Intended for healthcare professionals


Intolerance of error and culture of blame drive medical excess

BMJ 2014; 349 doi: (Published 14 October 2014) Cite this as: BMJ 2014;349:g5702
  1. Jerome R Hoffman, professor emeritus of medicine1,
  2. Hemal K Kanzaria, Robert Wood Johnson clinical scholar 2
  1. 1University of California Los Angeles, USA
  2. 2Robert Wood Johnson Foundation Clinical Scholars Program, US Department of Veterans Affairs, Emergency Medicine Center, University of California Los Angeles
  1. Correspondence to: J R Hoffman jrh{at}
  • Accepted 29 August 2014


Jerome R Hoffman and Hemal K Kanzaria argue that efforts to reduce overdiagnosis and overtreatment should focus on changing professional and public attitudes towards medical error and uncertainty


  • Contributors and sources: JRH teaches students, residents, and fellows both clinical medicine and health services research. He has published extensively and spoken widely on the topic of overdiagnosis and overtesting. HKK is a practicing emergency physician and conducts research promoting patient and physician engagement in efforts to reduce overutilization. Both authors contributed substantially to the development of this article, drawing from their reading of the literature and their experience within the US healthcare system. JRH is guarantor.

  • Competing interests: We have read and understood BMJ policy on declaration of interests and declare the following interests and have no interests to declare. The content of this essay is solely the responsibility of the authors and does not necessarily represent the official views of any of the funding agencies.

  • Provenance and peer review: Commissioned; not externally peer reviewed.

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