-Thomas Jefferson, Declaration of Independence

            These last few lines from one of our nation's founding documents remind us exactly what we do when we inscribe our signature.  Our signature represents not only our name, but also our values and honor codes as a future professional. Whether it be a legal document, an honor statement, a prescription, or something as simple as a check or credit card receipt, the piece of paper with a signature automatically becomes a commitment to adhere to a certain set of standards. 

            Many of us sign our names often enough that it becomes routine.  Writing a check or signing a credit slip is so commonplace to us that we do not stop to think of what we are actually doing.  Signing a check is a binding contract, stating that the amount of the check will be deducted from one's account, based on the assumption that the account contains at least the amount for which the check was written.  If a person falsely leads the seller to this assumption, she may suffer costly consequences and may be financially and socially scarred for life. 

            Any other type of legal document, such as a marriage certificate or apartment lease, requires a valid signature to be binding and admissible in court.  In the case of a marriage certificate, the couple has made spoken vows to each other and the legal document solidifies these vows.  Breaking the marriage contract both dissolves the relationship and nullifies the document.  Similarly, a renter signs an apartment lease to demonstrate that the rules stated are satisfactory to both parties, and that both parties will abide by these rules.  Signing the document is not simply writing one's name on a piece of paper.  The signature means that the person agrees to the conditions outlined and also agrees to perform the actions stated in the contract.  The person signing pledges to follow the rules and also pledges to accept the consequences if she fails to do so.  It is both legally and socially required of a person either to uphold her end of the bargain or to assume responsibility if she does not. 

            The above example is a perfect illustration of the value of a signature.  The merit of historical documents such as the Declaration of Independence and the U.S. Constitution relies heavily on the integrity of the men signing them.  Their signatures reveal to us that they believe in the inherent value of the documents and the ideas discussed in them. Those who signed the Declaration of Independence made a promise to risk their comfort and ultimately their lives for their young country and for their cause.  Many of the ideals and beliefs upon which the founding fathers based these early documents are the sources of our present-day laws, codes of ethics, and folkways.  It is clear that these men were aware of the intrinsic importance of signing one's name.  As a society we should follow the example of these men and realize that our signature is a reflection of who we are as people and as professionals.

As students and future physicians, we place a certain value to the signing of our name.  Every time we take an exam we are required to sign our names to the statement, "On my honor I pledge that I have neither given or received aid on this exam."  The words "on my honor" explicitly describe the significance of our signatures - that our signing the honor statements reflects our integrity as future professionals.  Even though we enter into an exam knowing that we should not act dishonestly by cheating, the simple operation of signing our names to the honor pledges externalizes our code of conduct as medical students.  It serves as a reminder that we are here to learn, and this learning takes place in an atmosphere of academic integrity. 

            Our performance as medical students serves as a foundation for our performance as physicians.  It is not simply that we must not cheat on an exam; it is that signing the honor pledge is a microcosm of many situations we will encounter in our future careers.  If we continually act unprofessionally and untruthfully as students, we may grow accustomed to acting in such a manner, discounting the fact that such actions violate the code of conduct to which we promised to adhere.  We may also allow such activity to become commonplace and expect our colleagues to behave in a similar manner.  Dishonest activity may become habitual unless we realize early in our career that acting without principle disregards the standards to which we have all agreed to uphold.  We must also respect the decisions of others around us to conduct themselves professionally and ethically.  It is necessary for us to understand that our behavior reflects negatively not only on us but also on our colleagues and teachers. 

            Physicians are constantly signing documents such as prescriptions, charts, laboratory results, and orders to other medical personnel.  Such a signature is the physician's way of stating that she has either read or written the documents and in fact is the one issuing the orders.  For instance, a physician may sign a chart for patient that her student or resident has seen, but whom she has not seen herself.  If the student or resident, who is still in the learning process, has made any sort of mistake that is not rectified by the attending physician, the patient may become seriously ill or even die.  Similarly, a physician may sign a prescription slip written by someone else, without looking to make sure the prescription was written correctly and for the correct dosage and frequency.  The physician can avoid these errors by carefully checking the performance of her students and residents, and in doing so, refusing to sign anything to which she herself has not verified.  Misrepresenting records or data can have consequences ranging from losing a license to losing a patient.            

            Even Hippocrates recognized the importance of a code of ethics, as is stated in his oath, that he as a physician will ". . .abstain from what is deleterious and mischievous."²  Though physicians in his day did not deal with written prescription slips and patient charts, Hippocrates would no doubt include falsely signing a document in the category of "mischievous."  He would almost certainly agree that a physician's signature carries a great deal of weight along with it.  A signature stands for everything the physician has been taught - not just her basic science and clinical knowledge, but also all her principles, beliefs, and ethical standards.  Falsifying one's signature is the same as falsifying her education up to that point.

            A professional must consider carefully what she is signing before placing her signature on any piece of paper.  A physician must recognize that misrepresenting her signature violates the codes of ethics, both written and unwritten, to which she agreed to adhere upon beginning her education.  She must establish a standard for herself and for those around her, and in doing so, encourage her colleagues to remain faithful to these codes, to their profession, and ultimately to themselves.

References

¹http://federalist.freeservers.com

²http://www.ccny.cuny.edu/history/reader/hippoath.htm