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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Texting between Father and Son – The Nature of Causation

How can we know if something causes something else? What is the difference between a sufficient cause, a necessary cause, and a risk factor? How can we avoid traps in understanding causes and non-causes? 

An acquaintance, a devoted Catholic, shared with me a text conversation that he had with his son last weekend.  It caught my attention, so we discussed it at the dinner table at our house Wednesday night.

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Father: R U going to be home to go to 9:30 mass or 1115 or 5PM?

Teenage son: Will’s here, can I just not go this week?

Father: No, that is not an option.  Will can come if he likes.

Son: The Catholic church has survived the ages by creating wars, having corrupt leaders, and blaming our problems on others.  I think that supporting an establishment that has built itself on hypocrisy is something that you shouldn’t encourage me to do.  God can be found in all things, right?  Then why do we bow to marble tables while destroying the world he made with pollution?

Father: I would love to have a philosophical discussion with you on this topic, but texting is not my preferred medium.  In the mean time you will come to mass, not because your presence is something that either God or the Church needs but because 1) it is best for you, and 2) because I am telling you to come.

Son: I’m about to go to a week in the woods!  That’s the holiest thing I can do…Can you pick us up at 11?

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This interaction is interesting on many levels. It demonstrates communication between a father and his son, and suggests real affection and a good relationship between the two. Not knowing the son, it is impossible to know whether he actually believed what he said about the Catholic Church or whether he was simply trying to spend more time with his friend and get out of going to Mass. Perhaps a little of both? For the sake of discussion, let us assume that the boy was at least partly serious about his allegations.

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