Written by Silvia Hanna
Edited by Christopher Orzech
Before becoming doctors, most medical students must take the Hippocratic Oath, stating that they will "first, do no harm.” However, with any treatment or surgery, there can be a degree of harm done to the patient. What makes them ethical is that their benefits far outweigh the risks of these treatments. It’s time that we extend this principle even further in medical care, to include preventing any unnecessary harm due to treatment, even if a treatment is beneficial or lifesaving overall, when we are in the power to do so.
An important issue with medicine today is how fast-paced the culture of care is due to how overloaded many doctors are with patients. Rather than taking a patient-centered approach to care where doctors take the time to individually listen to each patient, educate them thoroughly, and involve them in medical decisions, the current healthcare culture has caused hospital staff to resort to methods that would make care as efficient as possible, even if this means increasing the cost of care and the length of hospital stay, while decreasing the quality of care. Intensive care unit (ICU) expert Wes Ely has helped spread awareness about the extensive research that has been conducted showing that ICU care has been causing substantial and unnecessary harm to patients, such as delirium. This condition describes a rapid decrease in mental abilities, which can result in confusion, disorientation, and memory and attention impairments. Not only does delirium severely impact the patient’s wellbeing, but it also greatly distresses family members and is associated with poorer health outcomes. ICU care can be a leading cause for delirium, as immobility and a lack of stimulation are major risk factors for the onset of the condition.
The situation has gotten significantly worse after COVID-19, as hospital congestion has reduced the quality of care for the many patients in intensive care units. For example, hospital teams have resorted to longer sedation and immobilization, and keeping patients from their family. This has greatly increased rates of ICU delirium, a manifestation of ongoing brain injury that can be caused by the “sedating medications, strong painkillers, isolation, and unfamiliar surroundings” (Weiner). Not only that, but extended ICU care can also cause other conditions such as muscle atrophy and PTSD and other mental health issues.
Ely is one of the many doctors who advocate for a more humanistic approach to care, especially ICU care. He says, “You can’t be a doctor with science alone… find the person in the patient.” Changes embodied in what is known as the ABCDEF bundle, which include using less sedation, weaning patients off of ventilators more quickly, and having the family present and engaged. These methods have been shown to help patients “achieve greater mobility, gain mental clarity, and renew the personal connections vital to healing” (Weiner).
Recently, there have been stronger efforts to implement this humanistic approach to ICU care. For example, Mount Sinai Hospital has The Hospital Delirium Program, which recruits volunteers to “provide non-medical interventions to promote cognitive stimulation, reorient to the environment, and increase mobility” (Mount Sinai). The hospital recruits volunteers to identify patients at risk for developing delirium using a computerized program and trying to provide as much stimulation for these patients as possible in order to prevent the onset of the condition. Overall, this program is a great example of a practical way humanism can be restored in medicine, and if hospitals continue implementing strategies similar to these, much of the unnecessary harm that results from ICU care can be prevented.
Delirium Program. Mount Sinai Health System. (n.d). https://www.mountsinai.org/care/psychiatry/treatment-programs/inpatient/delirium
The Mount Sinai Hospital Patient-related volunteers. Mount Sinai Health System. (n.d). https://www.mountsinai.org/locations/mount-sinai/about/volunteer/patient
Shmerling, R. H. (2020, June 22). First, do no harm. Harvard Health Publishing. https://www.health.harvard.edu/blog/first-do-no-harm-201510138421
Weiner, S. (2022, November 14). Physician calls on colleagues to end harmful ICU care. AAMC. https://www.aamc.org/news/physician-calls-colleagues-end-harmful-icu-care