How to Do No Harm

How leaders can minimize harm in health care, in other industries, and in all areas of life.

“How can we change this process to prevent this error from happening again?” the senior ward nurse asked the group. It is a common question, one that I have heard thousands of times from experienced and dedicated health care professionals of all stripes.

I have worked in health care for many years, serving in positions from volunteer to emergency medical technician to senior attending physician to chief of staff at a hospital to chief medical officer of a large network. In every position, “do no harm” is a fundamental theme. This famous statement from the writings of Hippocrates encapsulates quality improvement, patient safety, access to care, and many other goals in modern medicine.

“Do no harm” can be thought of as eliminating risks that could lead to a bad outcome, such as injury or death. Occupational and Environmental Medicine physicians learn that there are four ways to decrease risk in the workplace and in the environment:

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Health Care Foibles – A Personal Tale

An example of the stupid things even doctors do when it comes to health care. 

In March of 2013 I wrote Healing the Health Care Cost Conundrum. Four years later, in March of 2017, I have retired from the US Army and am practicing medicine in Memphis, TN. My practice is in the inner city, and our focus is serving the Medicaid population. Our patients are impoverished and often very sick, with chronic diseases frequently showing up 20 years earlier than in their more affluent counterparts. Many live in dangerous communities, have no reliable transportation, and have unhealthy food. Obesity is the norm, violence is taken for granted, and serious mental illness is widespread. It comes as no surprise that many patients abuse drugs, citing chronic pain that may or may not be real. Some come to the clinic for no other reason than to feed their drug habit, and try to get narcotics to generate a little extra income. It is the toughest medical environment I have encountered since my combat tour in Iraq.

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How to Improve your Health and Health Care

Most people get lost in the maze of health care, and suffer as a result. Some strategies help…

Throughout Central Asia, the Middle East, and much of the developing world, people have told me that they cannot get good medical care. In some cases good care is too expensive, in other cases medical care is affordable but poor quality, and in still other cases medical care, good or bad, does not exist. Some friends with significant health care problems labor in austere conditions never knowing when a medical emergency will strike, and if they will be able to get help when and where they need.

Some people have similar problems in the developed world, even including the United States. America has been swept by debates about health care, especially about how to make quality health care available to all Americans. Medicare is a government single payer program for the elderly and Medicaid is the same for the poor, but these programs pay providers too little and yet are unsustainably expensive for the nation. The Affordable Care Act (ACA) was the most recent Federal attempt to improve Americans’ health, but the results have been mixed. Fundamentally the ACA was health insurance reform, not health care reform, and providing someone with an insurance card is not the same as providing them with health care. Hence we have millions who lost their insurance, millions who got new insurance, and millions waving their new insurance cards in the air who cannot get care because it doesn’t exist in their area, wait times are too long, or the system pays so little that providers cannot afford to take these patients.

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