For this series on the time pressures on today's clinicians, let's look at the evolving culture in which they work.
A highly respected pediatrician admits a teen with abdominal pain and vomiting for IV hydration and pain meds. After consulting a gastroenterologist, the white-haired physician reassures the trusting parents of the value of supportive care and tincture of time for what appears to be a viral syndrome—a working diagnosis supported by blood and ultrasound findings.
But as the teen’s overnight observation stretches into a week of minimal improvement, family members push the parents to request further evaluation, insisting, “They don’t have a diagnosis after a whole week? You need another doctor.”
“A whole week?” The boy is medically stable and reasonably comfortable on IVs, facts confirmed by bedside exams. Why subject him to repeated scans? Endoscopy? Are the potential benefits to the patient worth the mega-bills that would soon arrive at the home of his working-class parents?
This scenario is replayed over and over as patients and their families demand more be done to arrive at a definitive diagnosis sooner or to see improvement faster.
I sympathize with their desire for certainty. But I cannot forget the pearl of a wise mentor during my training: In some clinical situations, the best thing to do is to “Hurry up and do nothing.”
Today, such a course of inaction is increasingly challenged in a culture that seems to have lost tolerance for uncertainty and waiting.How did this happen?