Clinical inertia

Medicine has traditionally focused on relieving patient symptoms. However, in developed countries, maintaining good health increasingly involves manag ement of such problems as hypertension, dyslipidemia, and diabetes, which o ften have no symptoms. Moreover, abnormal blood pressure, lipid, and glucos e values are generally sufficient to warrant treatment without further diag nostic maneuvers. Limitations in managing such problems are often due to cl inical inertia-failure of health care providers to initiate or intensify th erapy when indicated. Clinical inertia is due to at least three problems: o verestimation of care provided; use of "soft" reasons to avoid intensificat ion of therapy; and lack of education, training, and practice organization aimed at achieving therapeutic goals. Strategies to overcome clinical inert ia must focus on medical students, residents, and practicing physicians. Re vised education programs should lead to assimilation of three concepts: the benefits of treating to therapeutic targets, the practical complexity of t reating to target for different disorders, and the need to structure routin e practice to facilitate effective management of disorders for which resolu tion of patient symptoms is not sufficient to guide care. Physicians will n eed to build into their practice a system of reminders and performance feed back to ensure necessary care.