'Do No Harm': A Hippocratic Oath for Schools
While some might argue that there is little connection between medicine and education, there are lessons that educators can learn from this very different field if you look for them.
Consider that medicine treats one patient at a time, while in education, teachers interact with students in large numbers simultaneously, and typically over a longer period of time. In schools, we seem to lump all students into one or another large group. We teach a whole class and not a single student. We focus on whether an entire school—and, to be fair, key subgroups—makes adequate yearly progress, not where individual students stand.
We show evidence of a school’s progress by hiding our failures in the average. For example, the national on-time high school graduation rate was 80 percent for school year 2011-2012. “Yay,” we shout and celebrate, “we had 80 percent of students graduate!”
But, wait, that means 20 percent of the young people who should have graduated that year did not. Are we really OK with that, after all we know about the reduced opportunities faced by students who drop out, or should we just acknowledge the average and celebrate?
We should, as medical professionals do, have zero acceptance of failure for each student in our care. We don’t need to emulate the medical profession in every way, but two practices stand out as learning opportunities for those in K-12 education.
The first involves the Hippocratic Oath, often summed up with the phrase, “First, do no harm.” The second is the “delicate nature of learning from medical error,” as the authors of a 2002 article in Academic Medicine: Journal of the Association of American Medical Colleges put it in their essay on morbidity and mortality conferences.
The Hippocratic Oath is solemnly taken by every medical doctor. It is a statement with relevance to educators as they consider their interactions with every student. The phrase should remind them that they work with individual human beings, and that they are in positions of influence with the potential for making a lasting impact on others’ lives.
There are few careers that are as publicly scrutinized and held to high expectations as a teacher’s. The public is hyper-aware of the potential harm educators may inflict on a child. Whether that influence is real or simply perceived, an educator can benefit by cautiously approaching his or her role toward each student.
Educational harms may not be akin to those caused by a failed surgery or misprescribed treatment, but what about the harm of simply not doing what is best for each and every student? It is the unintentional action or lack of action that may eventually lead to a real problem.
Yet in education, knowing full well the repercussions of dropping out of high school (greater likelihood of living in poverty, receiving public assistance, going to jail, suffering poor health, living fewer years), we continue to allow it to happen.
Is it acceptable when most, or at least half, of the students in a school graduate? By contrast, what’s an acceptable threshold for harm or death in a hospital? Do doctors plan on a 70 percent recovery rate for patients and just accept that 30 percent will have serious pain and suffering, or do they hold the expectation that everyone with a treatable condition can recover and live? Is perfection the goal in education?
The sad fact remains that, for a variety of reasons, we will continue to have dropouts and failing students. Inevitably, there are students who do not succeed. That is reality, and we have accepted that education will be less than perfect.
Even the medical field admits there is a “necessary fallibility” inherent in the practice that can never be absolutely eliminated.
But medical professionals are held and hold themselves to a level of perfection, even with the known possibility of failure. The medical profession believes so strongly in this that its members implement systems and structures to evaluate and analyze the near-deaths and deaths of patients in their care. The structures for this are embedded in regular morbidity and mortality conferences, or M&MC’s.
Although there are different models for them, the modern-day M&MC revolves around identifying medical errors to learn from them and to improve medical practice. Medical researchers have gone so far as to call the conferences themselves a manifestation of medicine’s inner commitment to face mistakes and grow from them.
By contrast, the education field has a difficult time with failure. It is such a stigmatizing label that many fear the slightest chance of being identified with it. We often brush failure away and consider dropouts as inevitable and move on. The acceptance with which we approach dropping out is similar in some ways to wartime expectations of casualties. We numbly move on.
We must embrace the reality of what failure means and learn from it. Education in its very nature is about learning. Should we not then learn even from the errors and failures we suffer?
We have failure in education. We have harm. How do we know? We know by the 20 percent of students who do not graduate from high school. We know by the public lists of “failing” schools.
The failure and harm in education is not left solely to the average, but to many individual students. Yet often we approach failure and harm (to use another medical analogy) as an ambulance parked at the bottom of the hill versus a fence at the top. We treat the symptoms and not the cause.
Upholding the “first, do no harm” principle as an educator may provide a vision toward preventing each and every student’s future failure.
And when we unfortunately do experience individual student losses, we can approach these losses in a new way, as a delicate way to learn from failure.
Vol. 34, Issue 04, Pages 23-24Published in Print: September 17, 2014, as 'Do No Harm': A Hippocratic Oath for Schools