Takeaway
Time can be used as a deliberate clinical tool that can clarify diagnoses and reduce unnecessary testing. For best results: combine with a solid patient-clinician relationship to strengthen trust.
Lifelong learning in clinical excellence | September 9, 2026 | 1 min read
By Jeffrey Millstein, MD, Penn Medicine
When a middle-aged woman presented to my office with abdominal bloating and irregular bowel movements that had started two days earlier, she appeared more worried than ill. She had no fever, bleeding, significant pain, or other alarm symptoms, and her examination was unremarkable. Despite this, she was concerned about pancreatic disease, a fear reinforced by conversations with a friend and online research. Like many patients, she wanted to know which tests would provide answers: blood work, ultrasound, or CT imaging.
The clinical reasoning
After reviewing her symptoms and examination findings, I explained that her symptoms were most consistent with a self-limited gastrointestinal illness. We discussed why conditions such as pancreatitis or other serious intra-abdominal disorders typically present differently, often with more severe pain, vomiting, or objective examination findings.
Time as a diagnostic tool
The most important diagnostic tool at that moment wasn’t a lab test or imaging study. It was time. Two days later, a follow-up call confirmed that her symptoms had nearly resolved, validating the diagnosis without exposing her to unnecessary testing.
Communicating this strategy to patients
Clinicians should be explicit when recommending a period of observation. Patients often interpret “give it time” as uncertainty or dismissal. Instead, we can explain that time itself is serving a diagnostic purpose. I tell patients, “The next few days will give us important information. Improvement supports our working diagnosis; persistent or worsening symptoms tell us we need to investigate further.”
When time isn’t appropriate
Of course, time isn’t always the appropriate diagnostic tool. Potentially high-risk presentations such as chest pain, neurologic deficits, or signs of sepsis demand immediate evaluation because the consequences of delay may be catastrophic.
Building trust through partnership
The test of time depends on a strong patient-clinician partnership. Patients need to understand the rationale, know what warning signs to watch for, and have a clear pathway for follow-up. Used thoughtfully, time isn’t diagnostic inaction. It’s a deliberate, evidence-based clinical tool that can clarify diagnoses, reduce unnecessary testing, and strengthen patient trust.
This piece expresses the views solely of the author. It does not necessarily represent the views of any organization, including Johns Hopkins Medicine.