What If You Do Nothing? Understanding the Risk of Inaction in Medicine

When patients come to me with a medical decision to make — whether it’s about starting a medication, getting a vaccine, or moving forward with a recommended procedure — the most common question I hear is: “What are the risks if I do this?” It’s an important and completely valid question. Every intervention in medicine, no matter how routine, comes with potential risks or side effects. And as physicians, it’s our responsibility to be transparent about those. But here’s the part of the conversation that often gets overlooked — and that I wish more patients would consider:

What are the risks if you don’t?

In medicine, this can be referred to as the “risk of inaction” — and it can be just as important, if not more so, than the risks of the treatment itself. Unfortunately, it’s a perspective that doesn’t come naturally to many of us. We're often trained — by media, past experiences, or even just human instinct — to be cautious of what could go wrong if we act. But we’re less likely to think through what could go wrong if we don’t.

Let me share what this looks like in real life.

The Statin Conversation

Imagine a 55-year-old patient with high cholesterol and a strong family history of heart disease. Her labs show elevated LDL, and based on national guidelines and her risk profile, I recommend starting a statin to lower her long-term risk of a heart attack. She’s concerned about the side effects she’s read online — muscle aches, liver damage, memory issues. She asks, “Is it safe to take this every day for the rest of my life?” My answer? “That’s a great question. But can we also talk about what happens if you don’t take it?” Because that decision also has a trajectory: continued plaque buildup in the arteries, increasing risk of heart disease, and possibly a heart attack that could have been prevented.

We Actually Already Do This — In the OR

Interestingly, the medical system already has one built-in place where both sides of the risk equation are formally acknowledged: informed consent before a procedure or surgery. When you sign a surgical consent, you’re not just agreeing to the risks of the operation — you’re also being informed of the risks of not proceeding.

Let’s take appendicitis as an example. A patient arrives in the ER with classic symptoms of acute appendicitis. The surgical team recommends an appendectomy. Before the patient is taken to the OR, the surgeon goes over the risks: bleeding, infection, damage to nearby structures. But — and this is key — they also explain the risks of not having the surgery: the appendix could rupture, leading to peritonitis (a life-threatening infection), sepsis, or the need for more invasive emergency surgery later. Even if the patient is scared of being put under anesthesia or worried about surgical pain, they usually understand this:

Doing nothing could be far more dangerous.

That’s why the risk of inaction is always part of that discussion. It should be part of every important medical decision, not just surgeries.

Vaccines, and the Fear of the Rare

Another common example is vaccinations. Whether it’s the shingles vaccine, the flu shot, or the newer RSV vaccines for older adults, I often hear patients express worry over possible side effects — and I understand that. No one wants to risk feeling unwell after a shot. But what’s often misunderstood is how risky the disease itself can be. Shingles isn’t just a rash — it can lead to long-term nerve pain (post-herpetic neuralgia) that can significantly impact your quality of life. RSV, which many think of as a “kids’ virus,” can cause serious complications in older adults with lung or heart conditions. So yes — it’s fair to ask, “What are the risks of the vaccine?” But we also have to ask, “What is the risk of the illness I’m trying to prevent?”

Doing Nothing Is a Decision

When a patient declines a recommendation — even temporarily — it’s easy to think of that choice as “playing it safe.” But here’s the truth:

Inaction in medicine is not neutral. It carries its own set of outcomes, and those outcomes can be just as serious as those we fear from treatment.

Sometimes, doing nothing is the right choice. Maybe the risks of treatment do outweigh the benefits in that moment. Or maybe more information is needed. But that decision should still be made with clarity — with a full understanding of both the risks of action and the risks of inaction.

Medicine Is a Balancing Act

As physicians, our goal is not to convince you to say “yes” to every recommendation. Dr. Garland and I try to help you understand the trade-offs — the possible benefits and the potential downsides — on both sides of the equation. We want our patients to feel confident making informed decisions. That means not just asking "What might go wrong if I do this?" but also: "What might happen if I don't?"

That’s the heart of shared decision-making. It’s not about pushing a treatment plan — it’s about having an honest, nuanced discussion where we weigh all the possibilities together.

The Bottom Line

Next time you’re facing a medical decision — whether it’s starting a medication, scheduling a surgery, or saying yes to a vaccine — remember to ask both sides of the risk question. You deserve to understand not just what you’re getting into, but also what you might be walking away from. Because in medicine, every decision — including the decision to wait or decline — carries a path forward. Our job is to help you see where those paths may lead.

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Dr. Garland + Dr. Cardona

About Cardona Direct Primary Care & RefineMD Aesthetics

At Cardona Direct Primary Care, Dr. Cardona and Dr. Garland provide personalized healthcare, including direct primary care, obesity medicine, and aesthetic treatments. Dr. Cardona is board-certified in both family medicine and obesity medicine and has a special interest in medical weight loss. Dr. Garland is board-certified in family medicine and is a certified medical marijuana provider. She has a special interest in skincare and is eager to assist with your individual skincare needs. Located in Jacksonville, FL, we are dedicated to prioritizing you. Contact us at 904-551-4625 or visit our website at www.cardonadpc.com to learn more and schedule your appointment today!