One of the things that makes the practice of medicine both challenging and frightening is that “doing something” isn’t always in the patient’s best interest.

Not everyone with a fever needs a laboratory workup. Not everyone with an upper respiratory infection needs antibiotics. Not everyone with abdominal pain needs a CT scan.

Missed/delayed diagnoses can be devastating and life-threatening. What is tough to reconcile is that unnecessary workup and treatment can also lead to patient harm. Radiation exposure is not benign. “Shotgun” laboratory testing can lead to slight abnormalities that drive further testing and patient anxiety. Antibiotics, improperly given, cause resistance patterns and lead to side effects. Medical expenses bankrupt families.

While the goal of training and of practice is to continue to hone our skills as a physician to be able to more accurately determine whose story warrants further intervention and whose requires watchful waiting, it’s not black and white. The fact that there are shades of grey requires vigilance and reverence on the part of both physicians and our patients.