“Primum non nocere”


It’s an old medical axiom. (Hey, I am a doctor, after all.) “First, do no harm.” And like all axioms it’s easy to grasp. It almost seems too obvious for words, even. You could almost wonder at the simplicity of those who thought it needed to be said. (Luckily for them, their exact identity appears lost in history!) Who’d in their right would want to do harm?

But when you think about it (beginning with the assumption that, perhaps, the original proponents of the axiom were not such utter simpletons) you realise – again like all axioms – that it’s not quite so obvious – or even so simple.

A good place to begin is why we choose this profession in the first place: other than love of lucre (even doctors are human, after all), many doctors attest to a desire to help humanity. And every doctor, no matter how jaded, can testify to having felt the rush of making that difference for a patient who had almost lost hope.

So the truth is, the first instinct – and rightly so – of any doctor worth his salt is to do good. (If you disagree, I’m willing to bet you have somehow missed opportunities to avail yourself of our services.) We’ve all heard the celebrated stories of the heroic doctors who for the love of their patients, took “calculated” risks to save near-hopeless cases. (Ben Carson, anyone?)

We’ve also heard of the doctors who “needlessly” risked patients’ lives, and in some cases even ended them. (Sorry, here is not the place to discuss the process of evaluating a risk as “calculated” or “needless.”)

Against that background, though, the axiom comes suddenly alive. Yes, we seek to do good to our patients. But in doing our job, we need the ancient axiom to remind us how limited we are to define what is “good.” We need it to protect our patients from our potential over-enthusiasm.

But it serves one other purpose: it reminds us that it is actually easier to define what is “harm.” That is what makes the axiom look so obvious. What is less obvious, however, is that we who work in the service of people must be careful not to mistake our own definition of good for theirs.

Your turn, then: in your own work, in what ways do you find yourself in danger of doing harm when you seek to do good?

Be heard – leave a comment!

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