When to Do Nothing in Medicine (And Why It’s Harder Than It Sounds)
Because sometimes the most advanced treatment is time.
“Sometimes, the greatest medicine is to amuse the patient while nature cures the disease.” - Hippocrates
The exam room is still. A blood pressure cuff sighs. Somewhere a printer hums out another lab order. The doctor hovers with a pen above the prescription pad, poised, capable, trained for action.
And then, the hardest thing happens: nothing.
The doctor looks up, smiles gently, and says, “Let’s wait.”
That sentence, so simple and so subversive, contains the entire paradox of modern medicine. We live in an age that worships immediacy, one-click relief, overnight delivery, drive-through diagnoses. Doing nothing feels like malpractice.
Yet when to do nothing in medicine may be one of the most difficult, and most important, decisions a clinician ever makes.
Our Culture of Compulsion
Modern medicine is a mirror of modern life: fast, impatient, and allergic to uncertainty.
Doctors are taught to act; patients are trained to expect it. A prescription equals progress. A test equals value. A “wait and see” plan? That feels like walking out of the mechanic’s shop with the same rattle still echoing under the hood.
But the human body isn’t a car. It’s a garden, alive, unpredictable, quietly self-repairing when left in peace. And sometimes the weeds we rush to pull out were protecting something deeper underneath.
Doing nothing is not the absence of care. It’s care refined to its most disciplined form.
The Lost Art of Observation
Once upon a time, physicians were watchers. They listened to breath, skin, and silence. Observation was the first and finest instrument in medicine. The pulse beneath the fingers told more than a lab could print. The learner’s mindset was humble, grounded in curiosity about the body rather than the hubris and ego-feeding that so often shadows modern medicine.
Then came penicillin, X-rays, MRIs, and genetic sequencing, miracles, all. But with each invention, medicine traded a little patience for power. Power for the practitioner, perhaps, and a little less faith in the quiet genius of Mother Nature. “Watchful waiting” became an outdated phrase, like a house call or a rotary phone, the kind that made you curse if your friend’s number had too many zeros.
We stopped listening for time’s voice. We started measuring its refusal to hurry.
Now, even the mildest cough provokes an algorithmic cascade. Somewhere between curiosity and control, we forgot that recovery is not something we do to the body; it’s something we allow the body to do.
Biology Already Has a Plan
Every cell is an optimist. Skin seals, vessels reroute, neurons rewire. The body doesn’t crave supervision; it craves space, and often just needs the basics covered.
To ask when to do nothing in medicine is to remember that biology rarely panics. A fever, inflammation, fatigue, even copious mucous during an upper respiratory infection, these are not malfunctions, they’re negotiations. They’re the body functioning as it should. Healing isn’t a miracle we perform; it’s a process we interrupt.
The immune system has the wisdom of an old teacher, slow, repetitive, occasionally exasperating, but nearly always right. It rehearses lessons we think we’ve already learned, over and over, until the body remembers. Collagen doesn’t care about your calendar. White blood cells don’t do rush orders.
And then there’s the endocannabinoid system, nature’s quiet middle manager, constantly renegotiating peace between stress, appetite, pain, and sleep. Its job isn’t to dazzle but to harmonize, tuning chaos into coherence. (See this post for more on the integral role of the human endocannabinoid system: doctorapprovedcannabis.substack.com/p/modernizing-medicine-why-medicare
Sometimes the most therapeutic act a physician can offer is to stop shouting instructions at a body that’s already speaking fluent recovery.
The Foot That Simply Hurts
Take the patient with a plantar wart. It’s not growing, not spreading, not stopping them from walking. But it’s there, visible proof of imperfection, and that alone can feel intolerable.
The treatment is simple: burn it, freeze it, slice it. The temptation is immediate: remove the thing.
Yet every intervention carries its own residue, pain, scar, infection, or just the sense that something was done that never needed to be. Sometimes the smartest move is the one that leaves the wart, and the patient, entirely alone.
Not every blemish is a battle. Some are simply biography.
The Bones That Complain
Or the runner whose feet ache after long commutes in tight shoes. There’s no fracture, no swelling, no real injury, just rebellion from below.
The reflex in today’s system: order imaging, send to podiatry, custom orthotics, perhaps surgery. But what if the answer is embarrassingly simple? New shoes. A pause. Less pavement, more patience.
In Medicine, complexity is often mistaken for sophistication. But sometimes a simple “let’s loosen the laces” can accomplish what a thousand-dollar insert never will.
The art of when to do nothing in medicine lies in knowing which stories end with stillness, not surgery.
The Cascade Effect
Of course, restraint is harder than reaction. We fear missing something. We fear being blamed for not doing enough. And so begins the most common trap in medicine: the cascade.
