Do you worry about harming your patients?

I feel it is very natural to have this emotion. I have been in healthcare for 17 years and it became a real feeling when I first became a nurse. It was amplified when I became a nurse practitioner. Yes, I have an attending physician, but realizing this fear became solid when I was able to order meds/treatments, etc. for my patients.

What do those feelings look like?

1. What if I misdiagnosed him/her?
2. What if I gave the wrong medication?
3. What if I under or over diagnosed?

This is similar to number 1, but has its own connotations. If you over diagnose, you could perhaps give too much of a drug or therapy. If you underdiagnose, it’s a possibility the patient could suffer more. Also true for over diagnosing too.

4. What if the treatment I prescribed causes death or major harm?

5. Is there another treatment plan for this disease process I just don’t know yet? (Despite what you may think, you can never know it all!)

Lesson!

Maleficence is the doing of evil, harm, or mischief.

Negligence is failure to take proper care in doing something.

Guilt is the fact of having committed a specified or implied offense or crime.

Ethics is relating to moral principles or the branch of knowledge dealing with these.

Autonomy is self-directing freedom and especially moral independence.

More and more states in the US have adopted an autonomous law, allowing practitioners to practice to the extent of their education and skill set without an overseeing physician. I feel this is imperative to the health of our country, since so many areas suffer from lack of healthcare access. Authorizing practitioners nationwide can boost the health of our country, and also prevent and pause disease progression that would otherwise go untreated.

History of the Intent to First, Do No Harm:

Medical and Osteopathic Doctors are required to take an oath once they enter into their field. It is called the Hippocratic Oath. The oldest dated document goes back to AD 275!

It is as follows:

I swear to fulfill, to the best of my ability and judgment, this covenant:

I will respect the hard-won scientific gains of those physicians in whose steps I walk, and gladly share such knowledge as is mine with those who are to follow.

I will apply, for the benefit of the sick, all measures [that] are required, avoiding those twin traps of overtreatment and therapeutic nihilism.

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 will not be ashamed to say “I know not”, nor will I fail to call in my colleagues when the skills of another are needed for a patient’s recovery.

I will respect the privacy of my patients, for their problems are not disclosed to me that the world may know. Most especially must I tread with care in matters of life and death. If it is given me to save a life, all thanks. But it may also be within my power to take a life; this awesome responsibility must be faced with great humbleness and awareness of my own frailty. Above all, I must not play at God.

I will remember that I do not treat a fever chart, a cancerous growth, but a sick human being, whose illness may affect the person’s family and economic stability. My responsibility includes these related problems, if I am to care adequately for the sick.

I will prevent disease whenever I can, for prevention is preferable to cure.

I will remember that I remain a member of society, with special obligations to all my fellow human beings, those sound of mind and body as well as the infirm.

If I do not violate this oath, may I enjoy life and art, respected while I live and remembered with affection thereafter. May I always act so as to preserve the finest traditions of my calling and may I long experience the joy of healing those who seek my help.

There are other variations of the oath, but this is used in many medical institutions today. As a nurse, I was not asked to swear an oath or pledge my allegiance to any governing body (unless you consider all the money you spend for school and licenses!). However, looking at this oath I feel it would be appropriate for practitioners to read it, know it, and follow its guiding principles.

My favorite line! I will prevent disease whenever I can, for prevention is preferable to cure.

xoxo,

-Aly