“Don’t just do something; stand there!”
Sore throat? Prescribe an antibiotic.
New headache? Get a CT scan.
P.S.A. at the upper limit of normal? Get a biopsy.
Blood pressure still high? Add on another medication.
Doctors tend to want to “do something” whenever they note something amiss. And patients, by and large, want something done when they have a symptom. Few people like being told just to watch and wait.
Of course, every “thing” a doctor does also has side effects — rampant bacterial resistance from antibiotic overuse; major increases in radiation exposure from unnecessary CT scans; incontinence or impotence from prostate cancer treatments that may do nothing to prolong life; toxic drug interactions from multiple medications, particularly in the elderly.
The admonishment “Don’t just do something; stand there!” reminds us that we should stop and think before we act, that there are many instances in which doing nothing is greatly preferable to doing something.
Every time I prescribe a medication — or order an invasive test, or refer a patient to a surgeon — it always feels like I’m placing a stone on a balance scale. Intellectually, my goal is to place the stone on the side of the scale that benefits my patient. But in my heart, I fear that it could end up on the other side, the side that harms, and the weight and permanence of the stone give me pause.
No one, of course, wants doctors who fail to act when action is necessary. And medical emergencies are a different story altogether. But most chronic illnesses, luckily, are not emergencies, so there is room for deliberation before action.