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 ignorant – nothing could be a space full of potential and possibility, made more potent by the endorsement and encouragement of an expert.
This past month has been a time marked by nothings. Closures and restrictions, cancellations and waiting. Challenges to be sure and perhaps not the first line treatment any of us might select again given the power of individual choice among a handful of options. And yet this nothing has overflowed with potential and possibility – creative connections, cooperative efforts, deep examination of and a realization that we do, indeed, have the capacity, however disgruntled we may feel, to pause and reconsider before stepping back into action or paving a new path forward. And while many aspects of our surface existence on this planet have been challenged, there is clear evidence of positive shifts in the atmosphere and precious natural resources long threatened by behaviors and actions that have been starkly and suddenly halted.
As National Osteopathic Medicine Week coincides with Earth Day in this unprecedented experience of annuum 2020 – I consider how we can truly expand our understanding and broaden application of the osteopathic concepts for the best health of ALL things – simultaneously and ubiquitously. Starting with that first choice of “do nothing” – neither inert or ignorant – we can hold space for potential and possibility, made more potent by the endorsement and encouragement of the greatest expert – the earth herself.
Listening for our role in interrupting the self-healing, self-regulating capacity of this planet requires quiet observation, conscious acknowledgement, acceptance of responsibility and heightened awareness. Heeding the call to transition from those who create obstacles and barriers to the deepest inherent health in existence, to those who remove them, reestablishing connections that we have broken, allowing for ease and flow through restoration.
Learning from the brilliant design of ecosystems in their natural or restored state requires a broad view, elevated vantage point to witness the true interrelationship of structure and function – one optimized for and by the other. Seeing where we can contribute to the rebuild instead of destruction, recognizing where our expectations of efficiency, expedience and economy have allowed us to compromise structural integrity leading to systemic failures from minor to cataclysmic.
Looking for lessons in integration of mind, body and spirit requires patience and a willingness to see beyond boundaries we have developed and imposed. In nature, they are indiscernible as the water, land, air, creatures experience the ebbs and flows of famine and plenty, pollution and cleansing, drought and flood together – the ultimate oneness creates and maintains the connection and relationship with an ease as great as the force we carry in our seeking.
From this place, can we take up the role of physician of this, our greatest patient, arriving with a chief complaint of malignancy with a grim prognosis. We must sort through the information – from the words of the planet to the findings on examination of her landscape to the results of studying her response to the recommendations of the cultures who revere her as colleague to review of the latest guidelines from the natural ecosystems – working with this patient to understand, filter, frame and choose best options. Can we accept the doing, fixing and acting that are within our capacity and part of our responsibility to implement meaningful treatment that leads to change, meeting her desire for correction of these problems, returning to normal or at least better than at present? Can we accept the challenge of “do nothing” when asked, from a place of potent possibility and potential, endorsed and encouraged by this indisputable expert? Can we offer "do nothing" with bravery, honoring the ever present power of choice, honoring her wholeness, just as she is?
On this 50th anniversary of Earth Day, may we look, learn and listen, holding space for nothing to be everything on the journey for the health of all things.