Our Oath is to First Help, not to “Not Harm”
“Into whatsoever houses I enter, I will enter to help the sick, and I will abstain from all intentional wrong-doing and harm.” Hippocrates, from what we know as “The Hippocratic Oath”
You’ve likely heard somewhere along your professional journey that we took an oath as physicians to “first do no harm” or its Latin equivalent, “primum non nocere.” While the phrase is attributed to Hippocrates and even more specifically, the “Hippocratic Oath,” that is not its origin. As noted in the quote above, it seemed quite important for Hippocrates to be clear that our role as physicians is to be helpers and healers, and while doing so, to minimize harm. The phrase “first do no harm,” has been traced back to English physician Thomas Sydenham (as in Sydenham’s chorea) in the 1600s rather than to our Greek physician predecessor in 460 BC.
Indeed, it would seem that our role as clinicians and as healers is always to “first help” while attempting to find balance in four pillars of contemporary medical ethics; beneficence (help), non-maleficence (don’t harm), autonomy, and justice. One doesn’t have to spend too much time reflecting on clinical practice to recognize we are continually navigating the challenges and dynamic tension of these four pillars, particularly that of “help/don’t harm.” Every surgeon knows they often cut through healthy tissue to get to the unhealthy, and all medications are prescribed recognizing the balance of potential benefits and harms.
But what does any of this have to do with helping to support each other on our professional journey? My intention is not to provide a lesson on ancient medical history, but perhaps a modern one instead. The data over the past decade has been quite clear that there are many hurting colleagues in our midst, likely including some who are reading this blog. If we are called to “first help,” it would seem such a professional obligation extends not only to our patients, but also to each other.
I am concerned that the same misunderstanding of “first not harming” rather than “first helping” for our patient care also often prevents us from reaching out to colleagues who we know, or suspect, are struggling. Instead, we may be tempted to anchor to beliefs such as “I don’t know what to say” or “What if I say the wrong thing and they push me away?” or even “Doing so is not part of my training” – all of which I would call “not harm” talk. Certainly, we never learned skills for professional connection and support during our medical training.
Fortunately, there are resources available to assist us in learning how to better help and support each other. I consider the PeerRxMed process to be one such resource. Additionally, physician colleague Simon Mittal provides a nice overview in this brief article, “How to Approach a Colleague Who May Be in Distress—Practical Guidance to Help,” which I would summarize as “reach out, tell them you care and want to help, and let them know they are not alone.” As we continue to collectively work to create a more supportive and sustainable professional culture, let’s remind each other that we are called to “first help,” for our patients and for each other. I suspect Hippocrates would agree that none of us should care alone, and that our attempting to do so would be … harmful.