Keijzers Gerben, Cullen Louise, Egerton-Warburton Diana, Fatovich Daniel M
Department of Emergency Medicine, Gold Coast University Hospital, Gold Coast, Queensland, Australia.
School of Medicine, Bond University, Gold Coast, Queensland, Australia.
Emerg Med Australas. 2018 Apr;30(2):273-278. doi: 10.1111/1742-6723.12922. Epub 2018 Jan 12.
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.
避免不必要的检查和治疗可能会很困难,而这些检查和治疗属于低价值医疗的一种形式。然而,医学中的每一项干预都有潜在危害,其危害可能超过潜在益处。审慎的临床惰性是一种通过不作为来做出积极回应的艺术。本文就如何将审慎的临床惰性融入我们的日常临床实践提供了建议,并概述了当前的一些倡议,如“明智选择”和“正确医疗联盟”。由于存在相互竞争的因素,“不作为”的决定可能很复杂,同时还强调了实施过程中的障碍。文中概述了几种促进审慎临床惰性的策略,重点是共同决策。预防医疗伤害必须成为现代医疗保健的支柱之一,而不进行干预的艺术,即审慎的临床惰性,可以成为一种以患者为中心的新型质量指标,以促进减少伤害。