First,Do No Harm (to the One You Train)

Abstract

Primum non nocere or “first, do no harm” is perhaps the most well-known aphorism in the culture of medical education. While its application to patients is well known, the injunction can also be read with medical trainees in mind. Teaching physicians have an obligation to recognize their role as moral teachers and coaches, who must consider “first, do no harm” not only when considering their patients but also when weighing the moral formation of their trainees, especially in a season in which medical educators are attempting to clarify the “harms” of medical training. This multi-valent vision of “first, do no harm” offers an alternative way to frame the contemporary difficulties of medical education while inviting a more candid, nuanced discourse between teachers and learners about the experiences of medical training, in which it can be difficult to discern between that which is truly harm and that which is merely “hard.” For those situations in which it is unclear—or indeed when harm is unavoidable—it may be through communal practices of reharmonization, reincorporation, and “reharm” that master educators might learn to tell the story of good medicine with their trainees anew, fostering moral articulacy for the trainees to whom they must also “first, do no harm.”

Summary

Primum non nocere or “first, do no harm” is among the most well-known proverbs in medical education. While its application to patients is well known, the injunction can also be read with medical trainees in mind. Teaching physicians might consider “first, do no harm” not only when considering their patients but also when considering the moral formation of their trainees. In a season when medical educators are attempting to clarify the “harms” of medical training, this reading can invite a more candid, nuanced discourse between teachers and learners about the experiences of medical training.