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, and palpation.
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 side effects.
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.