To raise awareness among trainees the importance of doing “as much as possible for the patient and as little as possible to the patient.”1 We often do too much to patients that is of little potential benefit and exposes them to unnecessary harm. As an example, 30% of health care costs in U.S. are on interventions that don’t benefit patients and 5% of the nation's gross national product is spent on tests and procedures that do not improve outcomes.2,3
We need a Do No Harm Project:
Harms from overtesting, overdiagnosis, and overtreatment are a serious threat to the health of our patients. We are thus ethically obligated to limit overuse when possible. Harms of overuse have not traditionally been taught to medical trainees and there are few incentives to pay attention to overuse: performance measures and payment incentives reward doing more and there is a dominant cultural belief that more care is better.
This stuff is going to be on the boards:
The next edition of ACP’s Medical Knowledge Self-Assessment Program (MKSAP) will have a focus on optimal diagnostic and treatment strategies, based upon considerations of value, effectiveness, and avoidance of overuse and misuse. Additionally, a high value curriculum for residents has been developed by the ACP.4
Important people are talking about the importance of avoiding overuse:
The Choosing Wisely Campaign: top 5 lists from specialty societies to raise awareness of “overuse or misuse of medical tests and procedures that provide little benefit, and in some instances harm.”5 Additionally, ACP Executive Vice-President and CEO Steven Weinberger has proposed high value care and resource stewardship as a 7th core competency for ACGME.6 A forthcoming section in JAMA Internal Medicine will showcase vignettes written by trainees that document the importance of avoiding overuse.
What we are doing:
Promoting clinical vignettes, written by trainees, about unnecessry care resulting in harm or harm that was narrowly avoided. These vignettes are posted online for vieweing by colleagues and submitted to conferences as well as to journals for publication.
1. Lown, Bernard. Social Responsibility of Physicians (Essay 29). Avoiding Avoidable Care Conference: April 26, 2012
2. Berwick DM, Hackbarth AD. Eliminating waste in US health care. JAMA 2012;307:1513-6
3. Orszag PR. Increasing the value of federal spending on health care. Testimony to Committee on the Budget, U.S. House of Representatives, 16 July 2008. Accessed at http://budget.house.gov/hearings/2008/07.16orszag.pdf on 4 December 2011
4. Ann Intern Med. 2012;():E-496. doi:10.7326/0003-4819-157-4-201208210-00496
5. Cassel CK, Guest JA. Choosing wisely: helping physicians and patients make smart decisions about their care. JAMA. 2012;307(17):1801-1802.
6. Weinberger SE. Providing high-value, cost-conscious care: a critical 7th general competency for physicians. Ann Intern Med. 2011; 155:386-388