A Culture Change in Medicine: Do No Harm to Do Less Harm

We all cite the Hippocratic Oath when we enter medical school. I remember like it was yesterday, standing together, holding up our hands in our short white coats, and swearing to follow its covenants throughout our careers.

To my surprise as I referenced the oath today, the phrase I remember most, “First do no harm,” is actually not a part of the oath. Yet somehow, this is what I remember holding my hand up and promising to uphold.

This is the culture of medicine that is ingrained in me, changing my memory and perception of what I swore to on that day. The culture that is accepted in society, amongst doctors, nurses and you and I: doctors are infallible. It is not fathomable at times and certainly not understandable or acceptable for physicians to make mistakes. But physicians are humans and humans make errors. There are unreasonable expectations that breed more and more unsafe practices, lack of transparency and lack of learning from our mistakes.

We ended with a video today that closed on the quote: “Do less harm.” This quote was one of the most thought provoking for me. It spoke to the many lessons I learned and jotted down on my note pad during the day about Patient Safety:

  1. Doctors are human and doctors (including you and I) make mistakes.
  2. Avoid cognitive bias / anchoring / whatever you want to call it – it’s deadly. (I don’t understand how we prevent this easy-to-fall-into trap.)
  3. Learn how to balance mindfulness and wastefulness
  4. Learn how to be reassuring but also always continue to reassess
  5. Say I’m sorry, say it early, but don’t stop there.
  6. The patient and family, no matter what, is ALWAYS right.

Errors need to be recognized , reported , and appreciated. It is unrealistic to promise to do no harm, but commendable to promise to minimize the harm in our unsafe system that exists and do less harm.

** This is not to say we shouldn’t aim for a zero error rate, we all absolutely should. But we need to be more accepting of human including caregivers’ fallibility.