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Emerg Med Australas. 2018 Apr;30(2):273-278. doi: 10.1111/1742-6723.12922. Epub 2018 Jan 12.

Don't just do something, stand there! The value and art of deliberate clinical inertia.

Author information

1
Department of Emergency Medicine, Gold Coast University Hospital, Gold Coast, Queensland, Australia.
2
School of Medicine, Bond University, Gold Coast, Queensland, Australia.
3
School of Medicine, Griffith University, Gold Coast, Queensland, Australia.
4
Emergency and Trauma Centre, Royal Brisbane and Women's Hospital, Queensland University of Technology, The University of Queensland, Brisbane, Queensland, Australia.
5
School of Clinical Science at Monash Health, Monash University Faculty of Medicine, Nursing and Health Sciences, Melbourne, Victoria, Australia.
6
Emergency Medicine, Royal Perth Hospital, The University of Western Australia, Perth, Western Australia, Australia.
7
Centre for Clinical Research in Emergency Medicine, Harry Perkins Institute of Medical Research, Perth, Western Australia, Australia.

Abstract

It can be difficult to avoid unnecessary investigations and treatments, which are a form of low-value care. Yet every intervention in medicine has potential harms, which may outweigh the potential benefits. Deliberate clinical inertia is the art of doing nothing as a positive response. This paper provides suggestions on how to incorporate deliberate clinical inertia into our daily clinical practice, and gives an overview of current initiatives such as 'Choosing Wisely' and the 'Right Care Alliance'. The decision to 'do nothing' can be complex due to competing factors, and barriers to implementation are highlighted. Several strategies to promote deliberate clinical inertia are outlined, with an emphasis on shared decision-making. Preventing medical harm must become one of the pillars of modern health care and the art of not intervening, that is, deliberate clinical inertia, can be a novel patient-centred quality indicator to promote harm reduction.

KEYWORDS:

Bayesian; clinical judgement; low-value care; overdiagnosis; shared decision-making

PMID:
29327445
DOI:
10.1111/1742-6723.12922
[Indexed for MEDLINE]

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