Evidence-based medicine advocates the “conscientious, explicit, and judicious use of current best evidence in making decisions about the care of individual patients” (1), and campaigns such as “Choosing Wisely” (2) and the BMJ “Too Much Medicine” (3) are encouraging critical thought as to what amount of “medicine” is appropriate for patients and when.  While evidence-based medicine can be one helpful guide to choosing wisely and avoiding doing too much in medicine, evidence can also help clarify those clinical situations in which “less” is actually “more” – ie, when a less invasive, less technological, or less “medical” approach may lead to better outcomes. (4) (5) This index is currently a personal (and extremely part-time!) project aiming to catalog literature documenting when “less is more” in a searchable and accessible format.

A few notes:

  • Each entry provides the title of a published article, a short summary of findings, and a link to the abstract in PubMed Mobile.
  • This information is meant for education only – clinical application of this information requires appropriate clinical education, and incorporation of all relevant clinical details for a given patient case.
  • The website is formatted to (hopefully!) work well on mobile devices
  • The “Strength of Recommendation” ratings are based on the Strength of Recommendation Taxonomy (“SORT”) developed by the American Academy of Family Physicians. (6)

Strength of Recommendation Taxonomy

Strength Definition
A Recommendation based on consistent and good quality patient-oriented evidence
B Recommendation based on inconsistent or limited quality patient-oriented evidence
C Recommendation based on consensus, usual practice, opinion, disease-oriented evidence, and case series for studies of diagnosis, treatment, prevention, or screening.

Bill Cayley, MD MDiv

(1) Sackett DL, Rosenberg WM, Gray JA, Haynes RB, Richardson WS. Evidence based medicine: what it is and what it isn’t. BMJ. 1996 Jan 13;312(7023):71-2. http://www.ncbi.nlm.nih.gov/m/pubmed/8555924/

(2) http://www.choosingwisely.org/

(3) http://www.bmj.com/too-much-medicine

(4) http://blogs.bmj.com/bmj/2013/11/18/william-cayley-doing-more-with-less-in-healthcare/

(5) http://blogs.bmj.com/bmj/2015/05/18/william-cayley-less-is-more/

(6) http://www.aafp.org/journals/afp/authors/ebm-toolkit/strength.html