Much Ado About (Doing) Nothing
Authors: Brendan M. Reilly
Journal: Annals of Internal Medicine (2009)

Editorials17 February 2009Much Ado About (Doing) NothingBrendan M. Reilly, MD and Arthur T. Evans, MD, MPHBrendan M. Reilly, MDFrom Weill Cornell Medical College and New York Presbyterian Hospital, New York, NY 10065, and Rush Medical College and Cook County (Stroger) Hospital, Chicago, IL 60612. and Arthur T. Evans, MD, MPHFrom Weill Cornell Medical College and New York Presbyterian Hospital, New York, NY 10065, and Rush Medical College and Cook County (Stroger) Hospital, Chicago, IL 60612.Author, Article, and Disclosure Informationhttps://doi.org/10.7326/0003-4819-150-4-200902170-00008 SectionsAboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail An important problem has surfaced in the wake of medical progress: "unnecessary care," defined as a diagnostic or treatment service that provides no demonstrable benefit to a patient. Remarkably, 30% of all medical care in the United States may meet this definition (1). If so, the medically "overserved" in the United States may outnumber the underserved. Reducing the former inequity (too much care too often for some patients) could free up resources to redress the latter (too little care too late for others).Unlike other problems in the U.S. health care system, only the medical profession can solve this one. ...References1. Fisher ES, Wennberg DE, Stukel TA, Gottlieb DJ, Lucas FL, Pinder EL. The implications of regional variations in Medicare spending. Part 2: health outcomes and satisfaction with care. Ann Intern Med. 2003;138:288-98. [PMID: 12585826] LinkGoogle Scholar2. Fisher ES, Wennberg DE, Stukel TA, Gottlieb DJ, Lucas FL, Pinder EL. The implications of regional variations in Medicare spending. Part 1: the content, quality, and accessibility of care. Ann Intern Med. 2003;138:273-87. [PMID: 12585825] LinkGoogle Scholar3. Reilly BM, Evans AT. Translating clinical research into clinical practice: impact of using prediction rules to make decisions. Ann Intern Med. 2006;144:201-9. [PMID: 16461965] LinkGoogle Scholar4. Büller HR, ten Cate-Hoek AJ, Hoes AW, Joore MA, Moons KG, Oudega R, et al; AMUSE (Amsterdam Maastricht Utrecht Study on thromboEmbolism) Investigators. Safely ruling out deep venous thrombosis in primary care. Ann Intern Med. 2009;150:229-35. LinkGoogle Scholar5. Wells PS, Anderson DR, Bormanis J, Guy F, Mitchell M, Gray L, et al. Value of assessment of pretest probability of deep-vein thrombosis in clinical management. Lancet. 1997;350:1795-8. [PMID: 9428249] CrossrefMedlineGoogle Scholar6. Wells PS, Anderson DR, Rodger M, Forgie M, Kearon C, Dreyer J, et al. Evaluation of D-dimer in the diagnosis of suspected deep-vein thrombosis. N Engl J Med. 2003;349:1227-35. [PMID: 14507948] CrossrefMedlineGoogle Scholar7. Kraaijenhagen RA, Piovella F, Bernardi E, Verlato F, Beckers EA, Koopman MM, et al. Simplification of the diagnostic management of suspected deep vein thrombosis. Arch Intern Med. 2002;162:907-11. [PMID: 11966342] CrossrefMedlineGoogle Scholar8. Oudega R, Hoes AW, Moons KG. The Wells rule does not adequately rule out deep venous thrombosis in primary care patients. Ann Intern Med. 2005;143:100-7. [PMID: 16027451] LinkGoogle Scholar9. Oudega R, Moons KG, Hoes AW. Ruling out deep venous thrombosis in primary care. A simple diagnostic algorithm including D-dimer testing. Thromb Haemost. 2005;94:200-5. [PMID: 16113804] CrossrefMedlineGoogle Scholar10. Toll DB, Oudega R, Bulten RJ, Hoes AW, Moons KG. Excluding deep vein thrombosis safely in primary care. J Fam Pract. 2006;55:613-8. [PMID: 16822449] MedlineGoogle Scholar11. McGinn TG, Guyatt GH, Wyer PC, Naylor CD, Stiell IG, Richardson WS. Users' guides to the medical literature: XXII: how to use articles about clinical decision rules. Evidence-Based Medicine Working Group. JAMA. 2000;284:79-84. [PMID: 10872017] CrossrefMedlineGoogle Scholar12. Wells PS, Anderson DR, Bormanis J, Guy F, Mitchell M, Gray L, et al. Value of assessment of pretest probability of deep-vein thrombosis in clinical management. Lancet. 