The Art of Doing Nothing

A few years ago I wrote about doing nothing instead of doing too much in a very limited clinical situation. New York Times blogger Dr. Abigail Zuger writes about stopping her futile efforts to diagnose and cure a patient with multiple somatic complaints that had pertsisted over a ten year doctor-patient relationship. Her inspiration and guidance came from a 1968 article in an obscure medical journal.

“Physicians have been trained to expect the worst of every symptom,” wrote the author, Dr. David F. Wehlage, an Indiana psychiatrist. They “ ‘do everything’ to diagnose and treat it without regard for the destructive aspects of doing too much.” In fact, Dr. Wehlage pointed out, even such simple bromides as “take my advice and don’t worry” can be harmful, casting patients in a passive, dependent role that undermines their natural problem-solving capabilities.

“The art of doing nothing is learning to help by not doing or advising,” he wrote. “The evaluation is the treatment.”

The doctor should avoid asking, “What can I do?” The patient should leave the office empty-handed. “Do not presuppose that people want something done. Do not do something for people they can do themselves. Do not presuppose there is something to offer.”

Instead, find out what is really going on.

Dr. Zuger stopped offering tests and medications to her patient. Instead she listened. She writes about her experience and how the patient finally took the initiative herself to do what she had previously rejected when it was the doctor’s idea:

But keeping a therapeutic relationship afloat without the usual tools, tricks or enticements — that is a rare achievement, and surely harder than the hardest microsurgery.

There are no courses in the art of doing nothing, no fellowships. Who would sponsor them? In fact, one might hazard that doing nothing is the most subversive activity in all of modern medicine, undermining as it does the agendas of all doctors, all patients and all interested corporate parties. Doing nothing has no billing code.

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