Embracing the Asclepion: a call for authenticity in medical symbolism

May 28, 2023

At the heart of the City of London sits an imposing building with massive brass front doors. Emblazoned and embossed on both doors is a symbol – the Caduceus, which in the U.S. is associated with medicine and health care. But why is it on the doors of the Bank of England, the second-largest repository of gold in the world?

Historically, the Caduceus was the staff of Hermes/Mercury, the patron of business, with the two snakes representing the complimentary aspects of commerce and negotiation. The story of how it became a symbol of medicine is fascinating, excellently reviewed in Wikipedia’s “Caduceus as a symbol of medicine.”

However, not everyone is happy about this transformation. In 1932, Stuart L. Tyson wrote in the Scientific Monthly, referring to Hermes/Mercury:

“… would not his symbol be suitable for certain Congressmen, all medical quacks, book agents, and purveyors of vacuum cleaners, rather than for the straight-thinking, straight-speaking therapist? As conductor of the dead to their subterranean abode, his emblem would seem more appropriate on a hearse than on a physician’s car.”

Even today, many in the medical profession believe that this symbol is unsuitable to represent the healing arts. Some think that it has become too closely associated with the commercial aspects of medicine, which raises concerns about the dominance of money in the U.S. health care system.

Another objection is that the Caduceus has been extensively co-opted by allied health professions, no longer exclusively representing physicians, but rather a generic “medical provider.” The symbol has lost its identity as the property of MDs and DOs.

Instead of clinging to the Caduceus, let us preserve the true symbols of our profession, such as the Asclepion, a single rod with a single snake entwined, and no wings.

Asclepius, the Greco-Roman god of medicine and healing, is represented by the single snake on his staff, symbolizing wisdom, healing, and resurrection. The traditional Hippocratic Oath begins:

“I swear by Apollo Healer, by Asclepius, by Hygieia, by Panacea …”

Asclepius, the son of Apollo, and his daughters Hygieia and Panacea, embody health, hygiene, cleanliness, and universal remedies. His staff is an appropriate symbol for physicians. While there has been some limited co-option of the Asclepion, there is still an excellent opportunity for physicians to reclaim it as their exclusive emblem.

In today’s hospitals, it is almost impossible for the general public to identify the exact nature of the “medical providers” they encounter. Proper symbols can help in this regard.

Scrubs, once exclusively worn by physician surgeons and their teams, are now ubiquitous, worn by various health care professionals, even the cleaning crew. Often, these scrubs bear the Caduceus, regardless of the wearer’s role in health care. Simply adding an embroidered “Dr.” is no longer sufficient to identify a person as a physician. Displaying the Asclepion with an embroidered MD or DO would clearly indicate the wearer as a genuine physician.

Another important symbol is the stethoscope. Physicians should invest in a quality stethoscope, such as the Sprague-Rappaport or even an electronic amplifying version. The tubing should be black, never colored. Only pediatricians are allowed to have colored ones with playful attachments. Never hang your stethoscope around your neck, a practice better suited for others.

Here, the white coat becomes important again. Its substantial pockets are where your stethoscope should be kept. Even if you rarely use one, the stethoscope should remain in your pocket, as it represents your heritage as a physician. The ceremonious removal of a substantial stethoscope from the pocket and placing it upon the patient is one of the most iconic actions of a true physician. Remember, always listen to a patient’s bare skin, as pretending to listen through clothing is unprofessional.

Regarding scrubs, surgeons should wear the original green color, which patients recognize as the color of surgery. Hospital scrubs should not be worn outside the operating room, as excessive laundering quickly fades and tatters them. Surgeons should wear their own scrubs, properly embroidered with their name, MD/DO, and the Asclepion, and wear the white coat over them, with the stethoscope in the pocket. Despite being a surgeon, they remain physicians first.

If other health care professionals choose to wear scrubs, they should select colors that project gravitas, such as charcoal grey, dark green (e.g., olive drab), or dark brown. Avoiding black, blue, or multicolored scrubs maintains a sense of professionalism.

Ensuring that physicians are easily and quickly recognized as such by others, particularly patients, is vital, especially for female physicians, who are often mistaken for nurses. Physicians should therefore abandon the Caduceus and embrace the Asclepion, proudly sporting their symbols of identity, so they may be accurately recognized for who they are.

Martin C. Young is a pediatric endocrinologist.

Tagged as: Primary Care

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