Much Ado About (Doing) Nothing

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. 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