Calm doctor amidst swirling medical instruments.

The Art of Doing Nothing: When 'Less is More' in Medical Decisions

Soraya Malik in Health & Wellness December 2025 • 4 min read.

"Why standing your ground and resisting the urge to over-treat can be the best medicine."

In the high-stakes world of soccer, penalty kicks are moments of intense pressure. Goalkeepers often dive acrobatically, yet research suggests they might block more goals by simply standing still in the center. The fear of appearing inactive, however, often drives them to dive, even if it's the wrong choice.

This dilemma mirrors a challenge in medicine: the pressure to act, to test, to treat—even when restraint might be the better course. The medical community often fears missing a diagnosis more than the potential harm of unnecessary interventions. This bias can lead to a cascade of tests and treatments that ultimately do more harm than good, such as the overuse of broad-spectrum antibiotics leading to Clostridium difficile infections.

Patients often equate more care with better care, further incentivizing physicians to lower their thresholds for testing and treatment. This article explores the concept of 'less is more' in medical decision-making, arguing that sometimes, standing your ground is the most effective approach.

The Perils of Reflexive Medicine: Blood Cultures as a Case Study

Calm doctor amidst swirling medical instruments.

Consider the routine practice of ordering blood cultures for febrile patients. While fever often triggers immediate action, it's a surprisingly poor predictor of bacteremia in hospitalized individuals. This reflexive response to fever can lead to unnecessary testing, increased costs, and the overuse of antibiotics.

The consequences of this approach are significant. False-positive blood cultures are common, driving further investigations, prolonged hospital stays, and increased healthcare costs. It’s estimated that roughly half of positive blood culture results are false positives, contributing to a substantial financial burden.

Unnecessary antibiotic use
Increased hospital stays
Higher healthcare costs

Instead of reflexively ordering blood cultures, a more thoughtful approach is needed. Factors such as rigors and bandemia are stronger indicators of bacteremia. Validated clinical decision tools, like the Shapiro criteria, can help guide appropriate blood culture ordering, reducing unnecessary interventions and improving patient care.

Embracing Thoughtful Inaction

The decision to culture requires reflection, not reflex. In cases like community-acquired pneumonia (CAP), routine blood cultures have shown limited value, rarely changing patient management. A more selective approach, focusing on high-risk subgroups, is more effective.

Resisting the urge to reflexively act can be challenging, especially when facing pressure from colleagues or ingrained protocols. It requires a commitment to personalized medicine, carefully weighing the risks and benefits of each intervention.

By embracing thoughtful inaction, physicians can improve patient outcomes, reduce healthcare costs, and move away from a culture of reflexive medicine. As Martin Gabel wisely advised, 'Don't just do something, stand there!'

About this Article -

This article was crafted using a human-AI hybrid and collaborative approach. AI assisted our team with initial drafting, research insights, identifying key questions, and image generation. Our human editors guided topic selection, defined the angle, structured the content, ensured factual accuracy and relevance, refined the tone, and conducted thorough editing to deliver helpful, high-quality information.See our About page for more information.

This article is based on research published under:

DOI-LINK: 10.1001/jamainternmed.2017.3628, Alternate LINK

Title: Don’T Just Do Something, Stand There!

Subject: Internal Medicine

Journal: JAMA Internal Medicine

Publisher: American Medical Association (AMA)

Authors: Pranay Sinha

Published: 2017-10-01

Everything You Need To Know

What does 'less is more' mean in the context of medical decision-making, and why is it important?

The principle of 'less is more' in medicine suggests that resisting the urge to reflexively test and treat can often lead to better patient outcomes. This approach recognizes that unnecessary interventions, such as overusing broad-spectrum antibiotics which lead to Clostridium difficile infections or ordering excessive tests, can cause more harm than good. It encourages a more thoughtful and measured response, prioritizing careful evaluation over immediate action.

What are the dangers of reflexive medicine, and how does the example of blood cultures illustrate this?

Reflexive medicine, as illustrated by the routine ordering of blood cultures for febrile patients, can lead to unnecessary testing, increased costs, and the overuse of antibiotics. While fever often triggers immediate action, it's a surprisingly poor predictor of bacteremia in hospitalized individuals, leading to false-positive results that drive further investigations, prolonged hospital stays, and increased healthcare costs. This highlights the importance of questioning standard practices and considering the potential downsides of reflexive actions.

How can clinicians adopt a more thoughtful approach to ordering blood cultures, and what factors should they consider?

Instead of automatically ordering blood cultures for every febrile patient, a more selective approach is recommended. Factors such as rigors and bandemia are stronger indicators of bacteremia, and validated clinical decision tools, like the Shapiro criteria, can help guide appropriate blood culture ordering. In cases like community-acquired pneumonia (CAP), routine blood cultures have shown limited value, supporting the need for a more targeted strategy focusing on high-risk subgroups.

What are the driving forces behind the pressure to act in medicine, and how do these pressures influence decision-making?

The pressure to act in medicine often stems from a fear of missing a diagnosis and a perception that more care equates to better care. This can incentivize physicians to lower their thresholds for testing and treatment, even when restraint might be the better course. Patients also contribute to this dynamic, often equating more care with better care, further incentivizing physicians to lower their thresholds for testing and treatment. Understanding these pressures is crucial for promoting a more balanced and thoughtful approach to medical decision-making.

How can healthcare providers effectively implement the principle of 'less is more' to improve patient care and reduce unnecessary interventions?

Applying the 'less is more' principle in healthcare involves embracing thoughtful inaction and questioning reflexive practices. It requires clinicians to carefully evaluate the potential benefits and harms of interventions, considering factors such as the patient's overall condition, the likelihood of a true positive result, and the potential consequences of unnecessary treatment. By using validated clinical decision tools, focusing on high-risk subgroups, and prioritizing careful evaluation over immediate action, healthcare providers can improve patient outcomes and reduce the burden of unnecessary interventions.