Society for Sex Therapy

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Society for Sex Therapy Research (SSTAR)April
3, 2009 - Arlington, VA.

• Contemporary Sexual Medicine
• for Sex Dysfunction
• What Would Hippocrates Do?
• Michael E. Metz, Ph.D.
• 821 Raymond Avenue, Suite 440
• St. Paul, MN 55114
• Voice 651-641-9317 fax [phone]
• MMetzMpls_at_AOL.com
• www.MichaelMetzPhD.com

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Dr. Hippocrates, MD, PhD, MPH
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Many images of Hippocrates
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Hippocrates Hippokrates of Kos (c. 460 BC
ca. 370 BC)

• an ancient Greek physician of the Age of Pericles
  25 centuries ago!
• considered one of the most outstanding figures in
  the history of medicine.
• referred to as the "father of clinical medicine"
  in recognition of his lasting contributions to
  the field.
• Born c. 460 bc Island of Cos.

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Island of Cos, Greece
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Hippocrates the Man Vitae

• Trained under his father, a physician.
• Studied in Athens.
• Traveled extensively.
• Returned to Cos to
• write
• teach
• practice
• Lived to age of 83 90.

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Hippocrates the Man Vitae

• Credited with being the first physician to reject
  beliefs that credited supernatural or divine
  forces with causing and curing illness.
• deductive reasoning.
• He believed that the goal of medicine should be
  to build the patient's strength through
  appropriate diet, life-style and hygienic
  measures, resorting to more drastic treatment
  only
• when necessary
• when the symptoms showed or clarified the
  ilnesss.
• Practice anchors
• patient education.
• problem (not symptiom) focused medicine.
• Interventions cautious incremental.

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Hippocrates the Man Vitae

• founder of the Hippocratic or Coan Asklepieion
  (school of medicine).
• was of enormous importance in separating medicine
  from superstition and philosophic speculation.

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Asklepieion on Cos -- Medical School
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Tree where Hippocrates lectured
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Tree of Hippocrates National Library of
Medicine, USA-NIH, Bethesda, MD

• A cutting from the Tree of Hippocrates, gift
  from the Island of Cos, Greece.
• Planted December 14, 1961 at the dedication of
  the National Library of Medicine, Bethesda, MD.

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National Library of Medicine, NIH, Bethesda
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Dr. Hippocrates_____________ The
seasonedphysician sex therapist ?
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Galen (c. 129 200 AD)

• After Hippocrates, the next significant physician
  was Galen, a Greek who lived from 129 to 200 AD.
• Galen perpetuated Hippocratic medicine.
• photo Nina Aldin Thune

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2nd centuryPhysician,Galen,teaching medical
studentsabout couple sex(14th century
manual)
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HIPPOCRATIC OATHEthical Practice of Medicine

• The Hippocratic Oath is an oath traditionally
  taken by physicians pertaining to the ethical
  practice of medicine.
• Basis for other helping professionals codes of
  ethical practice.
• Its summary axiom Do No Harm.

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Question?

• In addressing sexual problems and sexual medicine
  / therapy
• for the 21st century
• is the Hippocratic Oath sufficient guidance for
  sexual health specialists?

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The Classic Hippocratic Oath

• I swear by Apollo Physician and Asclepios and
  Hygeia and Panacea and all the gods and
  goddesses, making them my witnesses, that I will
  fulfill according to my ability and judgment this
  oath and this covenant
• To hold him who has taught me this art as equal
  to my parents and to live my life in partnership
  with him, and if he is in need of money to give
  him a share of mine, and to regard his offspring
  as equal to my brothers in male lineage and to
  teach them this art - if they desire to learn it
  - without fee and covenant to give a share of
  precepts and oral instruction and all the other
  learning to my sons and to the sons of him who
  has instructed me and to pupils who have signed
  the covenant and have taken an oath according to
  the medical law, but no one else.
• I will apply dietetic measures for the benefit of
  the sick according to my ability and judgment I
  will keep them from harm and injustice.
• I will neither give a deadly drug to anybody who
  asked for it, nor will I make a suggestion to
  this effect. Similarly I will not give to a woman
  an abortive remedy. In purity and holiness I will
  guard my life and my art.
• I will not use the knife, not even on sufferers
  from stone, but will withdraw in favor of such
  men as are engaged in this work.
• Whatever houses I may visit, I will come for the
  benefit of the sick, remaining free of all
  intentional injustice, of all mischief and in
  particular of sexual relations with both female
  and male persons, be they free or slaves.
• What I may see or hear in the course of the
  treatment or even outside of the treatment in
  regard to the life of men, which on no account
  one must spread abroad, I will keep to myself,
  holding such things shameful to be spoken about.
• If I fulfill this oath and do not violate it, may
  it be granted to me to enjoy life and art, being
  honored with fame among all men for all time to
  come if I transgress it and swear falsely, may
  the opposite of all this be my lot.

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6 Classic Medical Ethics Principles Ethical
Values and Sexual Health

• Non-Maleficence first, do no harm.
• Beneficence always ensure the best interest of
  the patient.
• Autonomy the patient right to choose or refuse
  treatment based on full disclosure.
• Justice fairness and equality concerning
  treatments.
• Dignity the patient and professional have the
  right to personal respect.
• Truthfulness honesty about evidence based
  treatments, and freedom from dual relationships.

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Dans article, The Ethics Corner in
Jan.09 SSTAR Newsletter. DAN WATTERS, Ph.D.

