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'Primum non nocere': First do no harm

Blog Author Ursala Jogezai

Blog Date 26/10/2015

​It's one of the basic bioethics principles taught to all health care students in school: Primum non nocere

"First, do no harm".


We now have a string of regulations designed to make us safer clinicians, putting our patients' safety at the forefront. And with the government set to impose a new contract on hospitals juniors, it feels like we could become the exact opposite of what's expected of us.


I think back to my first day at dental school. The feeling of elation of embarking on a career which was a lifelong undertaking of service to humanity was truly empowering.


I am certain all my dental and medical colleagues feel the same way. Most of us get into our professions knowing that we are making a commitment which may give us many sleepless nights but which will always prove be rewarding in the greater scheme of things.


We get into these professions knowing that we will be facing real people with real problems and at times we will be overwhelmed by these but we will also be given a chance to make a difference in their lives be it saving them with cutting edge surgery or simply getting them out of pain. We are given a chance to show them that someone cares, and someone who has their best interests at heart.


I grew up in a medical household. Both my parents are medical doctors, and a lot of my childhood was spent in hospitals. I remember seeing them donning their white coats and putting in long hours at work with many sleepless nights but I also recall them happily discussing their successes with their peers and learning from each other by working through their failures.


I remember such camaraderie amongst their professional colleagues from all areas of health care. It was like one big party in the midst of back breaking, intense hard work.


But I never once recall my parents complaining about their profession.


Despite the on call nights and many unpaid extra hours, they were always satisfied with the work they did. I never respected them as much as I have once I myself have found myself in a hospital training post where I am putting in unsocial hours as well as oncall nights. And that is just one small aspect of hospital life now. Due to regulation surrounding nearly all aspects of the healthcare we provide, I constantly find myself filling in endless amounts of paperwork often at the expense of clinical experience.


There are not many places in this world that can truly boast of a system which provides such good quality medical care to the rich and poor equally, without discriminating. A system which has produced hundreds of brilliant clinicians. But this system is now under threat.


The proposed new junior doctor contracts go against the very principles which underpin provision of safe patient care. I have spoken to many colleagues around me in the hospital I am based, and I find a blend of emotions ranging from rage, shock, sadness to simple disappointment at such little respect for the kind of work healthcare professionals do.


The contracts talk about pay cuts and longer hours. Money is always a sensitive matter to talk about but it's no rocket science to figure out that healthcare professionals provide one of the most valuable and labour intensive services to humanity. They undergo more years in training than most other professions and come out with the highest debts. Am I missing something here? Pay cuts? Really? Can someone please tell me what is going on!


While pay cuts are undesirable to all, it's the hours that are really making people angry. Most if not all, feel that more hours simply mean no life outside of work which in turn is likely to affect their families and friends indirectly and put emotional and psychological pressures on them. Add to it the fact that longer hours simply means exhausted clinicians. When has anyone ever worked at optimum efficiency with over exhaustion?


Tired doctors are liable to make mistakes and in turn put patient safety at risk. Again, am I missing something here? Is this all going to make sense at some point? And if not, then why are we even having this debate? Wasn't labour mistreatment a thing of the past? The last I checked we were in the 21st.

As distasteful as industrial action may sound, the fact that the medical profession has been pushed to a point where they have felt the need to consider such measures speaks volumes about the lunacy of the propositions.


We as their dental colleagues feel just as incensed and prepare to stand by our medical colleagues each step of the way. This is just not about junior medical doctors, this means a blow to the entire health care profession because the aftershocks of such an act will reverberate for many years to come.

Here is to hoping that sense will prevail and while NHS may be rife with challenges, we can and will overcome them


Ursala Jogezai is working as a dental core trainee in oral and maxillofacial surgery for a year and is based in Sunderland