Primum Non Nocere

Primum Non Nocere. That’s Latin for “first, do no harm”. This is one of the guiding principles of the practice of Medicine.

I remember my Training Director in Internal Medicine making that point time and time again. He said that the first thing you do when you are called into the patient room, is to put your hands in your pocket. This is to prevent you from doing something or writing something without thinking it over first. However, even the simplest task or the most benign procedure can have the potential of disaster.

We were 4th year Medical students in University of Sto. Tomas. It was our first day in the hospital wards as medical clerks. My first rotation was in the Neurology ward. We were not allowed to administer medications nor push IV meds. We were not to make decisions of our own without the guidance of our Medical Residents or our attending physicians. We were not to write any orders in the patient’s chart without the co-signature of our supervising Interns. We were not to do any bedside procedure without the supervision of our  seniors. Not much we can do right?

We were there though to take medical history, examine the patient, help monitor them and take their vital signs. Armed with just stethoscope, sphygmomanometer, and thermometer, how can we do harm? Well, you lack imagination.

As part of our duty, one of my classmates placed the thermometer in the mouth of the patient to check his temperature. However, this patient has seizure disorder. All of a sudden he went into convulsions with his whole body flailing. He bit the thermometer and crushed it into small pieces. Can you imagine the horror of my classmate!

After the seizure was over, we helped our classmate retrieve the broken thermometer in the patient’s mouth (at least what is left of it). I’m not sure if we recovered the mercury or not.

Did the patient develop oral lacerations from shattering the thermometer? Did he suffered esophageal or gastric ulcerations from the swallowed glass pieces? Did he develop mercury poisoning? Or did he become a human thermometer? God alone knows.

Over the years, I have heard, have witnessed, and have been involved in medical misadventures. So it is with great diligence and prudence that I perform my duties, and with humbleness I accept my limitations and mistakes. May I always be guided by the precept of “first, do no harm”.

So help me God.

Post Note: I don’t use oral thermometers anymore. Neither do I use rectal thermometers. I can just imagine what catastrophe I can do with that!