Do Nothing

Decision making is a regular part of the work of a physician. Sorting through information – from the words of a patient to the findings on exam to the results of studies to the recommendations of colleagues to review of the latest studies and guidelines – and working with a patient to understand, filter, frame and choose best options consumes the vast majority of time (not to mention the documentation of all of the above). There is an expectation for doing, fixing, acting; hope of finding solutions and implementing meaningful treatment to lead to change; desire for correction of a problem, return to normal or at least better than at time of presentation. One of the greatest challenges that physicians face is the presentation and selection of the option “do nothing.”

I recall vividly the candid and caring interactions of a surgeon with his patients during my years in training – he would often have a handful of options for patients and the first was always to “do nothing.” At the time, it was so routine, and frequently not the selected option, it was easy to overlook as a key aspect of the discussion. As I have moved through the development of my own practice, navigating conversations with patients and discussing the utility of the treatment options I have to offer, I see through a new lens the critical nature of this step. Offering do nothing as always an option reveals the ever present choice. It empowers the patient and acknowledges their wholeness just as they are.

In many cases, doing nothing carried a negative connotation – particularly for patients in severe pain or debilitated by loss of function that had plagued them for years or was worsening significantly. But sometimes, against the other options, nothing was the best choice – carried the least risk, bought time and allowed for acknowledgment of their body’s potential for recovery, highlighting the osteopathic tenet of self-healing and regulation – boosted by encouragement of a reassuring exam, the comfort of experience and previous cases with positive outcomes achieved through observation and patience. Nothing was not necessarily inert or