What does it mean to “do no harm?” Is the maxim a guideline establishing the bounds of ethical and beneficial clinical practice, or an affirmative obligation for something else?
The 2025 capstone presentation from then-Mayo Clinic Chief Resident Dr. Taylor Christian, titled “First do no harm: the history and origin of medical racism,” provides one potential theory.
The presentation’s teaser asks the question, “Can we fulfill our oath to ‘do no harm’ if we ignore the harm of racial injustice in medicine?”
“Understanding the historical roots and persistent impact of medical racism isn’t just informative; it is a call to action,” the teaser continues. “This presentation is an opportunity to learn, reflect, and act to become better advocates.”
It is absolutely the case that racism has no place in medicine and that physicians should ensure they do not engage in racial discrimination in clinical practice.
Yet by conflating a physician’s duty to his or her patients with an affirmative obligation to “advocate” against “racial injustice,” Dr. Christian is making a category error, and a very harmful one at that.
“Doing no harm” is not a call for physicians to transform themselves into activists in the workplace; in fact, quite the opposite. Physicians cannot provide the best possible care to their patients if they are mediating their clinical interactions through the lens of a particular political agenda.
Unfortunately, Dr. Christian’s presentation would suggest otherwise.
The premise of the presentation itself is that systemic racism is the driver for disparities in health outcomes between racial groups, and physicians have an obligation to address systemic racism in clinical practice.
Although details are scarce on what the actual mechanisms of racism are that could cause these disparities, Dr. Christian does provide a few explanations, including implicit bias.
“I encourage each of you to take the Harvard Implicit Association Test, or the IAT for short,” she said, referring to a test aimed at measuring implicit or unconscious bias.
As ample research has shown, these tests are, at best, a poor predictor of real-world behavior such that “implicit bias” cannot be seriously characterized as a catch-all explanation for racial health disparities that lack convenient explanations.
It is unwise, to say the least, to attribute causal significance to a phenomenon that can neither be reliably measured nor demonstrate any degree of validity.
Next, to describe the model values of physicians working to combat racism in medicine, Dr. Christian quoted the Mayo Clinic’s “Commitment Against Racism.”
That included efforts to work on “Reflecting the diversity of our patients and communities among our staff, students and leaders by ensuring equal employment, educational and advancement opportunities for all.”
It also included a pledge to “strengthen our diversity and inclusion pipeline programs for health care professionals” and “recruit and develop clinical leaders who are representative of our broader community.”
Dr. Christian concluded the presentation by discussing ways for physicians to address racism in clinical practice.
These included policing microaggressions, incorporating anti-racism into curricula, and “promoting diversity” more broadly.
“So, as far as our call to action today: what can we do as healthcare providers?” Dr. Christian asked. “Acknowledge and challenge our implicit biases. Advocate for policy and systemic changes. Promote diversity, equity, and inclusion. Get involved with our emergency department DEI team.”
(Interestingly, the Mayo Clinic renamed its DEI department to the “Office of Belonging” in April 2025.)
In short, this is a vision of clinical practice that presents activism and advocacy as a necessary part of a physician’s duties.
This is not “doing no harm,” but reimagining the physician as a DEI activist, to the detriment of patients and medicine more generally.
