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Primary care
Reducing overuse by recognising the unintended harms of good intentions
  1. David Slawson1,2,
  2. Allen F Shaughnessy3,4
  1. 1 Department of Family Medicine, Atrium Health, Charlotte, North Carolina, USA
  2. 2 Department of Family Medicine, University of North Carolina, North Carolina, United States
  3. 3 Department of Family Medicine, Tufts University School of Medicine, Malden, Pennsylvania, USA
  4. 4 Department of Family Medicine, Cambridge Health Alliance, Malden, Massachusetts, USA
  1. Correspondence to Dr David Slawson, Family Medicine, Atrium Health, Charlotte, NC 28203-5812, USA; slawson.david{at}


Overdiagnosis and overtreatment—overuse—is gaining wide acceptance as a leading nosocomial intervention in medicine. Not only does overuse create anxiety and diminish patients’ quality of life, in some cases it causes harm to both patients and others not directly involved in clinical care. Reducing overuse begins with the recognition and acceptance of the potential for unintended harm of our best intentions. In this paper, we introduce five cases to illustrate where harm can occur as the result of well-intended healthcare interventions. With this insight, clinicians can learn to appreciate the critical role of probability-based, evidence-informed decision-making in medicine and the need to consider the outcomes for all who may be affected by their actions. Likewise, educators need to evolve medical education and medical decision-making so that it focuses on the hierarchy of evidence and that what ‘ought to work’, based on traditional pathophysiological, disease-focused reasoning, should be subordinate to what ‘does work’.

  • information management
  • health informatics
  • education & training (see medical education & training)
  • quality in healthcare
  • medical education & training

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  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Provenance and peer review Not commissioned; externally peer reviewed.