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Welcome to The Do No Harm Project - Department of Medicine

University of Colorado School of Medicine

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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 incentives. 


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


Clinical vignettes 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 patient.”1


The Do No Harm Project:

·    Recognized 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 Competition2


·   Recognized by the Lown Institute as a key program to help trainees around the country reduce medical overuse and improve patient care


·    Recipient of the John Tooker Evergreen Award by the American College of Physicians, 2014


· ​   A convenient way to meet the aims of the CLER (Clinical Learning Environment Review) program from ACGME


·    A 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.

 2.  American Board of Internal Medicine Foundation. 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. doi:10.1001/jamainternmed.2013.9967