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First, Do No Harm

Few can say they are as determined or resilient as medical students. The gumption and grit we’ve demonstrated up until this point has carried us further than most. And yet every year, right around this time, we’re blindsided by overwhelming doubt, exhaustion, and anxiety. It’s right around this time that Hippocrates’ words “primum non nocere”, first, do no harm, begin to lose their meaning…

Now when I say these words lose their meaning, it isn’t like we all become as sadistic as Hannibal. (By the way, why didn’t more people watch Hannibal?) What I mean is that we forget that the words, “first, do no harm” apply to us, not just our patients. The truth is, medical school is terrible. Yes, the friends and colleagues you meet are amazing. Yes, becoming a physician is an honor. But that said, medicine is a Hero’s Journey, a liminal state of not quite being, and not quite having been. It’s painful, a burden on our finances, our free-time, our health, our psyche, and most importantly our relationships. Few understand, and the ones that do, can’t explain. It’s lonely and debilitating, even surrounded by 199 other people doing experiencing exactly the same thing. I’ll be the first one to admit, I became someone I hated during my first year of medical school because I forgot to do no harm.

So what does it mean to do no harm to ourselves? It doesn’t mean “do what feels good,” because if that were true, I’d never spend another minute in the library. What it does mean is that we have to reorient our priorities. True, medical school is important, but it’s not most important. Medical school will come and go, and you will in all likelihood pass and get into a decent residency. Your identity and hope and joy cannot be based in “future me’s” success-it’s a surefire way to misery.

Instead, we have to figure out what is most important. For me, I’m a list guy, so I have 3 lists: People, Priorities, and Pleasure. The “People” list is a list of relationships outside of medicine I absolutely refuse to give up on-my support structure. Maybe it’s your spouse, your family, your best friend-doesn’t matter. Find the 5 people you can’t do without, and engage in their lives, and allow them to engage with you. This is not negotiable- you cannot afford to cut them off. Be intentional about pursuing these relationships.

The “Priority” list is things you can’t do without outside of people. For me, it’s a short list of 3- My faith, good health, and alone time. If I wrote a fourth priority, it would be medicine. But for me, if those things aren’t on track, medicine is the last thing on my mind.

Finally, the “Pleasure” list is a list of things you love to do to unwind-a list that doesn’t include Netflix, youtube, or social media. These are the things where you unplug from the world, from medicine entirely, and take care of yourself. Ideally, you get to do two or three of those things each exam block. When we realign ourselves with our priorities, this difficult path we undertake becomes so much more bearable.

My last suggestions are simple. Deal with life stuff first, and get help when, not if, you need it. Remember, medicine’s central tenant applies to you as much as it does your patients. Don’t let school and fear and “The Future” in big bold letters, fool you into abandoning what is true and good. Figure out what matters, and pursue it fervently- that’s what “first, do no harm” means.

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