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Archive for the ‘Musings’ Category

musings on…primum non nocere

In Medicine, Musings, Philosophy on Tuesday, 26 February 2013 at 07:04

for years, I have been hearing people “quote” a portion of the hippocratic oath that referencing “first do no harm” as the main point and an exact quote.   while not the type to directly correct someone, especially about something that i think a majority of people believe,  and it just makes me look like a philosophical snob or elitist.  that said, i heard someone mentioning the “first, do no harm” portion in conversation and ascribing it to the hippocratic oath again yesterday which precipitated this posting.  i don’t believe that people deliberately want to misquote or mislead others as this seems to be a generally held belief.

for the record, the original version of the hippocratic oath is as follows:

“I swear by Apollo the Physician and Asclepius and Hygeia and Panaceia and all the gods and goddesses, making them my witnesses, that I will fulfill according to my ability and judgment this oath and this covenant:

To hold him who has taught me this art as equal to my parent and to live my life in partnership with him, and if he is in need of money to give him a share of mine, and to regard his offspring as equal to my brothers in male lineage and to teach them this art—if they desire to learn it—without fee and covenant; to give share of precepts and oral instruction and all other learning to my sons and to the sons of him who has instructed me and to pupils who have signed the covenant and have taken an oath according to the medical law, but to no one else.

I will apply dietetic measure for the benefit of the sick according to my ability and judgment; I will keep them from harm and injustice. I will neither give a deadly drug to anybody if asked for it, nor will I make a suggestion to this effect. Similarly I will not give a woman an abortive remedy. In purity and in holiness I will guard my life and my art.

I will not use the knife, not even on sufferers from stone, but will withdraw in favor of such men as are engaged in this work.

Whatever houses I may visit, I will come for the benefit of the sick, remaining free of all intentional injustice, of all mischief and in particular of sexual relations with both female and male persons, be they free or slaves.

What I may see or hear in the course of the treatment or even outside of the treatment in regard to the life of men, which on no account one must spread abroad, I will keep to myself holding such things shameful to be spoken about.

If I fulfill this oath and do not violate it, may it be granted to me to enjoy life and art, being honored with fame among all men for all time to come; if I transgress it and swear falsely, may the opposite be my lot.

Hippocrates (c. 460–c. 370 B.C.).  The Oath and Law of Hippocrates.
The Harvard Classics.  1909–14.

as one can see in the oath the passage “I will use treatment to help the sick according to my ability and judgment, but never with a view to injury and wrong-doing” and “In whatsoever houses I enter, I will enter to help the sick, and I will abstain from all intentional wrong-doing and harm” (pp. 299, 301) IMPLIES to do no harm but the exact wording “first do no harm” (in latin, “primum non nocere”) is not in the hippocratic oath.

Hippocrates (c. 460–c. 370 B.C.).  The Oath and Law of Hippocrates.
The Harvard Classics.  1909–14.

clearly, there is an explicit and implicit understanding in the oath to “first do no harm” however, this is not part of the hippcratic oath.  the mention not doing harm IS in the hippocratic corpus.  not that there isn’t controversy surrounding the corpus as its true authorship is a much-debated topic, but we will ascribe it to hippocrates as some of the greatest philosophic scholars can not say for sure.  it has actually been postulated that many ‘authors’ had their hand in writing the many books of the corpus.  even so, the corpus is largely associated with hippocrates and we may never know for sure whose work it was or who contributed to it.

alas, for now, I leave you with the part most have come to accept of as one of the main points of the hippocratic oath:

in  latin, “primum non nocere” which literally means “first do no harm” is seen in one of the books of the corpus .  “As to diseases, make a habit of two things—to help, or at least to do no harm. The art has three factors, the disease, the patient, the physician. The physician is the servant of the art. The patient must co-operate with the physician in combating the disease.”

Hippocrates, Epidemics, book 1, section 11.—Hippocrates,trans. W. H. S. Jones, vol. 1, p. 165 (1923).

so, now you know if you didn’t already!

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musings on the madness…

In Education, Musings, School Psychology, School violence on Saturday, 15 December 2012 at 13:00

the real madness.  not the madness of the occurrences in newtown.  education madness.  how this MIGHT have been avoided.  or at least how i feel i could have done something…were we not focusing on the wrong things.

1.  he has “some” kind of mental illness…

there are only a handful of “mental illnesses” with a higher than average propensity toward violence or carrying out violence. and, even fewer to do something of this magnitude. i have my suspicions as to what, if any, diagnosis, this person has (and, let me give you a clue, it’s not an autism spectrum disorder (asd), a learning disability, or obsessive compulsive disorder (ocd). at any rate, while NO unstable person should have access to a gun, i don’t want people thinking that this boils down to some mental illness and that being an excuse.  unless you are saying “someone MUST have seen the signs” as they have been known and written about for YEARS.

2. we already know the “signs.”  research.  read the literature.  BE INFORMED!

to me, what this shows so very clearly (more than the talk of second amendment rights OR gun control)

3.  i am not advocating that we shouldn’t talk of such things, just not now.

is the need for EARLY INTERVENTION via better early mental health screenings and resources, more education regarding mental health, resources for help…i could go on and on. ironic (but in an horrifically tragic way) that the SCHOOL PSYCHOLOGIST was among those killed.  SHE would have been one of the most qualified to screen, support, and follow children such as these (and, we DO have them). as a school psychologist in the age of education funding cuts and one person doing the work of what was once divided by two or three positions, WE CAN’T DO IT ALL.

4.  you know, i keep asking for the to be one of my super powers, but no luck yet.  maybe i can make it one of my evaluative goals for next year…

unfortunately, things like just taking time to get to know the kids, spending time doing things like reaching out, mentoring, being a real part of a school (as opposed to your FOUR schools) are difficult to come by.  i am confident we (i am speaking as a school psychologist, but counselors, teachers, administrators, etc. can tell you A LOT about your kid/s) can be instrumental in screening and providing resources and intervention if we could just go back to doing all the other things we are good at

5. and, yes, we are good clinicians and do like our assessment, but we are not merely “testers” as much as we have been relegated to the role, we are not taking it gladly

i say this talk needs to be about stopping this crazy education-reform-value-added-data-driven madness and make education and mental health services (especially early INTERVENTION programs, NOT after the fact!) a priority in this country.  

6.  look i love sports and entertainment as much as the next, but there’s something off about a country that cares more about “reality” tv than the reality their kids face every day…the place they spend the majority of their time every week

PEOPLE! many times we are with your children more than you are! we mold YOUR most precious asset.

7.  it really should be.  if not, check yourself

why in the world would you want to CUT funding to education? why would you want LESS resources allotted? i don’t get it.  we pour money into entertainment, sports, alcohol…education should come first. these are kids. YOUR kids.

i just think we are focusing on the wrong things.  in the end, children and adults lost their lives.  other children will be haunted by this for days, weeks, months, and years to come.  how many kids need to be killed?  we can stop this now.

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