The case for masterly inactivity

Rectal biopsy forceps

Rectal biopsy forceps. ‘My doctor,’ says Dalrymple, ‘whom I have never met, sends me (or rather his computer sends me) repeated calls for screening. I don’t want to know whether or not I have a 10 per cent chance of a heart attack within the next 10 years.’ Dalrymple always respectfully declines screening offers from fellow physicians. For example, when receiving a colonoscopy invitation, ‘I always tell myself I am too busy just now, I will have it another time.’

Many screening procedures, writes Dalrymple,

are doubtful at best; some do more harm than good, by arousing anxiety or by promoting unnecessary surgery, as well as through more immediate side-effects. Increasingly, the patient is not so much ill as the bearer of risk factors for disease, whose statistical effect the doctor attempts to nullify.

Annual health checks may be

a waste of time—unless wasting time by occupying it is the whole object of the activity, in which case wasting time is not wasting time but using it gainfully. Gainfully, that is, to the person who wastes his time (the doctor) rather than has his time wasted for him (the patient). His time is well and truly wasted.

There is, says Dalrymple,

the assumption that doing something must be better than doing nothing. Doctors of the past, because there was so little they could in fact do, employed a technique known as masterly inactivity: they assumed an alert watchfulness, giving the patient the impression, which was false but reassuring, that they would do what had to be done in the event that anything untoward happened. Since most people got better anyway, this seemed to confirm the wisdom of the doctor.

But masterly inactivity

is no way to increase your fee for service or gain a reputation for technical mastery. Patients too prefer to think that they are doing something rather than nothing to preserve themselves. That is why some of them are not merely surprised, but aggrieved when illness strikes them: for they have done all that they were supposed to do to remain in good health, from eating broccoli to regular bowel biopsies.

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