You know the patient is stable. The labs from this morning were reassuring. The exam is unchanged. But it’s 2 AM, your attending might round at 6, and something whispers that you should order one more test. Just to be safe. Just to show you did something.
So you order it.
And you add another task to the night shift nurse. Another cost to the healthcare system. Another layer of exhaustion to your already tired mind. But here’s the cost nobody talks about: you just taught yourself that your clinical judgment can’t be trusted.
Do that enough times (override what you actually think to do what feels safer) and eventually you stop recognizing what good medicine even looks like.
If this sounds familiar, you’re not alone. And you’re not wrong for feeling this way.
The Time I Learned This the Hard Way
I once ordered a chest X-ray on a completely stable post-op patient at 4 AM because I couldn’t articulate why I felt uneasy. Nothing on the exam suggested it. The patient’s oxygen saturation was perfect. But I was a newer PA, I was alone, and the what-ifs were louder than my clinical sense.
The X-ray was normal. The patient was annoyed at being woken up. The nurse gave me a look that said, “Really?” And I learned nothing except that my anxiety had a $200 price tag.
What I didn’t realize then was that I’d just reinforced a dangerous pattern: when in doubt, do something. Anything. Because doing something feels like being a good clinician, and doing nothing feels like negligence.
It took me years to understand what I was actually doing to myself.
Someone Tried to Warn Me
Thirty-four years ago, when I was a PA student at Duke, Dr. Frances Widmann came to lecture our class. Dr. Widmann was the author of Widmann’s Clinical Interpretation of Laboratory Tests, a foundational text we all carried. Her lecture was titled “Don’t Be a Swab.”
I remember it like it was yesterday.
She stood in front of us, this accomplished physician and educator, and essentially told us: stop swabbing everything you see. Stop ordering tests because you’re uncomfortable. Learn to sit with uncertainty. Trust your clinical judgment.
She was trying to teach us what I’m writing about now. That reflexive action isn’t the same as good medicine. That sometimes the most skillful thing you can do is wait and watch.
But here’s what’s haunted me: I heard that lecture. I understood it intellectually. And then I went out into the real world, where nobody reinforced that message, where the hidden curriculum taught me the opposite. Where covering yourself mattered more than clinical restraint.
It took me decades to come back to what Dr. Widmann tried to teach me that day.
The Two Forces Working Against You
There are two powerful cognitive biases at play here, and understanding them can change how you practice medicine.
Action bias is our brain’s deeply wired tendency to favor action over inaction, even when inaction is the better choice. Research on soccer goalkeepers shows they dive left or right on penalty kicks 94% of the time, even though staying centered gives them better odds of making the save. Why? Because if they dive and miss, they tried. If they stand still and miss, they failed.
In medicine, action bias shows up when we order that extra imaging study, prescribe that borderline-indicated antibiotic, or consult another specialist when watchful waiting would actually serve the patient better. We do this not because the evidence supports it, but because doing something feels safer than doing nothing.
The ambiguity effect makes us avoid options where information is missing or uncertain, even when those options might be better. As newer clinicians, we’re especially vulnerable to this. When we don’t know everything about a case, we gravitate toward the familiar, the algorithmic, the “covered” decision, even if a more nuanced approach would better serve our patient.
The hidden curriculum in medicine amplifies both these biases. Nobody teaches rounds on the patient who got better with tincture of time. Nobody gets praised for the antibiotic they didn’t prescribe. And nobody writes you up for over-testing, but missing something? That’s a different story.
Dr. Widmann tried to teach against this current. But one lecture, even a memorable one, can’t compete with years of institutional pressure to always do something.
What This Is Really Costing You
Every time you act against your clinical judgment just to feel safer, you’re training yourself not to trust your own thinking. Every time you choose the certain-but-mediocre path over the ambiguous-but-better one, you’re reinforcing your imposter syndrome.
You’re also contributing to defensive medicine, rising healthcare costs, and patient harm through overtreatment. But the cost to you is just as real: decision fatigue, moral injury, and the creeping sense that you’re not actually practicing good medicine. You’re just protecting yourself.
After enough shifts of second-guessing yourself into over-testing, something shifts. You stop asking “What does this patient need?” and start asking “What will keep me safe?” Those are two completely different questions. And only one of them is actually medicine.
A Way Forward: Building Tolerance for Uncertainty
Here’s how to work with these biases instead of against them.
Start by naming what you’re feeling. “I want to order this test because I’m anxious, not because it’s indicated.” That simple acknowledgment creates space between the emotion and the action. Then practice one moment of relief when you choose watchful waiting, and the patient does fine. Let yourself feel that win. Those moments are evidence that your judgment is sound.
Build a decision-making practice that engages your clinical reasoning. Before ordering anything, ask yourself three questions: “What am I worried will happen if I don’t do this?” Then: “What’s the actual probability?” And finally: “What would I advise a colleague to do?” This engages your thinking brain instead of your fear brain.
Find one trusted colleague or mentor who explicitly values appropriate inaction. Share your close calls where doing nothing was the right call. These conversations normalize uncertainty and model confidence in clinical judgment. If you’re the only one talking about watchful waiting, it will always feel risky. Find your own Dr. Widmann, someone who permits you to trust your clinical sense.
Reconnect with why restraint matters. You became a clinician to help people, not to generate billable procedures. Sometimes the most helpful thing you can do is spare a patient from unnecessary intervention. That’s good medicine. That’s meaningful work. Remind yourself of this when the 2 AM anxiety kicks in.
Track your wins differently. Instead of counting procedures or orders, notice when you resist the urge to over-treat, and the patient does well. Keep a small log if it helps. “Today I didn’t order the CT. Patient stable at discharge.” These are real clinical accomplishments. Maybe the most important kind.
Recognize that every unnecessary test you order costs you energy. Every decision made from anxiety instead of judgment depletes you. Practicing appropriate restraint actually preserves you because you’re not constantly second-guessing yourself or swimming upstream against your own clinical sense.
Small Shifts You Can Make Tomorrow
Before you order anything, take three deep breaths. Ask yourself: “Am I doing this because it’s indicated, or because I’m uncomfortable with uncertainty?”
Create a phrase you can use with attendings, such as “I’m considering watchful waiting because…”, and practice saying it out loud. Get comfortable defending inaction when it’s the right call.
Find one example this week where a patient got better without intervention. Write it down. Let it be evidence that sometimes your job is to monitor, not to fix.
At the end of each shift, ask yourself: “What did I not do today that served my patients well?” Celebrate those moments of clinical restraint.
Your Takeaway
The pressure to constantly do something is real. The discomfort with uncertainty is valid. But your clinical judgment is more reliable than your anxiety.
Dr. Widmann was right thirty-four years ago, and she’s right now: Don’t be a swab. Don’t reflexively test everything because you’re uncomfortable with not knowing. Learn to sit with uncertainty while you gather more information.
Learning to tolerate ambiguity and resist unnecessary action isn’t just good for your patients. It’s essential for your own well-being and longevity in this field. Because every time you override your clinical sense to feel safer, you’re not just ordering a test. You’re teaching yourself that you can’t be trusted.
And after enough of those lessons, you start to believe it.
You don’t have to have all the answers. You just have to be willing to sit with not knowing while you watch and wait. That’s not a weakness. That’s wisdom. That’s what Dr. Widmann tried to teach us.
