Michael Steinberg, MD
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Steinberg M. Clinical Inertia. Ann Intern Med. 2002;137:547. doi: 10.7326/0003-4819-137-6-200209170-00024
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Published: Ann Intern Med. 2002;137(6):547.
TO THE EDITOR:
After reading the Perspective by Phillips and colleagues on clinical inertia (1), I was inclined to agree that the desire of patients and physicians to “stay the course” when treating chronic illnesses often interferes with achieving excellent care. However, on further reflection, I felt that the paper greatly oversimplified many aspects of day-to-day medical practice.
Phillips and colleagues underestimated the extent, depth, and persistence of clinicians' discussions with patients and families about the benefits, risks, and costs of intensifying medical therapies for chronic diseases. Some patients with atrial fibrillation who are otherwise excellent candidates for anticoagulation decline it despite my best efforts at persuasion. Likewise, many diabetic patients opt to avoid the demands of more intense glycemic control, despite the attendant increased risks for hypoglycemia and weight gain. Because discussions about such decisions are ongoing and often span months and years, however, their depth may not be adequately reflected in chart notes. Over time, tolerance of the status quo may appear to an outside reviewer as “inertia.”
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Print ISSN: 0003-4819 | Online ISSN: 1539-3704
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