The Latin “Primum non nocere”, which translates to “first,
do no harm”, has been a guiding principle for physicians since the
beginning of time. It means that whatever the intervention or procedure,
the patient’s well-being is the primary consideration. Although
this phase is not in the Hippocratic Oath which nearly 100% of physicians
swear to on graduation from medical school, its intent is clearly a focus
of this important graduation ritual. How could it then be possible that,
based on a recent study by Dr. Makary at Johns Hopkins Medical School,
medical errors are now the third leading cause of death in America, behind
heart disease and cancer?
Clearly, there could be numerous reasons contributing to this extremely
shocking statistic. These include:
1. Many doctors see the oath as little more than a tradition of the past,
holding little value in the healthcare delivery processes o2. today. Because
some of the tenets in the oath are controversial today, such as not participating
in abortions and not assisting in euthanasia, the commitment on “doing
no harm” somehow gets lost.
2. The education process for physicians has changed over the last decades,
eliminating the required year of general internship, and there is a decreased
emphasis on physical diagnosis using inspection, auscultation, percussion,
3. An arrogance that is tolerated in the profession which precludes the
practitioner from admitting what he or she “does not know”
and seeking more experienced assistance.
4. Use of technologies that seemingly “have the answers”. This
has allowed physicians to rely to heavily on computer generated information
; and the result is they do not do a final review of the data applying
their experience, knowledge, and, above all, “common sense”.
5. An excessive workload for some practitioners, driven by revenue production,
which inhibits accurate diagnosis and treatments, particularly for the
young and less experienced physician.
6. Practicing health care in silos, with little coordination between primary
care and specialists, acute care and post-acute care, and between physicians,
nurses, and other support personnel has contributed to an unfortunate
lessening of information exchange and communication. It has been long
known that poor care results from a poor and uncoordinated hand-off of
the patient from one level of care to the next. This includes no commitment
to doing any follow-up on the patient to assure that the discharge instructions
were fully implemented.
7. Physicians not being willing to change their established patterns and
failure to support best practices and evidenced-based medical protocols.
8. Physicians listening uncritically to pharmaceutical and medical devices
sales persons as to how to best treat their patients. This has resulted
in to high a use of medical devices and medications which have known toxic
If any or all of these reasons are contributing to the cause of death from
medical errors for Americans then, by knowing them, action plans to correct
them can be identified and implemented. As in all challenges, one solution
will not fit all. But it is clear that the competencies for practicing
physicians overall must be elevated. Physicians must accept that scrutiny
is good for their patients and good for their clinical skill improvement.The
knowledge, skills, abilities, attitudes, and behaviors of doctors must
be enhanced for the profession so the tolerance of mediocrity does not
stand in the way of reaching excellence.