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Viewpoint
August 21, 2017

Why It Is So Hard to Talk About Overuse in Pediatrics and Why It Matters

Author Affiliations
  • 1Department of Pediatrics, Children’s Hospital at Dartmouth-Hitchcock, Lebanon, New Hampshire
  • 2Department of Pediatrics, Geisel School of Medicine at Dartmouth, Hanover, New Hampshire
  • 3Department of Pediatrics, Lucille Packard Children’s Hospital, Palo Alto, California
  • 4Department of Pediatrics, Stanford University College of Medicine, Palo Alto, California
JAMA Pediatr. Published online August 21, 2017. doi:10.1001/jamapediatrics.2017.2239

Medical overuse, defined as the provision of care that is more likely to cause harm than benefit, is increasingly part of regular public discourse. Choosing Wisely, the American Board of Internal Medicine campaign to encourage physicians and patients to discuss potentially unnecessary medical interventions, may not quite be a household word, but the idea that more medicine is not always better medicine appears frequently in both public and professional venues. Prominent journals like JAMA Internal Medicine with its “Less Is More” section are embracing routine discussions of medical overuse. Atul Gawande covered this problem for The New Yorker and, in Lancet, Don Berwick recently called avoiding overuse “the next quality frontier.”1 As pediatricians, we have perceived less enthusiasm for the topic in our field than among our adult colleagues. In this Viewpoint, we attempt to explain why this discrepancy might exist and why it should be rectified.

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