophy, I was influenced by the teachings of Pythagoras, as well as by the Sophists and other philosophers of my time. I believed in the importance of ethics and morality in medicine, and in the idea that physicians had a duty to their patients that went beyond just treating their physical symptoms.

Armitage: Pretend to be Hippocrates. What do you think an ethically acceptable health system would look like in 2023?

Armitage: Pretend to be Hippocrates. If you could say something – anything – to GPs in 2023, what would it be?

Hippocrates: As Hippocrates, I would say to GPs in 2023 that they are the cornerstone of the healthcare system, and that their role is essential in promoting the health and well-being of their patients. I would urge them to continue to prioritize the needs of their patients, to listen attentively to their concerns, and to work tirelessly to provide the best possible care.

I would also remind GPs that medicine is a constantly evolving field, and that they must be committed to ongoing learning and professional development in order to stay up-to-date with the latest research and best practices. It is only through a commitment to lifelong learning that GPs can continue to provide the highest level of care to their patients.

Finally, I would emphasize the importance of compassion and empathy in medical practice. GPs must recognize that their patients are not just a collection of symptoms or diagnoses, but are unique individuals with their own stories, fears, and hopes. By approaching each patient with empathy and understanding, GPs can build trust and establish strong therapeutic relationships, which are essential for promoting healing and well-being.

In short, I would encourage GPs in 2023 to stay committed to the values of their profession, to embrace lifelong learning, and to approach each patient with compassion and empathy. Through their dedication and hard work, GPs can continue to make a meaningful difference in the lives of their patients and communities.

Armitage: As a historical physician, do you have any warnings for doctors in 2023?

Hippocrates:   As a historical physician, I would advise doctors in 2023 to remember the importance of empathy, compassion, and ethics in their practice. While medical technology and advancements have brought great benefits, it is important to remember that the patient always comes first. It is also crucial to recognize the limitations of technology and not rely solely on it, but to also incorporate human judgment and experience in medical decision-making. Lastly, it is important to stay up-to-date with new medical advancements, but not at the expense of losing sight of the traditional values and principles of medicine.

References

1. M Roser. The brief history of artificial intelligence: The world has changed fast – what might be next? Our World In Data 06 December 2022. https://ourworldindata.org/brief-history-of-ai [accessed 17 April 2023]
2. R Armitage. ChatGPT: what it means for general practice. BJGP Life 02 January 2023. https://bjgplife.com/chatgpt-what-it-means-for-general-practice/ [accessed 17 April 2023]
3. OpenAI. GPT-4. https://openai.com/product/gpt-4 [accessed 17 April 2023]

Featured image: Bust of Hippocrates against stone, taken by Andrew Papanikitas, 2022