• PEGGY KLEINPLATZ, Ph.D.
• SSTAR Sunday Workshop
• Ethical Dilemmas Clinical Conundrums
• in Sex Therapy
• 900 a.m. 1200 noon.

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• HIPPOCRATES TODAY ?
• Scientist
• Teacher
• Clinician

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I.HIPPOCRATES

• SCIENTIST
• Objective Observer
• Caring Thinker

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Ancient Greek Medicine
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The Pantheon of gods

• Zeus.
• gods vs. giants. Haides god of death.
• Hekate -- goddess of
• witchcraft

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The gods

• lt-- Athene being reborn Plaque with figures
• from head of Zeus. from religious rituals.
  
• 
  
  
  

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Healing Stele of Horus (Egyptian, c. 300 b.c)
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Asklepios god of medicine and healing

• Asklepios Hippocrates
  teaching and Asklepios
• arriving at the Cos Asklepieion School.

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Hippocrates the Scientist

• He challenged beliefs of supernatural or divine
  forces as
• sources and causes or
• cures of illness.

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Hippocrates TODAY Sex Therapy

• would teach to demythologize unreasonable claims
  of sexual performance
• treat hype about sex (e.g., perfect erections)
  as though it were claims from the gods.
• would promote reasonable sexual knowledge and
  expectations of sexual performance and couple
  satisfaction.

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Hippocrates TODAY Sex Therapy

• would teach an integrative biopsychosocial
  approach to sex problems
• hed teach the inseparable unification and
  interaction of biological, psychological, and
  interpersonal dimensions and
• never address one without consideration of the
  others.

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II.HIPPOCRATES

• INSIGHTFUL
• TEACHER
• Trainer
• Mentor

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Hippocrates the Teacher TODAY

• He would be concerned about the misinformation
  and primitive skills level of many
  professionals / clinicians to address sexual
  concerns.
• He would strongly promote greater and specific
  sex therapy training requirements for degree
  programs and licensure for all healthcare
  professionals.

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Hippocrates the Teacher Today

• Would promote sex therapy training in traditional
  and new ways
• traditional
• First be a good clinician,
• then a good sex therapist.
• (Harold Leif, M.D.)
• newer
• Interactive on-line knowledge and
• skills training resources.

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Hippocrates the Teacher Today

• Examples
• RUThinking.co.uk UK teen sexual health.
• http//www.ruthinking.co.uk/
• Children in the Middle (divorce)
• interactive classes, seminars for
• Parents
• Professionals
• http//www.childreninthemiddle.com/classes2.htm

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III. HIPPOCRATES

• COMPASSIONATE CLINICIAN
• Sex Therapist

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Hippocrates the Sex Therapist

• Professional identity VOCATION
• calling to serve others, to use knowledge in
  the service of his patients overall (sexual)
  health.
• focus on the total person physical, mental
  interpersonal/family.

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Hippocrates the Sex Therapist

• professional patient collaborator
• more than a technician
• fellow-worker with his patients for their health.
• credited with practicing with an eye for evidence
  from
• detailed personal family history
• kept a patient record
• that would follow to other physician.
• patient observaton
• continuous pulse during history for evidence!

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Hippocrates the Sex Therapist TODAY

• would assess and treat from a comprehensive
  evidence-based approach
• empirical knowledge factual
• qualitative knowledge -- compassionate

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Professional Myopia ?Awareness of our
Professional Filters

• Hippocrates would also challenge our clinical
  perceptions because
• We tend to find what were
• looking for
• MD DX TX --gt only
• physiological ?
• MH DX TX --gt only
• psychological ?
• SW / MFT DX TX --gt only
• interpersonal ?
• Hippocrates would integrate
• all of the above

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Hippocrates the Sex Therapist TODAY

• ? He would pursue the
• sexual problem
• with careful, detailed histories,
• to seek the source and the impact,
• and treat all features.
• TREAT THE DISEASE,
• NOT THE SYMPTOM.

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Hippocrates the Sex Therapist TODAY SUMMARY

• would honor his calling to be a sexual health
  professional with loyalty to the ethical
  principles.
• would be steadfastly patient-centered.
• would treat the sex problem as an
  all-encompassing biopsychosocial problem
• not simply symptom relief.

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Hippocrates the Sex Therapist TODAY SUMMARY

• Would teach / educate to empower his patients
  with accurate knowledge and reasonable
  expectations.
• promote individual couple satisfaction as the
  vital purpose of sex medicine therapy.
• teach reasonable sexual health such as
• Metz McCarthy (2007)
• --gt Good-Enough Couple Sex
• Kleinplatz, Menard et al, (2007)
• --gt Optimal Sexuality AND.

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Dr. Hippocrates, MD, PhD, MPH

• He would be a
• SSTAR
• COLLEAGUE

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Any resemblance between HIPPOCRATES and the god
ZEUS is purely coincidental.
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Dr. Hippocrates, MD, PhD, MPH

• OUR
• SSTAR
• COLLEAGUE

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Society for Sex Therapy Research (SSTAR)April
3, 2009 - Arlington, VA.

• Contemporary Sexual Medicine
• for Sex Dysfunction
• What Would Hippocrates Do?
• Michael E. Metz, Ph.D.
• 821 Raymond Avenue, Suite 440
• St. Paul, MN 55114
• Voice 651-641-9317 fax [phone]
• MMetzMpls_at_AOL.com
• www.MichaelMetzPhD.com