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Primum Non Nocere

Updated: Nov 15, 2022

In this era of unprecedented technological advancement, the so-called Hippocratic oath, “First, do no harm,” has become impossible to uphold. Surgeons and clinicians struggle as procedures, medications, and other treatment modalities have considerable side effects. There would be no need for consent or disclaimers if there were no adverse effects of treatments. A long list of iatrogenic disorders testifies to this reality. But how does this oath apply to pathologists?


For the pathologist, taking such an oath constitutes no apparent conflict at the outset. However, the pathologist must be vigilant against violating the oath more than any other physician, as a clinician’s treatment often depends on a pathology report. Diagnostic or reporting errors or misleading reports may cause harm to the patient due to over or undertreatment. Hence, without prescribing or dispensing treatment, we can be a direct cause of iatrogenesis. Nevertheless, pathologists can remain true to their oath as long as they perform their duty with diligence and honesty, a luxury not often afforded to their colleagues in other fields of medicine.

Expectations for a conclusive diagnosis may bare heavy on the pathologist, notwithstanding the constraints present in certain situations. These constraints are part of daily practice; lack of clinical correlation, non-representative biopsy, poor histology, and artifacts are some of the issues. In the tug of limitations and expectations, the pathologist must maintain a balance that does justice to the patient and himself. Rushing to give a diagnosis may not be the best course of action when the grounds for making a proper diagnosis are not there. Clear communication between the pathologist and the clinician, either through the report or a telephonic conversation, is the best approach for the sake of the patient.

Reverence awarded to this profession is unlike any other. Our experiences, anecdotes, and media make us aware of these sentiments. The images of a doctor caring for his patients in a nineteenth-century village or her sick Klingon on a spaceship have held us in thrall. On the canvas of reality, a nurse discovering the cause of periumbilical nodule or a pathologist earning a Noble prize for finding the cause of peptic ulcer disease has inspired us to follow in their path.

This glorious tradition, started by Imhotep and adorned by the likes of Hippocrates, Ibn Sina, Pasteur, and Fleming, is the result of their uncompromising dedication to ridding humanity of disease. I hope that contemporary physicians can revive the soul of their oath and steer the profession back to the direction its founders intended for it.

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