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First, do no harm


To the Editor: Maintenance and improvement of physical and mental health should be based on the principle of primum non nocere, meaning “first, do no harm”.

I would like to discuss this issue using the example of a common clinical presentation to general practitioners — spinal pain with features suggesting idiopathic or biomechanical spinal pain syndrome. A diagnosis can be difficult to make because the anatomy of the spine and adjacent soft tissues is complex. Diagnosis is based on the history, clinical examination and, when necessary, laboratory procedures and imaging.

It should be noted that fewer than 1% of presentations of spinal pain in primary care are associated with a serious disorder (such as fracture, malignancy, infection, cauda equina syndrome).1

When deciding which imaging is most likely to aid in diagnosis, the risk versus the potential benefit of the procedure should be considered, especially with regard to the patient’s exposure to ionising radiation. This is important as radiation exposure from medical imaging substantially increases the risk of cancer.1 When considering computed tomography (CT) or magnetic resonance imaging (MRI) scans, it is important to note that there is substantial…