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April 20, 2011

Clinical Inertia as a Clinical Safeguard

Author Affiliations

Author Affiliations: Department of Geriatrics and Metabolic Diseases, Second University of Naples, Naples, Italy.

JAMA. 2011;305(15):1591-1592. doi:10.1001/jama.2011.490

Inertia is the resistance of a physical object to a change in its state of motion or rest. Phillips et al1 have described clinical inertia as “failure of health care providers to initiate or intensify therapy when indicated.” Although clinical inertia may apply to all medical fields, given the lag time between advances in clinical understanding and incorporation into clinical guidelines, as well as the other time needed for the translation of clinical guidelines into clinical practice, Phillips et al1 intended to limit the discussion of inertia to disorders in which abnormal values may be the only manifestation of the disease, such as diabetes, hypertension, and dyslipidemia. Quiz Ref IDMain causes of clinical inertia include overestimation of care provided, use of “soft” reasons to avoid intensification of therapy (incorrect perception of clinical improvement, dietary nonadherence, and concerns about translation of clinical trials results to individual patients), and lack of understanding about achieving therapeutic goals. While physicians may cite patient refusal or nonadherence as the reason for clinical inertia, it seems likely that in many instances, physician inertia is the reason for the problem.

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