Welcome to the Nexus of Ethics, Psychology, Morality, Philosophy and Health Care

Welcome to the nexus of ethics, psychology, morality, technology, health care, and philosophy

Wednesday, August 7, 2019

First do no harm: the impossible oath

Kamran Abbasi
BMJ 2019; 366
doi: https://doi.org/10.1136/bmj.l4734

Here is the beginning:

Discussions about patient safety describe healthcare as an industry. If that’s the case then what is healthcare’s business? What does it manufacture? Health and wellbeing? Possibly. But we know for certain that healthcare manufactures harm. Look at the data from our new research paper on the prevalence, severity, and nature of preventable harm (doi:10.1136/bmj.l4185). Maria Panagioti and colleagues find that the prevalence of overall harm, preventable and non-preventable, is 12% across medical care settings. Around half of this is preventable.

These data make something of a mockery of our principal professional oath to first do no harm. Working in clinical practice, we do harm that we cannot prevent or avoid, such as by appropriately prescribing a drug that causes an adverse drug reaction. As our experience, evidence, and knowledge improve, what isn’t preventable today may well be preventable in the future.

The argument, then, isn’t over whether healthcare causes harm but about the exact estimates of harm and how much of it is preventable. The answer that Panagioti and colleagues deliver from their systematic review of the available evidence is the best we have at the moment, though it isn’t perfect. The definitions of preventable harm differ. Existing studies are heterogeneous and focused more on overall rather than preventable harm. The standard method is the retrospective case record review. The need, say the authors, is for better research in all fields and more research on preventable harms in primary care, psychiatry, and developing countries, and among children and older adults.