The Issue With Always Treating

The Issue With Always Treating

Joy Stepinski, MSN, RN-BC

October 2, 2025

In a previous article, we reviewed the fourth assumption in Less Medicine More Health by Dr. H. Gilbert Welch [1], which suggests that seeking more information may not always be the best choice for some people. This month, let’s examine the fifth assumption, that action is always better than inaction.

The author starts with a story about President Garfield. Garfield was shot in the back with a pistol in 1881. The bullet stopped by his pancreas, and miraculously, the president survived. The gunshot wound did not kill him. Instead, surgeons attempted to locate the bullet under exploratory surgery. Unable to retract the object with fingers, they inserted different instruments into the president’s wound. What killed him was an infection. Garfield experienced fever, a large abscess with pus, and consequently, abscesses in other parts of the body. He lost significant weight. Although the gunman admitted to shooting the president, he did not plead guilty to the murder. The culprit was the surgeons who attempted to treat the president. While many soldiers suffered gunshot wounds during the Civil War, they did not always die as a result of their injury. This was due to the decision not to treat them and not to perform exploratory surgery.

This story is meaningful. President Garfield is not alone. Many patients unnecessarily suffer infections and other events at the hands of healthcare.

Welch states that several motivating factors encourage doctors and patients to seek treatment. Performing a treatment offers a tangible solution to make patients feel valued and heard when they are suffering. Some patients will improve naturally simply with the gift of time, but the treatment receives the credit. Other patients get better simply by having their problem addressed, due to the placebo effect. Finally, patients and doctors may experience less regret just by trying something.

A good question to ask when making decisions is: “What happens if I do nothing?” (p. 138). Sometimes, not doing anything allows the body to heal on its own. Refusing treatment or waiting before acting is a patient's right and part of informed decision-making.

Reference:

1.      Welch, H. G. (2015). Less medicine, more health: 7 assumptions that drive too much medical care. Beacon Press.