Sunday, 14 October 2007

Doing Nothing

A touch facetious (since it's rare I see a patient without generating a management plan with at least half a dozen interventions even if they're all nursing or psychoeducation), but I'm indulging myself.

As a junior doctor, when called by staff to a patient it was always because something needed "doing". Put in a venflon, write a drug card, inject iv antibiotics, assess a rash, tell them they're dying, consent them for a procedure, defib their VF, whatever.

It's taken some time to step back and gain perspective, from "doing".

An anaesthetic Pain Consultant was saying of orthopaedic surgical collegues, "when you're holding a hammer, everything looks like a nail." I think it's a delightful turn of phrase she used to mean that when you're used to offering surgery, undertaking surgery, working in a surgical unit and seeing surgical referrals, you tend to think/do just surgery.

She p'raps was being overly harsh since most clinicians evolve a more balanced perspective over time, realising they can't "do" their thing all the time and often stepping back to do no harm and not meddle is the best course of action.

Training at the moment is focussed on Direct Observation of Procedures and "doing" which is important. But maybe Dr Basch had it right.

Maybe the trick of it is Law 13, to do as much nothing as possible.


Kelly said...

I'm doing as much nothing as I can right now - is that the way to approach med school too? ;-)

Calavers said...

Haha, my comment was going to be something along the lines of Kelly's, too! She got there before me! :(

I'll say what I always say - being a medical student has its advantages. I love the fact that I'm not expected to know or do anything, or make any major decisions!

Quite scary, this 'being a doctor' malarkey, like.


Dr Andrew Brown said...

“If the only tool you have is a hammer, you tend to see every problem as a nail” is a quote from Abraham Maslow, the psychologist of "hierarchy of needs" fame. You will no doubt know much more about him than I.

And it is such a pertinent quote. We can see our dear politicians doing it every day. He has indeed hit the nail on the head. :-)

Dr Andrew Brown said...

And a reworking of Law 13 is "don't just do something, stand there!"

We crusty old GPs know something about that: time as a diagnostic tool, tolerating uncertainty, yada yada.

Jan said...

I love Law 13. I wish the psychs who've taken charge of my care over the years had done more nothing, other than observing what the effect of the nothing was. But there is a tendency to wish to be seen to do something that affects politicians and docs alike.

Locum psychs are particularly bad at observing Law 13, reminding me of Erving Goffman's expression "the tinkering professions".

Calavers said...

*goes off to Google Law 13*

PhD scientist said...

Always good to see a link to the wonderful The House of God. Mrs PhD always swears this should be the "primer" book for junior medics about hospital life and how to survive it.

Did you ever read the many-years-later follow-up Mount Misery, Shrink? I thought you would have since it is specifically psychiatric. Actually Mount Misery sounds a bit like Lake Cocytus, figuratively speaking.

The Shrink said...

Dr Brown, yes I've taken to rushing to see "urgent" referrals and busily done nothing. Well, done assessments, given advice about understandable experiences and how nursing staff can manage things optimally, but this week I've yet to meddle with a patient. Okay, it's only 40% through but I've done ward round and my weekly out patient clinic work now, so not doing too badly at resisting the urge to meddle!

Jan, agreed, there's an urge to act and if you're not there for the long haul to see how things work out, with you and your patient being there through it together over time. It's often simpler to make an intervention "just in case" and then the treatment's done so all must be well.

Oh and Cal, Law 13 from the House of God was on the clicky.