Field notes. Some phrases I never say.

Preparing patients for pain is an art that’s often botched.

Getty Images, Stephen Welstead.

The most famous rule about the practice of medicine is to “First, do no harm.”

The reality is that we do harm all the time, but with good reason. The rule should be more like, “Do no net harm.” But even that wouldn’t be enough. We should only do the minimum harm necessary to achieve a net benefit. Somehow though, that isn’t quite as catchy.

The point is obvious enough. When I wield a scalpel to make an incision in an infected area of skin, I’m doing harm up front, in service of net benefit by the end.

Meanwhile, the obvious goal is to make patients as comfortable as possible before any pain occurs without misleading them. Collectively, we clinicians are terrible at this. Over the years, this has been something I’ve been working to improve in my own practice, and I want to tell you about some of my approaches.