The Do No Harm Project. Brandon Combs, MD & Tanner Caverly , MD, MPH. O rigins. Harms from overuse occur frequently but clinicians fail to recognize Our goals : 1) promote recognition of harms from overuse 2) foster local discussions 3) change local culture .
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The Do No Harm Project
Brandon Combs, MD & Tanner Caverly, MD, MPH
1) promote recognition of harms from overuse
2) foster local discussions
3) change local culture
Pre-operative testing prior to cataract surgery in a patient who feels well
Using insulin to decrease A1C from 8 to 6.5 in an elderly patient with type 2 diabetes
Prescribing TMP/Sulfa for UTI in a patient with a sulfa allergy
Avoiding low dose chest CT for lung cancer screening in an otherwise well 65 year old, 50 pkyr smoker
A & B
A, B, & D
These all represent overuse
Institute of Medicine 2012. “Best Care at Lowest Cost: The Path to Continuously Learning Healthcare in America.” Accessed April 30, 2013. http://www.iom.edu/bestcare
Wait, how much?!
1/3 of the pie
1/4 of this waste
Easy to ignore – harms may be downstream or counterintuitive e.g. harm from prostatectomy 2 yrs after PSA detected cancer
Labels – patients do worse when told they are sick
Lots to diagnose with good prognosis if left alone e.g. 70% of men > 70 yrs have occult prostate cancer
Coley CM, Barry MJ, Fleming C, Mulley AG. Early detection of prostate cancer. I. Prior probability and effectiveness of tests. Ann Intern Med 1997;126:394-406
Lown, Bernard. Social Responsibility of Physicians (Essay 29). Avoiding Avoidable Care Conference: April 26, 2012
Authors: 3 or fewer. The first author must be a trainee (professional student, intern, resident, fellow, masters or doctoral student, or post-doctoral student).
Format: 600-800 words, including a clinical vignette headed “Story from the Front Lines” (an engaging story with enough clinical information for readers to understand the clinical issues) and a summary of the clinical issues headed “Teachable Moment” (succinct summary of the clinical issues, stating the evidence for overuse and suggesting an alternative approach).
References: 5 or fewer.
Narrativeswritten by trainees describing:
(1)unnecessary care resulting in harm or harm that was narrowly avoided or (2) the misdiagnosis of patient preferencesthat subsequently led to unnecessary care and harm or harm that was narrowly avoided.
Manuscripts should be 600-800 words, provide a clinical vignette that documents overuse of medical care, and a summary of the evidence that documents the care provided was unnecessary.