Do No Harm, Unless Doing No Harm Hurts

SEPTEMBER 08, 2013
Steven P. Levine, MD
“Do no harm” is the most iconic line recited by every new doctor entering the profession with the Hippocratic Oath. Most fledgling physicians proclaim those words without stammering. After all, they did not endure a grueling educational course just to hurt people.
 
But the thing is that many of our treatments can hurt people. Just ask the fast-talking guy at the end of the new medicine commercial, or listen to the ad from the class-action lawsuit firm. To add to the confusion, we’re not exactly there yet when it comes to having reliably effective treatments for all diseases and syndromes, and most medications have a wider spectrum of potential application than their narrow indications approved by the US Food and Drug Administration (FDA), which has led to the relatively gray area of off-label prescribing. 
 
Presented with illness and suffering while supplied with a distasteful menu of remedies to choose from at times, what’s a doctor to do? It helps to have some kind of standard in mind, such as, “What kind of treatment would I want my family member to have?” For me, it’s a matter of satisfying two voices in my head. (Yes, I’m a psychiatrist who hears voices.)


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