When Doing Nothing is the Best Treatment
“Don’t just do something; stand there!”
Sound clever? It’s the kind of thing that teaching clinicians of every discipline spout off at their students. A good clinician does their best to do their best for their patient and sometimes – that’s nothing.
Here are some medical examples:
Sore throat? Get an antibiotic.
New headache? Get a CT scan.
Backache? Get an X-ray.
Still got a backache? Get an MRI.
PSA at the upper limit of “normal”? Get a biopsy.
Blood pressure still high? Add 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 medical 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.
In fact, there are some doctors for whom “doing nothing” is the dominant way of thinking, who are not reflex “do-ers.” They tend to lean to toward the status quo: If the patient is doing fine right now, why rock the boat?
There’s a term for this in the medical literature – clinical inertia – a term with a distinctly negative connotation. It describes the doctor who, for instance, sees a patient with cholesterol levels that are not optimum but who does not prescribe a statin. Or the doctor who notices that a diabetic patient’s blood sugar levels are still not normal but refrains from increasing the patient’s medication. Of course, this is not black and white: there is a continuum of practice styles, just as there is a continuum of personalities in general. At one end are doctors who jump on the merest hint of a borderline lab value; at the other are doctors who avoid making changes unless absolutely necessary.
An essay in the Journal of the American Medical Association called “Clinical Inertia as a Clinical Safeguard” postulated that doctors who tend toward inertia might actually benefit their patients by protecting them from overzealous medical intervention. Keep in mind that what follows is based on U.S. information. Here in Canada, because of our more socialized medical approach, we are often inadvertently protected from overzealousness.
The study focused on three common medical conditions – diabetes, elevated cholesterol and hypertension (high blood pressure) – for which there are established clinical guidelines for doctors to follow and “quality measures” that evaluate medical care. For all three illnesses, “lower is better” is the dominant mantra.
Yet, while “lower is better” is probably true for large populations, that is not always the case for individual patients. In fact, there are some clinical trials in which aggressively lowered blood sugar or blood pressure have been association with higher rates of dying. (This doesn’t surprise me because the condition is stressful on the body and the treatment just increases the stress.)
The authors weren’t saying that medical conditions shouldn’t be actively treated, but they did caution that standard clinical guidelines tend to favor overaggressive treatment in pursuit of “good numbers.” In the stampede toward good numbers, individual patients can be harmed by the side effects of these treatments. Clinical inertia might actually act as a safeguard for such patients.
No one wants doctors who fail to act when action is necessary. Medical emergencies are a different story altogether. Most chronic illnesses are not emergencies, so there is room for deliberation before action. I think many people could be saved by inertia.
As a chiropractor I’ve seen so many people, especially older people coming in with lists that exceed two or three and can reach up to 14 and 15 different medications. Often patients don’t know what each one is for and can’t keep straight when they are supposed to take each one. I just remember the Doctor from Sunnybrook who taught us pharmacology saying that taking more than 3 medications at one time meant that the doctors were treating the side-effects of medications with other medications and that the patient would become so toxic that it was dangerous. And the more medications a person was on, the more confusing the symptoms would become.
I feel fortunate to be a chiropractor. Even if I for some reason decided to overtreat somebody for a period of time (and they went along with it) the worst that could happen is some joint hypermobility that can be resolved with rest and muscular strengthening exercises. Chiropractic is not inherently dangerous or toxic. Since most people who go to chiropractors are undertreated because of scheduling, monetary, and other considerations, they never actually attain optimum spinal function and over treatment is almost never a danger.
As a Certified Chiropractic Wellness Practitioner I still think that the best treatment for chronic conditions like diabetes, high cholesterol and high blood pressure is prevention and life style modification. If you already have these conditions, it’s not too late to change some of your behaviours and help your body heal and function better. Talk to me about alternatives.
Start the New Year out right and get a check up.
Dr. McCallum’s office is located upstairs in the Bay SevenOaks, 32900 South Fraser Way, Abbotsford, BC. Call 604-864-8232 to book an appointment. We love helping people regain and maintain their good health.
When you need chiropractic adjustments Abbotsford is the place to be. Dr. Dorothea McCallum provides General Chiropractic Care for people of all ages, Pre and Perinatal care for Moms and babies – Webster Technique Certified, Wellness Care and Coaching – Certified Chiropractic Wellness Practitioner (CCWP), Custom Corrective Orthotics.
Our office (inside the Bay) can be viewed on our CanPages site: www.canpages.ca/page/BC/abbotsford/mccallum-chiropractic-at-the-bay/4270514.html
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