Saturday, November 12, 2011

Masterly Inactivity

Hippocrates, in an aphorism once wrote, "The wise physician amuses his patient while nature affects the cure." We used to have a phrase for that willingness to stay the hand. Masterly Inactivity! A small, but distinct segment of patients fit the need for this category of care. This active pursuit of inactivity has nothing to do with interest or disinterest of the patient by the physician. It simply means that when there is nothing to do, do nothing stupid; or "Do nothing, stupid!" Patients are frequently unhappy with this approach, even those sufficiently sophisticated who have been counselled that diagnosis and continuing observation is all that is required for their condition! After some time taken at explanation, the response will be, "For heavens sake, you have to do something rather than nothing!" The simple fact is many conditions are self limiting and many other conditions inevitably worsen! Hippocrates aphorism applied for this is, "Cure occasionally, comfort always!" Reputations for success are achieved often by the institution of an active treatment for a self-limiting condition just before its denouement! Credit where none is due thereby, is still useful, at least for the aura of the practitioner! Useless treatments applied to conditions where deterioration is inevitable can always be excused with, "They tried everything and they worked so hard to help!" There is some comfort that there was never neglect for the trying! Setting science aside, the Art of Medicine does not include taking credit for Mother Nature, and burdensome treatments for untreatable conditions. The line between Hope, Comfort, and Reality needs a careful tread! Somehow the ideas of a Greek Corpus, 2500 years ago, are still relevant today.

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