You are not going to do what?

05/25/2009 at 5:41 AM Leave a comment

Nothing! That’s right. I am doing nothing.  Of course if I put it that bluntly the patients would have a much harder time with it. but the point is: Nothing is quite a reasonable option.  A large portion of the time, after hearing all the history, doing the exam, looking over any tests that may or may not be needed, it is clear that the thing to do is absolutely NOTHING. 

In this country of ever increasing speed and immediate gratification, this places me in the position of a lone wolf crying in the wilderness. However, it does not mean that I can’t dress up NOTHING to look like something. In fact I need the patient to be allowing time to do its thing, not to be so anxious that the anxiety will obscure the improvement.

There are many ways to dress up NOTHING. Having them keep a chart is one. they document the timing, severity, and duration of events. You can have them take a benign OTC at prescribed times or follow a certain diet. Usually these last two are tailored so that the diet or the OTC will work on a side complaint. The point is that the body is amazing  and the great healer. The vast majority of people that come in the office will heal themselves (oops, can you put that cat back in the bag?). What I add, is understanding of the illness, information on how to make the symptoms better and shorten the course, and a sense of comfort about the seriousness of the illness.  ex. For someone with chronic headaches and worried about brain cancer, my being able to tell them the clear difference between the symptoms of those illnesses gives them a lot of relief.

My main job is to give clarity, understanding, and instructions on how they may help themselves. The medicine as good as it is, is a close second.  As you will hear on the news, the vast majority of chronic illness is lifestyle choices. If I could count what percentage of my weekly visits were directly or mostly due to : tobacco, alcohol, other drugs, lack of excercise, lack of common sense, poor diet, excessive worrying, stressful life choices, you would be amazed.  In fact I will try to do that this next week and further I will ask some of the other docs to estimate that percentage also. It will be interesting.

Back to NOTHING.  A kid with mild symptoms is brought in for an antibiotic. I feel he will get better in a day or so. But it is Friday or Saturday, the mother, quite reasonably is worried that if I am wrong she has to deal with a sicker kid for the weekend and then start the medicine later and it will take longer to heal. This will effect her work attendance, his school attendance, not to mention the extra cost of coming back to the office.  It is not rocket science but it is usually easy to finesse this problem. Most of the time, the moms are willing to give it a day or so as long as there won’t be a subsequent delay or cost. So I might give them the prescription and tell them exactly when they should fill it ( temp goes up, etc.) or if I think they will fill it immediately and it is a weekday, we are set up to have them call the next day if the child is worse and then call in the script.

In a similar vein, for a different type problem, I will write out a series of sequential instructions for adults that I want to buy some time with.  First might be a change in diet, activity, or current medications. if that does not improve the problem in a specified time I may have them try something new, then after so much more time they are to call me back if they are not improved. It is not that I am stalling, but I am trying to get the patient to give the body a chance to heal. In fact, knowing whether the body heals the  problem or not is an essential part of diagnosing some things. 


Nothing in effect can be something.


Entry filed under: Uncategorized.

You never know what people will do. Memorial Day memories

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