Primum Non Nocere

Primum Non Nocere

‘First, do no harm’

One of the fundamental health principles taught in health is the latin phrase ‘first, do no harm.’ The phrase itself seems rather obvious, right? When performing any professional health duties, it makes sense to first ensure that we are not going to be causing any harm toward a patient, followed by two, implementing an intervention that might assist the patient.

And yet, throughout history we have had multiple examples of a failure to abide by this statement. There is a common tale arising from the 19th century that doctors in Europe were not washing their hands or sterilising their instruments in between patient consults. This led to a higher rate of infection, resulting in more deaths.

To this day, medications are prescribed for sporadic painful episodes like acute back pain, even though most of these episodes resolve within 6 weeks, with or without medication. So what is the benefit of pain medication in this instance, really? Furthermore, despite bed rest and inactivity being shown to be the worst intervention for almost any musculoskeletal injury, it continues to be prescribed as a form of recovery.

The blaring question that arises is then – why do we give what we know is not beneficial, or at worst, harmful? For one, we do not know what we do not know. Two, it can come across rather ridiculous if a patient asks their doctor or health professional for advice and they say ‘just keep going as you are. You’ll get better.’ The body is an expert at regeneration, and although ‘carrying on’ is all that you need in most instances, quite often this answer will not satisfy the client.

Let us dissect the first point. I believe it is a problem of observation and hubris. We cannot observe the effects of our actions until after the fact. Not only are our results in retrospect, but often we measure only for a few variables that represent success. It does not measure variables that could be harmful. It is only via a period of time where enough adverse effects accumulate that we are able to detect patterns of harm.

There is an innate hubris in every health professional because of our extensive training. Armed with what we think is the latest and greatest scientific knowledge, we believe we are able to make a lasting impact on every person we come across. It does not feel good to be told that what we are doing could in fact, be less effective than it really is, and in fact, harmful. This hubris is of course challenged as decades and decades of new graduates appear, ready to dispel the science we thought was once ‘gold standard’, not realising that perhaps in another two decades, the same will happen to them.

Secondly, our clients have been conditioned through decades of medical treatment, that every problem requires some sort of external treatment – ie. That they require professional guidance. From the latest analgesic pill to a massage gun, the reliance on remedies existing outside our bodies has probably led to more catastrophising than recovery. When’s the last time you saw a commercial saying ‘If you have back pain… do nothing! It will disappear in 6 weeks normally.’ No, what you see ‘take this pill for instant back relief.’ The sad reality is this, our clients/patients just aren’t taught to trust their own bodies.

Moving forward, the most pragmatic lessons I’ve learnt throughout my career is this – do not overestimate your own impact. You will cause harm without even knowing, so be extra vigilant in your practice. Be as truthful as you can, even if your client does not appreciate it.