Great piece. Restraint is a dying art in medicine. Medical maximalism somehow feels like better care, both to doctors and patients. But as you say, sometimes the best tincture is time and patience.
Great example, thanks for taking the time to write. But if only you didn’t have to follow the sodium for two more days in house…😀
I live in the surgical world, so many people (not everyone) get frustrated with me when my plan is “let’s not decide right now and wait a bit”. When I recommend “do nothing”, sometimes they are downright apoplectic. What do we call that, the “aren’t you going to do something” bias? I think it stems partly from an overinflated idea of the efficacy of our interventions.
I object to “doing nothing”—you sat with her, listened to what makes her happy, and set a basic plan (rehab) to get her back to her independence. You did so much to meet her needs. Had her hyponatremia not improved, she still would have felt better after that.
This is where AI would be no help. It’s what I call Contrary or Paradoxical therapy. Do the opposite of what common medical wisdom would dictate. It is an intuitive approach. Forget guidelines and algorithms.
When I was an intern, we had an infant with 20-30 second breath holding (apneic) spells. We had no CT Scans in those days. Baby had numerous primitive scans and 24 hour monitors. In the corner, the grandmother quietly said, "I think he's just ornery." Chief of service said, try doing nothing. Intuition. Discretionary physician thought.
There is a lot of wisdom here. The longer I practice, the more I see that doing nothing and patiently waiting is the right thing to do—far more often than I appreciated early in my career.
Loved this post. Seems to me that Dr. Alexander’s “humility levels are a tad elevated” for a person in his profession. I recommend he should do nothing about that.
It was nice to see that physicians are teaching the residents and students that sometimes doing nothing is the right thing. I have been teaching for 30 years and one of the areas that we talk about often is when doing more work up or treatment is good and the times when perhaps doing nothing but keeping an eye on the patient is the best therapy. It is satisfying to see the young doctors embrace this as often they have come off a hospital specialty service that is accustomed to testing and treating when the absolute desired numbers are not achieved. Your approach of looking at the patient in front of you brings a smile to my face. Thanks.
In all my years managing inpatient electrolyte disorders I have found drink more/less, or normal or half-normal saline at 75-125 cc/hr based on clinical presentation beats laborious calculations and 3-4x daily labs. There is an old expression: "the dumbest kidneys beat the smartest residents every time."
This is the very definition of medical CARE- common sense, evidence-based, critical thinking judgment. Please post this case study in every treatment protocol textbook globally!
As a hospitalist, I consider my main job to get people out of the hospital. Or to never come in to begin with. A hospitalist not admitting? Yep, that is sometimes right.
Great piece. Restraint is a dying art in medicine. Medical maximalism somehow feels like better care, both to doctors and patients. But as you say, sometimes the best tincture is time and patience.
Wonderful article. A beautiful example of the essential role of common sense in the practice of medicine.
Great example, thanks for taking the time to write. But if only you didn’t have to follow the sodium for two more days in house…😀
I live in the surgical world, so many people (not everyone) get frustrated with me when my plan is “let’s not decide right now and wait a bit”. When I recommend “do nothing”, sometimes they are downright apoplectic. What do we call that, the “aren’t you going to do something” bias? I think it stems partly from an overinflated idea of the efficacy of our interventions.
I object to “doing nothing”—you sat with her, listened to what makes her happy, and set a basic plan (rehab) to get her back to her independence. You did so much to meet her needs. Had her hyponatremia not improved, she still would have felt better after that.
This is where AI would be no help. It’s what I call Contrary or Paradoxical therapy. Do the opposite of what common medical wisdom would dictate. It is an intuitive approach. Forget guidelines and algorithms.
When I was an intern, we had an infant with 20-30 second breath holding (apneic) spells. We had no CT Scans in those days. Baby had numerous primitive scans and 24 hour monitors. In the corner, the grandmother quietly said, "I think he's just ornery." Chief of service said, try doing nothing. Intuition. Discretionary physician thought.
There is a lot of wisdom here. The longer I practice, the more I see that doing nothing and patiently waiting is the right thing to do—far more often than I appreciated early in my career.
Loved this post. Seems to me that Dr. Alexander’s “humility levels are a tad elevated” for a person in his profession. I recommend he should do nothing about that.
🙂
I thought this was going be a parody with the title and George Costanza's real name. Nope. What a great read and enjoyed the positive outcome.
It was nice to see that physicians are teaching the residents and students that sometimes doing nothing is the right thing. I have been teaching for 30 years and one of the areas that we talk about often is when doing more work up or treatment is good and the times when perhaps doing nothing but keeping an eye on the patient is the best therapy. It is satisfying to see the young doctors embrace this as often they have come off a hospital specialty service that is accustomed to testing and treating when the absolute desired numbers are not achieved. Your approach of looking at the patient in front of you brings a smile to my face. Thanks.
In all my years managing inpatient electrolyte disorders I have found drink more/less, or normal or half-normal saline at 75-125 cc/hr based on clinical presentation beats laborious calculations and 3-4x daily labs. There is an old expression: "the dumbest kidneys beat the smartest residents every time."
We posted that chestnut at the same time!
The dumbest kidney is smarter than the smartest doctor.
I learned that in residency.
It's also true of pancreases.
This is the very definition of medical CARE- common sense, evidence-based, critical thinking judgment. Please post this case study in every treatment protocol textbook globally!
As a hospitalist, I consider my main job to get people out of the hospital. Or to never come in to begin with. A hospitalist not admitting? Yep, that is sometimes right.
Such a simple thing - I love an example where the patient wins with no restrictions!
Agree. God’s original design is for the human body to heal itself. Classic example. ❤️