Observations Ethics Man

“Make the care of your patient your first concern”

BMJ 2011; 342 doi: http://dx.doi.org/10.1136/bmj.d646 (Published 02 February 2011) Cite this as: BMJ 2011;342:d646
  1. Daniel K Sokol, honorary senior lecturer in medical ethics, Imperial College London
  1. daniel.sokol{at}talk21.com

The brevity of the GMC’s first rule of medical practice necessarily obscures the complexity of the job

The first rule of Good Medical Practice, issued by the General Medical Council, is: “Make the care of your patient your first concern.”1 With its strong Hippocratic flavour, the statement captures a fundamental truth about the practice of medicine, pointing to the sacred and timeless nature of the encounter between the healer and the sick person.

Yet, however noble in spirit, the rule should be no more than a rule of thumb. Although “patient” is in the singular, few doctors have only one patient. Doctors must therefore choose how to allocate their “concern” among their many patients. It is neither possible nor desirable to treat each patient as a first concern, as some patients, usually the sickest, merit more concern than others. The principle of justice requires the doctor to determine which patient deserves the greatest attention.

In a field hospital in a conflict zone, four polytrauma patients are admitted after an explosion. One has multiple traumatic limb amputations. The others have less severe injuries but require blood transfusions. Treatment of the first victim will activate the …

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