By Emily Chapman, MD, pediatric hospitalist at Children’s Hospitals and Clinics of Minnesota
A really long time ago, as a new pediatrician, I sat with a tearful, exhausted mom, her toddler restless on her lap — gooey, flushed, and in bad temper. Surely, I could do something for her; couldn’t I? No pneumonia… no otitis… darnn. Resigned, I explained the nature of viruses, blah, blah, blah… and why I didn’t have anything to offer her. I felt sure she’d wasted her co-pay and that I’d failed her on some level by doing nothing. I apologized.
I got a little older. At some point, I took my own son to see my partner for a rash. I knew the name of the rash; I knew he didn’t need medicine; I even knew how to care for him. My partner looked at my son, looked at me, nodded his wise head and said, “Yes, that’s exactly what he has.” And I felt much better. I had taken my son, and my maternal instinct, to the doctor — to have nothing done — and I felt much better. I didn’t need him to do anything; I just needed to share my son’s rash with someone.
And, I got even older. A few years ago, my father fired his internist, a man I knew to be both intelligent and considered. I gave Dad a quizzical look.
“Every time I go see him for something, he gives me medicine,” Dad answered, in a tone that suggested that his reasoning should have been obvious. I remembered what my med school professor had written across the board one day, “Don’t ever confuse ‘curing’ with ‘healing.’” In my own practice, I stopped apologizing for doing nothing.
And, now, I’m older still.
The AAP just published new guidelines for the management of bronchiolitis. Rather than contain a list of things to do, it contains a list of things NOT to do, and little more. In the hospitalist community, this was meet with applause and the birth of a prideful slogan, “Nobody does nothing like a hospitalist!”
We docs are doers. We got ahead, our whole lives, by doing things, tackling things, fixing things. We were that guy who came through with the solution. But the message is becoming very clear: by doing things that may not need to be done, we’re hurting children, sometimes even killing children.
Our professional societies are challenging us to “Image Gently” or to “Choose Wisely” or to “Safely Do Less.” Lists of pharmaceuticals or details of radiologic studies are easy to learn. Doing nothing, is not. Nobody ever taught us how to do that.
In my experience, doing nothing takes tremendous confidence and resolve. It takes a fundamental faith that we are of inherent value to our patients – even without our tools, our medicines or our studies. It takes a faith that our words, our attention, and our touch are of intrinsic value. Take this, and cloak it in a touch of wisdom, and it can be worth its weight in gold.
When you start to believe that you, in and of yourself, are worth your weight in gold, you’ll get a hell of a lot better at doing nothing.
This article also appeared in Minnesota Medicine.
