Clinical Inertia: It Can Be Good For Your Health

This article cites a fascinating study in JAMA that looks at the benefits of the "less is more" approach to certain aspects of medicine. The authors "Phillips et al¹ intended to limit the discussion of inertia to disorders in which abnormal values may be the only manifestation of the disease, such as diabetes, hypertension, and dyslipidemia." This is a key characteristic of the conditions that can be treated to the point of danger in the name of prevention.

October 20, 2011, 10:20 am
When Doing Nothing Is the Best Medicine
By DANIELLE OFRI, M.D.

“Don’t just do something; stand there!”

It’s one of those phrases that attending physicians will spout off to their medical students while on rounds, trying to sound both sagacious and clever at the same time. It sometimes grates, but it does make a valid point, because so much of medicine is about “doing something.”

Sore throat? Prescribe an antibiotic.

New headache? Get a CT scan.

P.S.A. at the upper limit of normal? Get a biopsy.

Blood pressure still high? Add on another medication...

Of course, every “thing” a doctor does also has side effects — rampant bacterial resistance from antibiotic overuse; major increases in radiation exposure from unnecessary CT scans; incontinence or impotence from prostate cancer treatments that may do nothing to prolong life; toxic drug interactions from multiple medications, particularly in the elderly.

The admonishment “Don’t just do something; stand there!” reminds us that we should stop and think before we act, that there are many instances in which doing nothing is greatly preferable to doing something...

They focused on three common medical conditions — diabetes, elevated cholesterol and hypertension — for which there are established clinical guidelines for doctors to follow and “quality measures” that evaluate medical care. For all three illnesses, “lower is better” is the dominant mantra.

But while “lower is better” is probably true for large populations, that is not always the case for individual patients. In fact, there are some clinical trials in which aggressively lowered blood sugar or blood pressure have been associated with higher rates of dying.

Of course there are myriad situations where aggressive intervention is required, but it is helpful to have the reminder that sometimes less harm is done if you leave "well enough" alone.
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