When Doing Nothing is the Hardest Decision

'Why I Ration Care' is an important essay published in this week's Newsweek.  Christopher Moore, a father and emergency physician, talks about his recent care of a teen who presented with mild head trauma sustained during a soccer game.  The piece details the decision to manage this low-risk child expectantly.  The reflexive head CT was forgone in favor of observation.

Moore refers to his decision as a type of rationing of health care resources.  I call it a refreshing example of good clinical judgment.  If all physicians exercised this level of thinking on a daily basis it’s conceivable that ‘reform’ would be a foreign word.

But great judgment is easier said than done.  Clinical decisions can be brutally difficult.  Testing is easy.  Exercising the judgment to not perform tests takes insight, experience, and confidence.

The drive to identify and fix has to be balanced with the patience and courage to watch and wait.  This balance, when maintained successfully, defines the most skilled clinician.

Comments

[Kathy Mackey]

You are right on target Doctor_V, Non-invasive watchful waiting between a trusted medical partner and a patient is the most dynamic of relationships. It is reserved for the best of the best.

Kathy Mackey
@mkmackey on Twitter

[DrV]

Thanks Kathy. I think we have regressed to a mechanistic, impractical way of treating the sick. It's no wonder participatory medicine is gaining such popularity. It's a true gift to have a relationship with someone caring enough to look at the whole picture in a balanced way. Thanks for chiming in.