Masterly inactivity - sometimes the best treatment is no treatment

Torbay Weekly

One of the most dreaded phrases feared by doctors is 'you must do something'.

Of course, if a doctor finds a treatable disease where we know treatment saves lives it is their duty to 'do something'.

It is also understandable that a suffering patient wants something done. The word 'patient' means sufferer.

But sometimes the best treatment is no treatment.

A sore throat is unpleasant but is usually caused by a virus.

There is a temptation to 'do something' by prescribing antibiotics. Not only will they not help but too many prescriptions for antibiotics will increase the number of resistant bacteria.

'Doing something' is not harmless. It could put at risk many seriously ill people who need a working antibiotic. The sore throat will get better in a week with antibiotics or seven days without.

For more serious conditions sometimes doing nothing is a positive decision.

Some prostate cancers grow slowly and may never need treatment. Treatment itself can cause problems.

Specialists review all the tests and may decide that 'watchful waiting' is safe.

No treatment is given but the man is followed up and tested regularly.

Having a known cancer and not treating it can sound scary but regular follow up will ensure that, if it does develop there is plenty of time to start effective treatment.

If it does not develop the man has avoided unnecessary and possibly unpleasant treatment.

In Torbay Weekly, Dr Andrew Gunatilleke wrote a fascinating column pointing out that morphine-type painkillers are not helpful for long-term pain or even back pain.

The guidance suggests that even paracetamol and anti-inflammatory drugs like ibuprofen are best avoided but with a patient in genuine pain the GP is often under pressure to prescribe 'something stronger'.

When a doctor refuses to prescribe any medication they can be accused of not taking the pain seriously.

Patients may see psychological support as suggesting that it’s 'all in the mind'. They are 'putting it on'. But offering support from groups such as ReConnect2Life is not denying the pain or 'doing nothing'. There is clear evidence that it is helpful.

Appearing to sit on your hands and doing nothing is a useful technique in other areas of life.

A helicopter parent tries to prevent every minor fall, bruise or bump. In a toddler this is not helpful, or even realistic.

Watching an older child climb up the net on Paignton Green Geopark can be scary but rushing over to help with every step can undermine their confidence.

As they reach teenage years being overprotective can lead to long-term problems.

Parents cannot choose their children’s friends or decide their career. Although every parent wants their child to succeed, sometimes we must let go and let them learn from their mistakes.

A child who has never been let free can suffer from poor self-esteem and lack confidence.

If they go to university or start an apprenticeship having never had to make their own decisions, they will find it tough.

I will always be grateful to my parents who did the opposite of helicopter parenting.

A few years ago my mother gave me my old school reports. They were awful. “Weren’t you and Dad worried?” I asked her. “No,” she replied. “We just thought you weren’t very bright.”

In politics and history doing nothing can be the right thing. Anthony Eden might have been more successful if he had not invaded the Suez Canal in 1956. One of Harold Wilson’s greatest and bravest decisions as Prime Minister was not to send troops to Vietnam to support the Americans.

In medicine masterly inactivity is often the result of a carefully thought-through plan.

Deciding to do nothing but wait and see can be the right call. Doing nothing is not always doing nothing.