Intended for healthcare professionals


Better understanding the downsides of low value healthcare could reduce harm

BMJ 2021; 372 doi: (Published 23 March 2021) Cite this as: BMJ 2021;372:n117
  1. Shannon M Brownlee, senior vice president1,
  2. Deborah Korenstein, chief of general medicine service123
  1. 1Lown Institute, 21 Longwood Ave, Brookline, MA 02446, USA
  2. 2Memorial Sloan Kettering Cancer Center, New York, NY, USA
  3. 3Weill Cornell Medical College, New York, NY, USA
  4. Correspondence to: S M Brownlee

Would we stop overusing low value healthcare if we knew how often it hurts patients? Shannon Brownlee and Deborah Korenstein argue for quantifying the preventable harm from overuse

In 1982 the US television programme 20/20 turned a harsh spotlight on anaesthesia incidents that injured patients. In an episode called “The Deep Sleep,” the show claimed that 6000 Americans a year were killed or seriously brain injured by anaesthesia mishaps. In response, anaesthesiologists from Harvard Medical School and the British Medical Society jointly convened an international conference, and the American Society of Anaesthesiologists launched a closed claims study that quantified harms and analysed causes in the United States. Organisations in the United Kingdom, Spain, France, and Denmark soon published their own damning studies. These reports shocked the medical world and spurred a series of initiatives that reduced the number of anaesthesia incidents and launched the modern patient safety movement.

Today, efforts to quantify and tackle gaps in patient safety have expanded far beyond anaesthesia. A distinct discipline with its own emerging scientific framework, patient safety has been declared “one of the most important components of healthcare delivery” by the World Health Organization.1 Yet there is one area of healthcare that remains sorely in need of similar data on harm and an equally sustained worldwide effort to reduce it. That area is overuse of low value healthcare services.

Overuse has been defined as the delivery of tests and procedures that provide little or no clinical benefit; are unlikely to have an effect on clinician decisions; increase healthcare spending without improving health outcomes; or risk patient harm in excess of potential benefits.2 Any treatment that offers little or no chance of benefit can still cause harm, yet much of the research and discussion around overuse have centred, especially in the US, …

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