The Hippocratic Oath & COVID-19: Dr Klaus Schustereder’s Perspective

This is a guest opinion by Dr Klaus Schustereder, a medical doctor specialized in general internal medicine, now working in Switzerland. Dr Schustereder has extensive medical experience, both in Europe and in Africa. He is treating COVID-19 on an outpatient basis, from his practice in Vevey, in the Montreux area.

The big advantage I had in my career is that I have been sick myself many times. I had malaria 13 times. Looking back, this was a gift. In 2005 I went to Central African Republic. Fantastic experience to be the doctor and the patient. Malaria kills about 1,5 Million people every year. There are about 1 Billion episodes every year. We are told that C-19 killed about 2. 3 Million so far. Most of the people died are over 75 years old. A lot (just god knows how much) have been tested Covid-19 positive, but in fact died of something different. However the virus particules have been identified and hence they increase the death rates. 

Having been in touch with the African reality very early in my carrer and having seen the tremendous need to simple, safe, effective and cheap treatment, since I lived in Africa I was always open for therapeutic approaches independently of any paradigme/ideology/world view. Africa and me being the patient transformed me to an open-minded person who has learned to evaluate patients just by observing, listening and examining patients with my hand. The African bush was the best medical school I could get and each time I had Malaria it got the best lecture in infectious diseases. 

There was not a single second I would refuse to treat C-19 patients with Hydroxychloroquine. Why would I refuse a medication that has been looked into by one of the world’s authorites in infectious disease (Prof. Raoult in Marseille)? Why would I refuse a treatment that is cheap and the medical world is familiar with for more than 5 decades? Why would I not prescribe a medication I am very familiar with and try to give relieve my patient? That’s what I am supposed to do! That’s why I have atttended Medical School. 

I love seeing people improving in their health. There is something very special happening between the patient and a nurse/doctor, when the patient improves. I guess no other profession has that. There is a level of trust and a particular sense of relationship developing. When a person takes care of another person suffering, something very unique emerges between these two. It’s something particularly beautiful. One person taking care of another person in an intelligent, emphatic way and really committed way coming from our heart is particularly human. I would also say: NOT DOING IT IS INHUMAN!!! 

My whole medical approach in my clinic ( – I run an outpatient clinic in the French speaking part of Switzerland) is oriented in triggering evolution of the people coming to see us. It’s the patient first independently from paradigmes/world views/etc. Sure, we also follow guidelines, national recommendations. However, we try to add as much value as possible to our patients as long as the approach is legal. Patients themselves have to see that they feel better.

I want to understand as much as possible about my patient. I try to put myself as good as I can into their position. Never I will forget that I have been in that place (being the patient) again and again when I had Malaria. I know what it means to be very sick, unable to walk just a few meters, shaking all night long with a fever, throwing up like mad, etc. and I will never forget how humble and grateful I felt towards the people taking care of me. 

When C-19 came and I looked into what is going on in African Countries and the Western World, I saw even more clearly what I saw when I came back to Europe after almost 3 years in Africa. The Medical World in the West is paralyzed. We cannot treat anybody as long as a treatment is not clearly defined in the national recommendations, best the US national recommendation. 

With such approach, we need to wait until the epidemic is basically over because we have not proved that a treatment has been shown to be effective in double blind randomized clinical trial. Meaning, we send the patient home, telling them: In case you are doing less well, go to the hospital. No legal issue here for the doctor. However, there is a clear ethical issue! A big one even!

The younger generation of doctors – say those who are younger than 40 – is educated with a mindset basically telling them: your clinical (firsthand experience) is not of any great importance. You just need to execute what has been concluded from big clinical research trials. I believe every doctor, every nurse should learn to trust their eyes, their observations, their hands in the first place. I do not say we should ignore big clinical data research, but we first need to trust our own senses! 

I had to learn to trust myself based on what I see and observe in the first place. Initially, I didn’t dare talk about this because I thought my colleagues would think I am crazy. But that was a sign of immaturity on my side. I had to grow as a human being, as a man, as a father and as a physician to dare speaking out about what I experience. It’s a great feeling when you dare saying what you think because speaking out about what we really think shapes us. This process made me an independently thinking and acting person, for the good of the patients who trust me and come to me at work. 

If we see things from such a perspective, I think the medical professionals need to grow at the personal level. I can see where this can take us because those who make a difference now are those colleagues who have courage and work passionately on the frontline. They are willing to take risks because they know deep within themselves that they are doing the right thing. 

Klaus Schustereder, M.D. 

Note: We would like to publish additional perspectives on this crucial question; you are most welcome to send us your own perspective on your hippocratic oath in the context of the pandemic.