Too much medicine,
or medical overuse, occurs when the benefits of an intervention are negligible,
the potential harms of an intervention exceed its potential benefit, or when a service
is provided to a patient who, if fully informed, would have declined it.
Spending on overuse is an important driver of healthcare costs in the United
States and may limit equitable access to necessary care. More importantly,
medical overuse manifesting as overdiagnosis and overtreatment exposes patients
to unnecessary harm. We are ethically obligated to limit overuse when
possible. Recognizing overuse and its downstream harms can be difficult and
failing to attend to potential harms can lead to interventions that are
harmful. In the United States, there is a dominant belief that more healthcare
is better – a belief that is reinforced by financial and legal
The goal of the
Do No Harm Project is to use clinical vignettes written by trainees to improve
recognition of harms that may result from medical
overuse and to drive a needed culture change in the practice of medicine.
are a potent way to humanize the harms of medical overuse and provide a
persuasive counterbalance to the “more is better” culture. Beyond
cost-consciousness, “do no harm” is a powerful appeal to our professionalism.
In an era of increasingly depersonalized health care, the Do No Harm Project
promotes the importance of thoughtful, individualized care tailored to the
unique preferences of our patients. To borrow a phrase from Dr.
Bernard Lown, we seek to remind clinicians of the importance of
doing “as much as possible for the patient and as little as possible to the
The Do No
by the American Board of Internal Medicine Foundation for its innovative
approach to medical education and named a winner in the national Teaching
Value/Choosing Wisely Competition.2
Recipient of the John Tooker Evergreen Award by the American
College of Physicians, 2014
series in JAMA Internal Medicine called “Teachable Moments” launched September 2013 as a
result of the Do No Harm Project and is dedicated to publishing vignettes
describing harms from overuse from trainees around the country.3
1. Lown B. Social responsibility of
physicians [essay 29]. Presented at: Avoiding Avoidable Care Conference;
Cambridge, Massachusetts; April 26, 2012.
American Board of Internal Medicine Foundation. http://www.abimfoundation.org/News/ABIM-Foundation-News/2013/Teaching-Value-and-Choosing-Wisely-Competition-Winners-Announced.aspx. Accessed November 11, 2013.
3. Caverly TJ, Combs BP, Moriates C, Shah N,
Grady D. Too much medicine happens too often: The teachable moment and a call
for manuscripts from clinical trainees. JAMA Internal Medicine. 2013.