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The Doctor Who Does Nothing

Nassir Azimi, MD, FACC, FSCAI, FASNC Nassir Azimi, MD, FACC, FSCAI, FASNC April 2, 2020

In the words of my mentor, H. Gilbert Welch, “Doctors worry that if they don’t do something, patients will be dissatisfied and go elsewhere.”

I clearly remember as a student being reminded of this in ambulatory pediatrics, where the attending said, “If I don’t prescribe antibiotics, the patient will go elsewhere.”  Dr. Welch argues that “doing something is a quick way to make patients feel heard, even if it is a poor substitute for actually having the time to listen. But we also feel pushed to act because many patients have been taught to believe that the good doctors can reliably fix problems by trying medications, ordering tests, and referring to specialists.”  Hence, our knee-jerk medicine. 

It is often said that the most expensive item in the clinical setting is the doctor’s pen (or these days the physician-entered orders) as they lead to very expensive treatments and tests. “More medications, more testing, and more referrals quickly add up to real money–money that is increasingly, as first-dollar insurance coverage disappears, coming out of your pocket.”

He further argues that these tests and treatments can lead to harm beyond financial. Incidental innocuous findings, may lead to harmful treatments and consequences.  His essay reminds me of an uttering heard on the wards during my training days.  “Time does the healing, and healthcare does the billing.”  

His conclusion rings true: “True professionals provide considered advice. And sometimes doing nothing is exactly the right thing to do…  Recognize that the doctor who advises no action may (sometimes) be the one who really cares for you.”

About me: I am an interventional cardiovascular physician with interest in all aspects of transcatheter treatments. I studied chemistry at Columbia and graduated from Dartmouth Medical School. I went on for internal medicine training at UCHSC in Denver. After residency, I embarked on fellowship training in Cardiovascular Medicine at Yale, then Nuclear Cardiology at Yale and Interventional Cardiology at Yale. Since finishing, I have lived in San Diego where I do interventional cardiovascular medicine, PFO/ASD closures, peripheral interventions, renal interventions, and coronary interventions. I love learning new devices and techniques and staying up on diverse topics. Although not affiliated with a university hospital, I am active in teaching and lecturing.[/vc_column_text][/vc_column][/vc_row]

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