We can do better.

Abstract

FigureFigureFigureFigureFigureFigureFigureOne of the most satisfying moments for PA educators, community providers, and clinical preceptors is watching students progress from new learners to highly skilled clinicians. We bookend these milestones of achievement with ceremonies that ask students/graduates, faculty, and alumni to reflect on, and commit to, a common set of values. In PA school, this usually is the Oath of the Physician Assistant. Importantly, this oath is a direct reflection of the Statement of Values for the PA Profession, and is a staple of white coat ceremonies and graduations alike.1 It reads as follows: “I pledge to perform the following duties with honesty and dedication: I will hold as my primary responsibility the health, safety, welfare and dignity of all human beings. I will uphold the tenets of patient autonomy, beneficence, nonmaleficence, and justice. I will recognize and promote the value of diversity. I will not discriminate. I will treat equally all persons who seek my care. I will hold in confidence the patient-specific information shared in the course of practicing medicine. I will actively seek to expand my knowledge and skills, keeping abreast of advances in medicine. I will assess my personal capabilities and limitations, striving always to improve my practice of medicine. I will work with other members of the healthcare team to provide compassionate and effective care of patients. I will use my knowledge and experience to contribute to a healthy community and the improvement of public health. I will respect my professional relationship with all members of the healthcare team. I will share and expand my clinical and professional knowledge with PAs and PA students. These duties are pledged with sincerity and upon my honor.” As we collectively reflect on the national and international events of the last couple years, we are struck by the following passages: “I will recognize and promote the value of diversity,” and “I will treat equally all persons who seek my care.” Although this oath, and the values it reflects, are ostensibly representative of the aspirations we collectively have of our graduates and trainees, we would ask: does this small nod to diversity adequately represent these aspirations? Is merely recognizing and promoting the value of diversity enough? Should we not be moving away from equality and toward equity in our pursuit of healthy people and communities? When silence in the face of oppression and injustice serves invariably to perpetuate it, are we, as a profession, content with this value, or are we failing to hold ourselves to a high enough standard? Looking across the healthcare professions, some professional oaths pay homage to the importance of diversity, equity, and inclusion (DEI), and others do not. Notably, the Hippocratic Oath, both the original and a widely accepted modern version, is silent on the issue.2,3 The Oath of the Pharmacist, on the other hand, was recently updated to describe not only the actions that will be taken to advance DEI (promote inclusion, embrace diversity, advocate for justice), but the ends this oath will achieve—advancing health equity.4 As we ask graduates to contemplate the weight, responsibility, and burden of their new office, we are missing an opportunity to them collectively contemplate and affirm, if ever so briefly, their commitment to advancing DEI. As we move forward, the language in the Oath of the Physician Assistant should align with the existing DEI statements and strategic plan pillars set forth by our collaborating PA organizations.5-9 This alignment moves the profession toward actions, instead of performative gestures, as we seek health equity, outcomes parity, and social justice. We expect that these statements will move us as a profession from rewarding intentions to celebrating health equity outcomes and greater diversity in our field. Thinking ahead beyond DEI, the next step is incorporating justice into healthcare. Words matter ... and the ones in the current oath are timid, incomplete, almost meaningless, and outdated at best, and at worst, reflect a mere perfunctory nod to what is one of many important determinants of health. In our new oath, a commitment to dismantling the racist, sexist, and oppressive behaviors of our healthcare systems should be included to ensure that we as a profession can commit to a truly equitable future. We can do better. Actually, we must do better.