Primum Non Nocere (First, Do No Harm)

Oct 18, 2021

In this episode we hear from eight leading physician educators about a core principle of patient care:  primum non nocere. We learn that limiting harm can translate into doing what’s medically right, putting the patient’s welfare first, judicious use of IV fluids, reducing opioid prescribing, making a habit of pausing when depleted, acknowledging the end of life, and allowing a natural death.

uests:  Cam Berg MD, Neda Frayha MD, Scott Weingart MD, Josh Russell MD, Haney Mallemat MD, Alan Sielaff MD, Vicky Vella MD, and Mike Weinstock MD

 We Discuss:

  • The importance of figuring out the core principles that drive your medical decision-making [1:30];
  • Primum non nocere, and how it is good for patients and good for us [02:40];
  • Cameron Berg is concerned about the harm caused by excessive prescription of opiates in the ED [05:10];   
  • Neda Frayha learned that ordering more tests on patients can cause more harm than good [07:25];.
  • Scott Weingart applies the “do no harm” principle to the use of IV fluids when resuscitating patients in septic shock [09:20];
  • Josh Russell tries to limit harm by thinking about what he’d want to have done, if he were in his patient’s shoes [11:00];
  • Haney Mallemat has come to learn that many patients are predestined for bad outcomes, and the provision of maximal therapy is actually harmful [13:40];
  • Alan Sielaff uses shared decision-making to help guide him in doing no harm [15:50];
  • Vicky Vella believes that “do no harm” is recognizing when a patient is near the end of their life and, as a physician, trying to act in a way that reflects that [16:20];
  • Mike Weinstock makes an effort to treat all patients as he would treat them if they were his own family member [17:15];

And more.

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