“I will apply, for the benefit of the sick, all measures [that] are required, avoiding those twin traps of overtreatment and therapeutic nihilism.”– Modern Hippocratic Oath
During my clinical years of medical school, every patient encounter, whether at the hospital or during a clinical exam, followed a similar pattern of discussion with the senior doctor: I would present the patient’s complaint, summarize the clinical findings, and then move on to propose differential diagnoses and suggest investigations. However, there was always an unspoken test hidden within the spoken one; I had to justify every single investigation I proposed. Why this blood test? Why that scan? What value would it add to this specific case? If my reasoning was weak, the senior doctor would remind me that no test should ever be ordered without a clear purpose. Behind this exercise lay a lesson far greater than exam technique. I understood that each unnecessary test not only strains resources but also adds anxiety, discomfort, and a financial burden on the patient. The oath’s wisdom echoed in those moments: medicine is not about doing everything possible, but about doing what is truly needed, guided always by balance, and focused on providing the best personalized care for each patient.
Also Read: A Noble Gift: Maintaining Respect and Dignity
I have seen overtreatment take many forms. It may be an elderly patient subjected to endless scans, when each trip down the hospital corridor leaves them breathless. It may be a series of unnecessary blood tests ordered to ease the physician’s anxiety rather than the patient’s need. These moments are not born out of cruelty, but often stem from fear: fear of missing something, or fear of saying “there is nothing more we can do.” I have also observed a more subtle form of overtreatment, one that arises not from medical need, but from the mindset and priorities guiding the physician. Some doctors approach medicine as if it were a catalog of services, negotiating treatment plans with patients almost like a business deal. When the mindset of business overtakes the calling of care, the patient can become a customer, and health becomes something negotiable.
Decisions start to revolve around what is financially viable or convenient rather than what is truly in the patient’s best interest. This mindset drifts far from the essence of the oath: to serve, to heal, and to guide with integrity. When business controls the way a physician thinks about treatment, the core purpose of medicine, to alleviate suffering and offer the best personalized and meaningful care, is lost. The medical practice can lose its humanity, becoming routine and impersonal, leaving patients to carry not only the burden of their illness but also the consequences of care driven by profit rather than compassion.
Click here to join our WhatsApp channel here
On the other side of overtreatment lies therapeutic nihilism, which is the quiet withdrawal that happens when a doctor believes there is nothing more to offer. It is not always the result of medical limitations or the disease itself, but often stems from fatigue, discouragement, or a sense of hopelessness. This attitude may leave the patients not only without treatment but also without guidance and reassurance. Preventing therapeutic nihilism requires awareness and reflection to recognize when our discouragement might cloud judgment, to seek support from colleagues, and to remember that medicine is not only about curing disease but also about being present to offer care and comfort even when a cure is no longer possible.
The balance between overtreatment and therapeutic nihilism is established through listening to the patient, to their story, to their fears and hopes. It is a continuous act of weighing, of asking not only “What can we do?” but also “What should we do?” For one patient, balance might mean pursuing a risky surgery because it offers them a chance to walk again and live fully. For another, balance might mean saying no to that very same surgery, because the burden of recovery would outweigh whatever time is left. For students and young doctors, it is very important to understand this balance and know how to apply it. In lecture halls and ward rounds, there is pressure to always know the right answer, to list every test, and every possible treatment. Yet the true art of medicine lies not in naming every investigation and intervention, but in choosing wisely, guided by both knowledge and compassion. What matters most is not how many facts a doctor can recall, but how they are applied for the benefit of each unique patient. Ultimately, balance is not about doing less or more, but about doing what matters most for the person in front of us.
What matters most is not how many facts a doctor can recall, but how they are applied for the benefit of each unique patient.
Looking back, the lessons from my clinical years will remain deeply carved in my memory. The thorough discussions I had with my senior doctors, the need to justify each investigation, and the attention to what truly matters for the patient taught me more than medical knowledge. These discussions taught me proper medical judgment, reflection, and responsibility. The habit of thinking critically about every choice, weighing risks and benefits, and always considering the person behind the illness, is what must guide us throughout our careers. It reminds us that care guided by balance is not just a principle in the oath; it is the way we ensure our decisions are made in the best interest of our patients and reflect the integrity and compassion that define the deeper purpose and responsibility of being a physician.
