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. 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. doi:10.1001/jamainternmed.2013.9967
----- WHAT'S NEW -----
Congratulations to Jennifer Weiskopf, MD - her vignette was recently published in JAMA IM's Teachable Moments series!
Congratulations to Roxana Naderi, the most recent winner of the Do No Harm Project competition! Her vignette about unintended hypoglycemia is here!
Read an excellent blog post by our very own Meredith Niess on why stories of overuse matter.
Read about our exciting collaboration with the Lown Institute for the first ever Do No Harm Project Vignette National Competition. Trainees: we want to hear your stories!
More vignettes from CU published in JAMA IM's teachable moments! Congrats to Ed Murphy, MD and Joseph Roberts, MD. Read their cases here and here.
More CU trainees getting their DNHP vignettes published! Congratulations to Allison Wolfe and Mim Ari! Read their vignette here.
Congratulations Ken Hung, MD - the most recent quartlery winner of the Do No Harm Project! His vignette is here.
Congratulations Mysha Mason, MD - her DNHP vignette was just published in JAMA IM! Read it here!
Two more CU trainees get their DNHP cases published in JAMA IM! Kudos to Kenneth Hung, MD from Internal Medicine and Avery Mackenzie, MD from Emergency Medicine! Their cases on the harms of medication overuse can be viewed here and here.
CU Dept of Internal Medicine Teams with Lown Institute for the first Improving Value, Reducing Harm: Right Care Alliance Conference Oct 11, 2014! Registration is free for CU medical students and internal medicine housestaff!
The Do No Harm Project has been identified by the Lown Institute as a key program to help trainees around the country reduce medical overuse!
Congratulations to Meredith Niess! Her case
is the first annual winner of the Do No Harm Project competition! Read it here: Pre-operative Chest X-rays: A Teachable Moment
Congratulations to Allison Wolfe, MD - Her case was selected by a panel from the Colorado Chapter of the American College of Physicians as the 4th quarter winner of the Do No Harm Project!
Shelby Badani, MSPH (MSIV) published in Teachable Moments in JAMA IM! Read our first case by a student: Chronic Concern Over an Acute-Phase Reactant
Pai Liu, MD published in Teachable Moments in JAMA IM! Read her case here: Diuretics and Diarrhea: A Dangerous Combination
Do No Harm Project in the UCH Insider Magazine!
The Do No Harm Project has been named an innovation winner of the ABIM Foundation and Costs of Care Teaching Value and Choosing Wisely Competition! Read about it here!
Congratulations to Meredith Niess! Her Do No Harm Project case is the first published in Teachable Moments in JAMA IM! Read it here: Pre-operative Chest X-rays: A Teachable Moment
Trainees: share your Teachable Moments with us and JAMA Internal Medicine! Learn more here: Too Much Medicine Happens Too Often: The Teachable Moment and a Call for Manuscripts from Clinical Trainees
Congratulations to Avash Kalra, MD - His case: "300 Days of Sunshine" was
selected by a panel from the Colorado Chapter of the American College of
Physicians as the third quarter winner of the Do No Harm Project!
Follow us on Twitter! @DoNoHarmProject
Updated lists from The Choosing Wisely Campaign on tests, procedures, and treatments "that physicians and patients should question."