July 28, 2017 | MANILA, PHILIPPINES

First, do no harm

Known as primum non nocere in Latin, “first, do no harm” is often thought to be a part of the Hippocratic Oath that physicians take to symbolize their formal entrance into the profession. While the exact turn of phrase is nowhere to be found in the modern-day version of the Oath, the ideal it espouses remains at the core of every medical professional.


In my line of work, I have had the chance to see firsthand some of the significant challenges faced by the medical profession. Ranging from bed shortages, medicine unavailability, undermanned medical staff, and poorly maintained equipment, there is no shortage of concerns. One glaring area of opportunity is around the working conditions of hospital front-liners, particularly the resident doctors who work through graveyard shifts and take charge of the emergency rooms. To be a resident doctor, one must have received a bachelor’s degree, graduated from medical school, completed a year-long post-graduate internship (PGI), and passed the licensure exams. However, after all those years of schooling (roughly 4 years of college, 4 years of medical school, and 1 year of PGI), resident doctors in our country continue to be severely underpaid and extremely overworked.


Now, mindful that many doctors enter medicine with the noble purpose of helping others, let us set aside for a moment the part on being underpaid for the important work they do. What concerns me more are stories about how our resident doctors continue to work extended duties of up to 36 hours.

By way of comparison, if you knew that the driver of a vehicle you were about to ride in has been awake for that long, would you be comfortable having him or her drive for you? It would be a minor miracle if he or she could keep his or her eyes open, let alone drive safely. Why, therefore, shouldn’t the same standard apply to our doctors, who are every bit as human as the driver in our scenario?

In a 2008 study published by the Joint Commission Journal on Quality and Patient Safety, resident doctors working shifts longer than 24 hours were found to be at much greater risk for “occupational sharp injury, a motor vehicle crash on the drive home from work, and making a serious or even fatal medical error.” These findings have since been backed up in a 2013 report by Dr. P. Murali Doraiswamy of the Duke University Medical Center, who cited that doctors who were forced to work more than 24 hours made up to five times more serious diagnostic errors versus those on shorter shifts. It is thus no surprise that in the US, Canada, Australia, and Europe, governments and medical associations have restricted daily work for medical residents from between 16 to 28 hours (already inclusive of the hours for transitioning care).

In the Philippines, Senator Loren Legarda has taken up this cause and sponsored the creation of the Medical Residency Act of 2009, which seeks to limit working hours of residents to 24 hours and increase their compensation. Unfortunately, eight years later, the bill continues to languish in Congress with no end in sight.

This system badly needs remediation. In the absence of government action on the matter, hospitals should step in, do what is socially responsible, and join their foreign counterparts in ending this practice of 36-hour and “perpetual” duties.

Whatever cost savings are incurred for keeping residents on these highly extended duties should not outweigh the risks to the care of patients, or the health of the doctors themselves (not to mention the legal and reputational risks for malpractice cases). Otherwise, we will continue to play with fire with the safety of patients and the well-being of resident doctors nationwide.

“First, do no harm” should not just guide doctors, but should apply to them, too.

Armando J. Aguado is an affiliate of the American Psychological Association and a lecturer with the Department of Psychology of Mapúa University. He is taking his Doctor of Business Administration studies at De La Salle University.

armando_ricardo_aguado@dlsu.edu.ph