Harm Can Be Found in Many Forms While Under Doctor's Care

Sept. 10, 2008— -- Primum non nocere.

First do no harm.

This wise teaching by the ancient Greek physician Hippocrates was drilled into us during medical school. We made this implicit pact with society when we entered medical school. We took this oath at our graduation ceremony.

This lesson was brought home to me again today when I read a study in this week's Journal of the American Medical Association. In this study, Dr. Vineet M. Arora and colleagues at University of Chicago and Northwestern University surveyed incoming interns at three training sites, anonymously evaluating these young doctors' participation in, and attitudes toward, unprofessional behaviors.

These researchers found that up to 79 percent of doctors-in-training report at least one unprofessional behavior. (For example, having nonclinical, personal conversations in patient care areas; making fun of other doctors; wearing inappropriate clothing.) Worse, 17 percent of these interns reported making fun of patients when the patients were under anesthesia or not present; and those that participated in this specific behavior were the least likely to think that it was unethical.

Primum non nocere.

How should we, as doctors, parse this out?

Obviously, avoiding harm means avoiding treatments and procedures that are dangerous or unnecessary. It means practicing medicine with solid scientific evidence as your guide. It means keeping up to date with new developments in medicine, ensuring that you will practice the standard of care.

But harm to patients is not always physical. It can be emotional as well. Patients can be abused by their physicians who are cold, uncaring or cavalier. They can be abused when the physician, directly or indirectly, disparages them, making them feel embarrassed, even angry.

I know this feeling, because, even though I am a physician, I have experienced it. Years ago I had outpatient surgery requiring general anesthesia. The staff was very professional in "prepping" me for surgery, explaining the procedure, putting me at ease.