Commentary: When Doing Less Is Best

H. Stephen Williams; Joseph A. Zenel

doi:10.1542/pir.34-10-423

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H. Stephen Williams, MD, MPH

Department of Pediatrics, College of Osteopathic Medicine, Michigan State University, East Lansing, MI

Joseph A. Zenel, MD, Editor-in-Chief

Author Disclosure
Drs Zenel and Williams have disclosed no financial relationships relevant to this article. This commentary does not contain discussion of unapproved/investigative use of a commercial product/device.

Abbreviations:

CBC:: complete blood cell count
CRP:: C-reactive protein

Editor’s Note: During her acceptance of the 2012 Joseph W. St Geme Jr. Leadership Award, Dr Gail McGuinness remarked that certain elements of clinical competence require time to attain: “problem solving, pattern recognition, judgment, (and) capability for self-reflection.”¹ At a recent resident continuity clinic that I attended, I observed residents counsel parent after parent that their children did not need an antibiotic for their colds. By clinic’s end, the residents were visibly fatigued, and their resolve to follow evidence-based medicine diminished. The following self-reflection by a seasoned pediatrician offers encouragement for all of us to assess critically what we do and to pursue resolutely what is in the best interest of our patients.

Reference

1. McGuinness GA. The transformation of pediatric education with a focus on the subspecialists. Pediatrics. 2013;131(4):767-771.

In anything at all, perfection is finally attained not when there is no longer anything to add, but when there is no longer anything to take away, when a body has been stripped down to its nakedness.Antoine de Saint-ExuperyWind, Sand and Stars

Although innovative medical treatment of childhood cancer, rheumatologic disease, metabolic disorders, and asthma has lengthened and improved the quality of life for many children, during the now 34 years I have been a practicing pediatrician, I have also seen many previously well-accepted diagnostic and therapeutic interventions abandoned as the result of improvements in patient safety and resource-sparing practice, representing retreats from accepted practice through advances in understanding gained from curiosity, healthful skepticism, a bias toward inquiry, thoughtful questions, and good research.

Of course, true caring for the patient must always be present; however, I believe another reliable …