Primum non nocere, or: First, Do No Harm!

“FIRST, DO NO HARM!” IS KNOWN TO EVERY HEALTHCARE PROFESSIONAL. However, I was surprised to learn that this famous phrase is not from the Hippocratic Oath!

In checking as I wrote the headline above, I learned that “the phrase expresses one of the principal precepts all medical students are taught in medical school and is a fundamental principle for the emergency medical services.” Wikipedia has an interesting discussion of early references to this sentence and its use in medicine, but does note that, by around 1900, it was in common use within the medical community here in the United States.

I wanted to call your attention to this precept of “First, do no harm!” in the context of the disclosure by Quest Diagnostics Incorporated that it had, for 18 months during 2007 and 2008, reported inaccurate Vitamin 25(OH) D results to tens of thousands of patients and had instituted a voluntary notification and retest program for patients who had received inaccurate test results. In speaking to THE DARK REPORT (which was first to break this important story) and the national press, Quest Diagnostics is downplaying the potential negative consequences to patients. One Quest pathologist even told a reporter that he doubted that patients would have suffered any harm from the problem! A written Quest statement read on a television news broadcast declared that, following its notification campaign, “we have not been made aware of any adverse impact to patients.”

I personally find this a disappointing public face to the problems created by the inaccurate test results Quest Diagnostics sent to patients and their physicians. The New York Times reporter quoted one doctor who said, “There was a patient we put on vitamin D and all of a sudden, for the first time ever, the patient came back with what seemed to be a toxic level of vitamin D.” When the patient had his Vitamin D tested by another laboratory, the “value was considerably lower.” On disease-specific bulletin boards and discussion groups, it is not difficult to find postings dating back two years by concerned patients who are upset by odd or discordant values on their Vitamin D tests performed by Quest.

By repeatedly stating “no harm to any patients (that we know of),” Quest shows a lack of respect for the turmoil it has caused to patients and physicians. Of course, lawyers have a hand in these public statements. Still, I come from the old-fashioned school of values, where admitting a mistake is the right thing to do and the first step to rebuilding trust with my customers and my friends.


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