Blog | Thursday, July 23, 2015

Learning to wait and observe by avoiding the 'do something syndrome'

A wonderful blog post made me think – Do Something Syndrome. It reads, “We all have moments where we fall victim to the curse of Do Something Syndrome. In fact the modern organization is full of do something syndrome. The key is to try and realize when we are doing it and back away.”

This post makes we wonder about the entire “quality” movement. As I recall, many advocates for performance measures have argued that we should start measuring things because we just have to start.

We have had harm from performance measurement! The famous 4 hour pneumonia rule provides one example: “The four-hour rule was based on 2 large retrospective studies, one of which appeared in the March 22, 2004, Archives of Internal Medicine. That study concluded that receiving a dose of antibiotics within four hours of arriving at the hospital was associated with ‘a 15% relative reduction in 30 day mortality,’ which calculates to a 1.1% absolute reduction.”

But adoption of that “rule” led to vast overuse of antibiotics – an overuse that continues to this day, despite the removal of the rule.

We have harm from tight control of diabetes measures and tight blood pressure measures.

The “quality” gurus took the attitude, do not just sit there – do something. We can see the “do something” syndrome cause unintended harmful consequences.

We should not do anything until we evaluate that something. We must understand that performance measurement development might let to care improvement, have no impact or actually harm overall care. If we can get everyone to understand that an adopted performance measure could harm care, then perhaps we will see true evaluations of each proposed measure.

Sometimes we need to take our time and not just “do something”.

db is the nickname for Robert M. Centor, MD, FACP. db stands both for Dr. Bob and da boss. He is an academic general internist at the University of Alabama School of Medicine, and is the Regional Associate Dean for the Huntsville Regional Medical Campus of UASOM. He still makes inpatient rounds over 100 days each year. This post originally appeared at his blog, db's Medical Rants.