Wednesday, July 6, 2016

I SWEAR...Primum non nocere; First Do No Harm!

               


I recently read here on FB (I have not verified the story) about a young boy from Vava'u who recently passed away at Vaiola Hospital.  Supposedly the boy and his mother were flown in from Vava'u after a sad ordeal of neglect by the Doctors and Nurses there.  He first presented with abdominal pain but was sent home.  This repeated a few more times over a period of weeks before he was admitted but received no treatment.  After days of begging, the mother and child were flown to Tongatapu.  They were repeatedly accused of trying to get a free plane ride to the main island.  I would like to emphasize again that I haven't verified the story.  However, it has caused me to reflect on my duties and responsibilities as a Healthcare provider and the oath that I am under.

These pictures were taken at our White Coat Ceremony (2010), where in addition to receiving our official clinical white coats, we took upon us the Modern Version of the Hippocratic Oath.  Basically, we made an oath and swore that we will do no harm to our patients either by commission or omission.  That's the short and straightforward version.

I think about this oath everyday...multiple times during the day.  I think about it early in the morning when I think about what my day in clinic or the Operating Room will be like.  I think about it as I drive to and from work.  I even think about it when I'm laying in bed counting sheep.  Whether patients understand and agree with my Assessment and Plan or they think I don't know what I'm talking about, I still remind myself "First do no harm".

I must admit, it is difficult at times.  Especially when you are dealing with "Drug-seekers".  They flip out when they hear "I see that you were seen yesterday at the ED and was given (pain killers XYZ) enough to last you a few days, so I am not going to give you any more today".  They get loud and animated.  They become disruptive and the encounter becomes awkward and uncomfortable for both parties.  I assume in their minds they are thinking "You are not wanting to help me".  In the meantime, in my mind I'm thinking "I'm trying to save you from yourself".  They are the extreme and they are pretty easy to sniff out.  The more challenging ones are those with malingering or fibromyalgia.  Everything everywhere hurts.  Now, don't get me wrong, these are legitimate medical issues.  They definitely remind you of one of the paragraph from that oath:

"I will remember that there is art to medicine as well as science, and that warmth, sympathy, and understanding may outweigh the surgeon's knife or the chemist's drug."

I recently read that various centers in the US are conducting research on how touch therapy helps improve wound healing, pain, anxiety, arthritis, and fracture healing.  Incredible!  So, even science now is driving the point home; medicine is both science and art!

Now, back to our unverified story.   There are many questions to be answered both from a moral and medical standpoint.  If the version on fb is accurate, perhaps we can ask: "Do you remember the oath you took?".  "Do you remember that medicine is both science and art?"  "Do you remember that we do not treat fever chart...but a sick human being?"  We can go on and on.

I will get off my high horse now.  My apologies!  I can't even begin to imagine the sorrow that this mother is going through.  My prayers are with her and her family.  I am saddened by the life that is lost.  I am grieved by the hearts that are broken and disappointment by the trust that has been violated.  There's nothing that I can do to bring the boy back.  However, I will let his story, regardless of the details, be part of my reminders.  I took the oath and swore when I first put on that freshly pressed white coat; Primum non nocere.





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