1997;350:1795-8. [PMID: 9428249] CrossrefMedlineGoogle Scholar13. Kearon C, Ginsberg JS, Douketis J, Crowther M, Brill-Edwards P, Weitz JI, et al. Management of suspected deep venous thrombosis in outpatients by using clinical assessment and D-dimer testing. Ann Intern Med. 2001;135:108-11. [PMID: 11453710] LinkGoogle Scholar14. Reilly BM, Evans AT, Schaider JJ, Das K, Calvin JE, Moran LA, et al. Impact of a clinical decision rule on hospital triage of patients with suspected acute cardiac ischemia in the emergency department. JAMA. 2002;288:342-50. [PMID: 12117399] CrossrefMedlineGoogle Scholar15. Emanuel EJ, Fuchs VR. The perfect storm of overutilization. JAMA. 2008;299:2789-91. [PMID: 18560006] CrossrefMedlineGoogle Scholar Author, Article, and Disclosure InformationAuthors: Brendan M. Reilly, MD; Arthur T. Evans, MD, MPHAffiliations: From Weill Cornell Medical College and New York Presbyterian Hospital, New York, NY 10065, and Rush Medical College and Cook County (Stroger) Hospital, Chicago, IL 60612.Disclosures: None disclosed.Corresponding Author: Brendan M. Reilly, MD, Weill Cornell Medical College, 525 East 68th Street, New York, NY 10065; e-mail, [email protected]cornell.edu.Current Author Addresses: Dr. Reilly: Weill Cornell Medical College, 525 East 68th Street, New York, NY 10065.Dr. Evans: Cook County (Stroger) Hospital, 1900 West Polk Street, Chicago, IL 60612. PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetailsSee AlsoSafely Ruling Out Deep Venous Thrombosis in Primary Care Harry R. Büller , Arina J. ten Cate-Hoek , Arno W. Hoes , Manuela A. Joore , Karel G.M. Moons , Ruud Oudega , Martin H. Prins , Henri E.J.H. Stoffers , Diane B. Toll , Eit F. van der Velde , Henk C.P.M. van Weert , and Metrics Cited byDeterminants of the de-implementation of low-value care: a multi-method studyValidation of Quality Indicators Targeting Low-Value Trauma CareQuality Indicators Targeting Low-Value Clinical Practices in Trauma CareEconomic Evaluation of In-Hospital Clinical Practices in Acute Injury Care: A Systematic ReviewLow‐value injury care in the adult orthopaedic trauma population: A systematic reviewLow-Value Clinical Practices in Adult Traumatic Brain Injury: An Umbrella ReviewPatients Left Behind: Ethical Challenges in Caring for Indirect Victims of the Covid-19 PandemicEconomic evaluation of intrahospital clinical practices in injury care: protocol for a 10-year systematic reviewCorrelation between NDI, PROMIS and SF-12 in cervical spine surgeryLow-value injury care in the adult orthopaedic trauma population: a protocol for a rapid reviewComparison of Multilevel Anterior Cervical Discectomy and Fusion Performed in an Inpatient Versus Outpatient SettingLow-value clinical practices in adult traumatic brain injury: an umbrella review protocolPatient-level resource use for injury admissions in Canada: A multicentre retrospective cohort studyLow-value clinical practices in injury care: A scoping review and expert consultation surveySafety of 2-level Anterior Cervical Discectomy and Fusion (ACDF) Performed in an Ambulatory Surgery Setting With Same-day DischargeValue based spine care: Paying for outcomes, not volumePhysician perspectives on Choosing Wisely Canada as an approach to reduce unnecessary medical care: a qualitative studyIntroduction. Predictive analytics in medicineThe Role of Clinical Registries in Health CareOutcomes and Value in Spine SurgeryLow-value clinical practices in injury care: a scoping review protocolClinical Registries and Evidence-Based Care PathwaysSearch Filters for Finding Prognostic and Diagnostic Prediction Studies in Medline to Enhance Systematic ReviewsChallenges to Radiologists: Responding to the Socioeconomic and Political Issues Keeping Radiologists Up at Night: The Third Annual Open Microphone Sessions at the 2011 AMCLCIncentive Compatible Reimbursement Schemes for Physicians 17 February 2009Volume 150, Issue 4Page: 270-271KeywordsCancer screeningD-dimerLikelihood ratioPatient advocacyPatientsPrimary care physiciansSafetySpecificityThromboembolismUltrasound imaging ePublished: 17 February 2009 Issue Published: 17 February 2009 Copyright & PermissionsCopyright © 2009 by American College of Physicians. All Rights Reserved.PDF downloadLoading ...