Thread by @tylerblack32

THREAD!

I've posted about this already, but "FIRST DO NO HARM" is:
* Not from the Hippocratic Oath
* Not accurately translated from Hippocrates
* Not actually a goal of medicine
(How could I say such a thing?!)
* Is very poorly understood.

#medtwitter #MedEd #hippocrates

If we did no harm, we would never do surgery. We would never give meds. We would never anaesthsitize patients, or attempt to replace lungs.

The actual goal (and oath!) is to BALANCE BENEFIT VS HARM so we endeavour to do more good than harm. We minimize harm when possible.

The Greek ὠφελέειν ή μὴ βλάπτειν (incorrectly translated to Latin as "primum non nocere") is a passage from the Hippocratic treatise on Epidemics "In illnesses one should keep two things in mind, to be useful rather than cause no harm".

As a physician on twitter, I routinely get this phrase thrown in my face as I discuss psychiatric medications, ECT, or hospitalizations, which can cause harm.

AND I RESPECT MY OATH, fully, completely, and with total reverence.

How?

Because I consider every harm I could do, and I do my best to minimize it whenever possible, but when it is for the benefit of the patient and they (or in lack of capacity, a third party) understand this and can give informed consent, I still can allow or do the harmful thing.

Because , overall, even if there is a short term major harm or risk of harm (think heart surgery!), if there is a long term benefit it is actually overall less harmful to do that.

In other words, avoiding harm would lead to no treatment. And, ironically, harm.

In other words, I actually follow these ancient teachings:

"In illnesses one should keep two things in mind, to be useful rather than cause no harm".

A great read:

health.harvard.edu/blog/first-do-…

Edit: my apologies for maiming the word "anaesthetize". Mobile phone and 2am.