The Do No Harm Project

The Do No Harm Project

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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.

To read the full release, click here.

Clinical Vignettes Increase Awareness of Overuse

Photo of Dr. Tanner Caverly, co-creator of the Do No Harm Project.

Dr. Tanner Caverly

The Do No Harm Project is an award-winning program that uses clinical vignettes written by trainees to improve recognition of the harms that can result from medical overuse. The goal of the program is to improve clinicians’ awareness of the harms patients may experience because of overuse, and to share ideas about how the delivery of care may be improved in the future. In an era of increasingly depersonalized health care, the Do No Harm Project promotes the importance of thoughtful, individualized care tailored to the patient.

The Project was created at the University of Colorado – Denver by Dr. Tanner Caverly and Dr. Brandon Combs, after Dr. Caverly attended the Lown Institute’s 2012 Avoiding Avoidable Care conference. In 2013, the program was recognized by the American Board of Internal Medicine Foundation and Costs of Care as a winner of their Teaching Value/Choosing Wisely Competition. It has also inspired the Teachable Moment series in JAMA Internal Medicine. More recently, this program has led to an Evergreen Award from the American College of Physicians.

How Do No Harm Works

Photo of Dr. Brandon Combs presenting the Do No Harm Project to the Medical Education Working Group at the 2013 Lown Conference

Dr. Brandon Combs presenting the Do No Harm Project to the Medical Education Working Group at the 2013 Lown Conference

Trainees participating in the Project identify a case where a patient was harmed by avoidable medical treatment, then write a clinical vignette reflecting on what went wrong in that patient’s care. After each case is written up, it is posted online for viewing by colleagues. A quarterly competition for “best case” is sponsored by the American College of Physicians and all participants are encouraged to submit for publication to “Teachable Moments” in JAMA Internal Medicine. Vignettes can also be presented to colleagues in a “morning report” format to promote discussions about how similar harms from overuse can be avoided in the future.

Participants have found that clinical vignettes are a potent way to humanize the harms of overtreatment, and provide a persuasive counterbalance to the “more is better” culture.

The Lown Institute, in collaboration with the Institute’s Fellow for medical education, Dr. Brandon Combs, is expanding the Do No Harm Project at institutions across the country. Do No Harm Projects and similar efforts are underway in residency programs at UCSF, The University of Alabama-Birmingham, the Geisel School of Medicine at Dartmouth, and Saint Louis University, and in the third-year longitudinal integrated clerkship for medical students at the University of Colorado.

Do No Harm Project Resources

To learn more about starting a Do No Harm Project in your medical school, teaching hospital, or other training program, contact our Manager, Strategic Outreach, Paul Williams, at pwilliams@lowninstitute.org.

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