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August 9, 1995

Error in Medicine

Author Affiliations

Hospital Clinic of Barcelona Barcelona, Spain

JAMA. 1995;274(6):460. doi:10.1001/jama.1995.03530060031024

To the Editor.  —In an excellent article published recently in JAMA, Dr Leape1 discusses the mechanisms and some models of medical errors. In his initial statement, however, a historical error is introduced. Florence Nightingale must take credit for many important contributions to the progress of medicine and nursing, but certainly not for being the original author of the dictum, "first, do no harm."Since the time of Hippocrates (circa 500 BC), the principle of "primum non nocere" ("the first thing [is] to do no harm" or "above all, do no harm") has been quoted by medical writers with respect and considered "medicine's most cherished principle."2 It has been taught this way to every medical and nursing student throughout the world and through the years. However, even the real meaning and logic of this principle has been questioned recently in an excellent review by Brewin,3 suggesting that it

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