News

First ‘Do No Harm’ awards given for describing effects of medical overuse

Awards combat the ‘more is better’ attitude in medicine

February 17, 2015 (Boston, MA)—The Lown Institute today announced recipients of the first national Do No Harm Project Competition, which encouraged clinical medical trainees to write vignettes, or essays, chronicling harm or near harm resulting from medical overuse. The two vignettes chosen by a panel of experts were written by Spyridoula Maraka, MD, with secondary authors Derek O’Keeffe MD,  and Victor Montori, MD, all from the Mayo Clinic; and Stephanie Chen, MD, from Johns Hopkins, Bayview Medical Center.

Maraka is an endocrine fellow and Chen is an internal medicine resident. Their vignettes were selected from 34 that were submitted from around the nation.

The goals of the competition include improving clinicians’ recognition of the harms that patients may experience from overuse, providing a persuasive counterbalance to the ‘more is better’ culture in medicine and sharing ideas on how the delivery of care may be improved in the future.

“Medical overuse affects millions of patients every year in the United States,” said Vikas Saini, MD, president of the Lown Institute. “These vignettes demonstrate again that the ‘more is better’ culture can be harmful to patients, and they address alternative approaches that focus on what is in the best interests of individual patients.”

The project, jointly sponsored by the Lown Institute and the Do No Harm Project, and supported by the Robert Wood Johnson Foundation, was developed at the University of Colorado School of Medicine by Tanner Caverly, MD, MPH, and Brandon Combs, MD, after Caverly attended the Lown Institute’s 2012 annual conference. The program has been recognized by the American Board of Internal Medicine Foundation for its innovative approach to medical education and named a winner in the national Teaching Value/Choosing Wisely Competition.

The Maraka vignette recounts the case of a woman who suffered ill effects in the course of treatment for subclinical hypothyroidism in pregnancy. Without overt symptoms of dysfunction, but following guidelines that label 15 percent of pregnancy women “sub-clinically” hypothyroid, the patient was started on thyroid replacement medication. Soon after, palpitations set in, ultimately leading to an emergency room visit. The case demonstrates the harms that can occur, despite best intentions, with low thresholds for disease labeling and the subsequent treatments that ensue.

Chen’s vignette describes the case of an elderly man with dementia, admitted to the hospital after a fall. Discovered in his evaluation was a new hip fracture and stable atrial fibrillation that led to telemetry monitoring—a reasonable intervention, but not recommended in the guidelines. Caught in the tangle of wires and sounding alarms as he pulled at the leads, sedative medication was given to the patient and delirium resulted. Chen’s case reminds clinicians to use telemetry appropriately, even as they search for more data.

Eight additional submissions received honorable mentions for being selected as top 10 finalists. Several of these vignettes will be submitted for publication.

Maraka and Chen will present their vignettes at a special workshop at the Lown Institute’s Third Annual Conference, Road to RightCare: Engage, Organize, Transform, March 8-11 in San Diego, and will later receive a consulting session with Combs on implementing the Do No Harm Project in their communities.

In addition to Saini, Combs and Caverly, judges for the competition included Shannon Brownlee, MSc, senior vice president, Lown Institute; Mysha Mason, MD, resident, University of Colorado School of Medicine; Chris Moriates, MD, assistant professor, University of California, San Francisco Medical School; and Neel Shah, MD, founder, Costs of Care.

About the Lown Institute
The Lown Institute, a nonprofit, action-driven think tank in Boston, is dedicated to transforming the culture of medicine and building a healthcare system that is affordable, effective, personal and just. The Institute was founded by renowned cardiologist and Nobel Peace Prize recipient, Bernard Lown, MD, and supports his vision for compassionate healthcare. Visit www.LownInstitute.org and follow us on Twitter at @LownInstitute.

About the Robert Wood Johnson Foundation
For more than 40 years the Robert Wood Johnson Foundation has worked to improve health and health care. We are striving to build a national Culture of Health that will enable all to live longer, healthier lives now and for generations to come. For more information, visit www.rwjf.org. Follow the Foundation on Twitter at www.rwjf.org/twitter or on Facebook at www.rwjf.org/facebook.

Contact: Margie Coloian
mcoloian@LownInstitute.org
617-992-9349