Sometimes, the Best Care is to do Nothing

The dynamics, interactions, and expectations that are played out in the office between doctor and patient can lead to some uncomfortable moments.  Most of the time, as a provider, I feel the need to obtain some test or order new medication to address the patient's issues.   Often, the provider feels obliged to prescribe something, or to obtain a study, even when there is no a clear indication for doing so.  This may be an attempt to provide a satisfactory encounter or to avoid professional liability risk.  Often, appropriately, the provider may be simply giving the patient the benefit of the doubt.  However, it may be a disservice to the patient to prescribe a test or medication if the doctor believes it isn't necessary.  We should, as providers who are committed to high quality care, renew our commitment to carry out the most appropriate course of action, regardless of whether that may lead to an awkward moment with the patient.  Here are a few simple illustrative examples:

• Patient has respiratory illness, probably viral, but requests antibiotic treatment.
• Patient has headache, probably tension, but feels a CT scan should be ordered "for good measure".
• Patient has chest pain and chest wall tenderness, but gets admitted to "rule out" a myocardial infarction.
• Patient has fatigue and mild depression, with "low normal" testosterone level, and asks you to prescribe testosterone supplement.
• Patient has had trouble losing weight with dieting and requests amphetamines for weight loss to "jump start" the process.

These are representative examples, but there are many other scenarios in which the cost or risk of side effects from the treatment likely outweigh the potential beneficial effects.  It is often tempting, rather than taking the time and effort to explain the reason why "a" or "b" is not needed, to go ahead and provide the prescription or order the test, then move on to see the next patient.  When we do this, we not only do the patient a disservice, but we contribute to the unsustainable cost of health care.

I consult a variety of financial, legal, and other professionals expecting them to render their honest appraisal and recommendations.  If this is a recommenation not to do something, I would certainly accept, and appreciate their candor; as a doctor I should do no less!

Your comments and dissenting opinions are always welcome!