One test leads to another, each step justified by the last. A single blood result whispers “abnormal,” and suddenly the patient is in a scanner, under anesthesia, or recovering from a procedure that solved the wrong problem.
The cascade starts with curiosity and ends with a complication. Each decision is defensible. Together, they form a tragedy.
The paradox of when to do nothing in medicine is that it often takes more courage to stop than to start.
The Doctor’s Dilemma
Physicians swim in a system that rewards motion. Insurance pays for action, not discernment. A surgeon rarely faces blame for operating; a primary care doctor might, for waiting. Inaction can feel like surrendering the sword, relinquishing the proud illusion that human ingenuity can outmatch time and biology.
Yet integrity asks for something quieter than ambition. It asks for judgment, the kind that only years, and often mistakes, can teach.
Young doctors learn to search digital resources at speed, to act fast, to intervene faster. Urgent care. Emergency care. Preventive care. Somewhere along the way, patient care becomes the pause we forget to make.
Seasoned doctors learn to hesitate.
Wise doctors learn to explain that hesitation, and humility before the power of nature, as care.
To pause is not to freeze. It’s to listen for what the body is already trying to say, to manage expectations, and to soften the illusion of omnipotence that medicine still struggles to outgrow.
The Patient’s Power
Patients, too, hold part of this decision. They know their pain, their fear, their tolerance for uncertainty. A doctor may understand risk ratios; a patient understands real life.
The most therapeutic moments I’ve seen happen not in operating rooms but in honest conversations:
“What if we waited?”
“What happens if we don’t?”
“What would time tell us if we gave it a chance?”
That’s shared decision-making, not a slogan, but a shift. The doctor provides knowledge; the patient provides meaning. Together, they decide what healing actually looks like.
Aging and Acceptance
As we age, the calculus changes again. Not every tremor, freckle, or fade is an emergency. The older body doesn’t need fixing; it needs honoring.
Aging is not failure, it’s translation. The body tells the same story, just in a slower tongue. Wrinkles are transcripts of motion. Scars are marginalia. The point isn’t to erase them but to learn to read them differently.
Knowing when to do nothing in medicine at this stage becomes an act of grace. It’s saying, “This change is not a threat; it’s a sign of survival.”
Medicine’s Humility
Medicine was born in a different paradigm. For generations, physicians were trained to know their patients—to learn their histories, study their symptoms, and form hypotheses that could be tested with examination, simple laboratory studies, or cautious, conservative interventions. Diagnosis was a process of discovery, not default.
But today, the culture of care has shifted. The tools once meant to confirm a diagnosis have become the diagnosis itself. Highly reimbursed labs, imaging, and even pharmaceutical trials are now folded into the workup as if action were understanding. The patient becomes data; the doctor, a data manager. In the rush to prove something, we sometimes forget to know someone.
The best doctors I know, especially my father, Lou Caplan, are listeners first. They lean back in the chair, cross their arms, and just watch you speak. They know the hardest part of the job isn’t remembering what to prescribe—it’s remembering when silence, caring, and attention heal more than words or hurried action.
Humility is the hidden stethoscope, the one that hears what data can’t. “I don’t know yet” might be the most honest, and most healing, phrase in medicine.
Restraint isn’t a refusal of care. It’s mastery. The courage to wait takes as much training as the courage to act.
An Old, Yet New, Pulse
When I teach younger clinicians, I tell them this:
Every intervention is a footprint, and every footprint casts a shadow. Walk carefully. Medicine is full of good intentions that limp with regret. Sometimes the best treatment plan is no plan at all. Sometimes the cure is time. Or laughter. Or sleep.
Sometimes the medicine is trust. And the doctor’s greatest instrument is restraint.
Medicine, like music, depends on the rests as much as the notes. The silence between interventions isn’t absence, it’s rhythm. And without those spaces, it all collapses into a crash of sound and fury — and we know what that signifies.
💭 Funny Business: Gentle Truths from the Clinic
1️⃣ The body is like a teenager — it does its best work when you stop hovering.
2️⃣ No one ever healed faster because they refreshed their lab results five times a day.
3️⃣ Sometimes “take two of these” means “take two deep breaths.”
💬 What’s YOUR experience?
Have you ever regretted a medical decision that, in hindsight, could’ve waited?
What’s harder for you, taking action, or trusting time?
If “doing nothing” were a prescription, what would you use it for first?
🗨️ Reach out & connect:
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IG: drbenjamincaplan
LinkedIn: drbenjamincaplan
TikTok: drbenjamincaplan
YouTube: CEDclinic
Professional Connection: CEDclinic.com
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