5 ms·
> Primum non nocere As kauffj eludes to though, it's also worth considering the implicit harm done through inaction. It should not be the wild west, but conver
by burke 11y ago
> Primum non nocere
As kauffj eludes to though, it's also worth considering the implicit harm done through inaction. It should not be the wild west, but conversely, articles like this are indicative of a bias toward increasing prevention of active, explicit harm at the expense of more unseen, implicit harm through inaction.
As with anything, there's a happy medium.
- scarmig 11y agoA happy medium is good, but I'd say that that "medium" falls closer to the conservative side. A lot of the value of "First, do no harm" comes from the point that we have a bias toward action over inaction. Humans, including doctors, want the ability to control our futures. So the temptation is constantly to do something instead of saying "well, that sucks, but we don't have strong reason to believe anything we do will substantially improve things." That's why we perform way too many interventions (particularly, invasive and surgical ones) that at best marginally improve average outcomes at incredible cost and substantial risk. Doctor and patient both want a magic fix. And all too often the fix is more harmful than helpful to the individual patient, even if on average it might be slightly beneficial. Obviously there's a place for heroic surgical efforts and research into exotic drugs. But we over invest in those compared to the alternatives of prevention and palliation. Conservatism is useful in medicine.
- burke 11y agoFor sure. I don't have a strong opinion either way on whether medicine is too conservative or liberal right now, which probably means it falls within the happy medium ground for some reasonable definition. Mainly, I think it's worthwhile to point out what appears to be dogma on both sides of any debate.
- bambax 11y agoThere's a recent study [1] that shows that outcome for cardiac emergency patients are better (way better) when they're treated at a (good) hospital while the top cardiologists were away (at a conference). That is, patient outcome is better for patients who go to a hospital with a good reputation, that has outstanding doctors (a teaching hospital) -- but the outcome is best when the top doctors are NOT present in the hospital when the patient checks in. After controlling for many variables, the only explanation the authors of the study came up with to explain this apparent paradox, is that top doctors want to try anything, esp. the latest procedure/drug, while non-top doctors are more conservative. At least in the short term, being conservative saves lives. 1. https://hms.harvard.edu/news/startling-benefit-cardiology-meetings https://hms.harvard.edu/news/startling-benefit-cardiology-me...
- JamesBarney 11y agoI don't think we need to group medicine as one thing that is too risk or conservative. We need to evaluate different branches of medicine. In the current culture, we have a bias to accept more risk from surgery than pharmaceuticals. Imagine you want to be appear more muscular. You could get implants under general anesthesia or you could take steroids. The first is legal, but the second is illegal. It is illegal because society deems that taking steroids is excessively risky. However general anesthesia and surgery are orders of magnitude more dangerous. This same bias present throughout medicine. Many surgical procedures and tests would never pass the FDA's requirements for pharmaceuticals.