{"id":34222,"date":"2015-05-18T16:57:31","date_gmt":"2015-05-18T15:57:31","guid":{"rendered":"https:\/\/blogs.bmj.com\/bmj\/?p=34222"},"modified":"2015-09-22T14:24:02","modified_gmt":"2015-09-22T13:24:02","slug":"william-cayley-less-is-more","status":"publish","type":"post","link":"https:\/\/blogs.bmj.com\/bmj\/2015\/05\/18\/william-cayley-less-is-more\/","title":{"rendered":"William Cayley: Less is more"},"content":{"rendered":"

\"bill_cayley_2\"<\/a>Both seasoned clinicians and learners in today\u2019s medical environment receive both explicit and unspoken messages that the best medicine involves advanced technology, the latest medications, and highly specialized care. Evidence based medicine, on the other hand, advocates the \u201cconscientious, explicit, and judicious use of current best evidence in making decisions about the care of individual patients<\/a>,\u201d and campaigns such as \u201cChoosing Wisely<\/a>\u201d and The BMJ<\/em>‘s \u201cToo Much Medicine<\/a>\u201d are encouraging critical thought as to what amount of \u201cmedicine\u201d is appropriate for patients and when.<\/p>\n

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 \u201cless\u201d is actually \u201cmore\u201d\u2014ie, when a less invasive, less technological, or less \u201cmedical\u201d approach may lead to better outcomes. For example, bandaging alone appears better\u00a0than bandaging plus suturing for small lacerations of the hand<\/a>, and performing a pelvic examination without stirrups may improve a woman\u2019s experience<\/a>, without decreasing the quality of pap smear specimens obtained.<\/p>\n

An area that remains inadequately explored and inadequately operationalized for clinical practice is the conceptual area encompassing evidence for when a \u201cless\u201d medical, invasive, or technological approach may actually be superior. Exploring, appraising, and translating into clinical practice the body of literature that provides evidence that \u201cless\u201d is \u201cmore\u201d could provide several parallel beneficial outcomes:
\n\u2022 Encouraging the use of lower cost approaches to care that benefit patients.
\n\u2022 Encouraging critical thought on the part of learners and clinicians as to the nature of medicine\u2014is it about medication and technology, or about evidence for best care of patients?
\n\u2022 Encouraging further development of critical appraisal skills.<\/p>\n

After posting some initial thoughts on this<\/a> over a year ago, I\u2019ve doodled, fiddled, made a couple of false starts and one meeting presentation, and finally put together a basic web resource to begin cataloging examples of clinical evidence for when \u201cless\u201d is actually \u201cmore\u201d: https:\/\/lessismoreebm.wordpress.com\/ <\/a><\/p>\n

This index is currently a personal (and extremely part time!) project, which aims to make literature documenting when \u201cless is more\u201d available in a searchable and accessible format.
\n\u2022 Each entry provides the title and a short summary of a published article, with a link to the PubMed mobile entry for that article.
\n\u2022 This information is meant for education only\u2014clinical use of this information requires appropriate clinical education, and incorporation with all relevant clinical details for a given patient case.
\n\u2022 The website is formatted to (hopefully!) work well on mobile devices (in order to enhance portability and useability).
\n\u2022 “Strength of Recommendation” ratings are based on the Strength of Recommendation Taxonomy<\/a> (“SORT”) developed by the American Academy of Family Physicians.<\/p>\n

Have a look, do a search (it\u2019s a pretty small index so far), see what you think. Is this useful for your practice? Does it give you some ideas for teaching? Might this be a way to re-set expectations of what we think of as the \u201cbest\u201d medicine?<\/p>\n

William E Cayley Jr<\/strong>\u00a0practices\u00a0at the Augusta Family Medicine Clinic; teaches at the Eau Claire Family Medicine Residency; and is a professor at the University of Wisconsin, Department of Family Medicine.<\/em><\/p>\n

I declare that I have read and understood BMJ policy on declaration of interests and I have no relevant interests to declare\u2014the “less is more” index project is a free, noncommercial, educational resource.<\/p>\n","protected":false},"excerpt":{"rendered":"

Both seasoned clinicians and learners in today\u2019s medical environment receive both explicit and unspoken messages that the best medicine involves advanced technology, the latest medications, and highly specialized care. Evidence […]<\/p>\n

More…<\/a><\/p>\n","protected":false},"author":1,"featured_media":0,"comment_status":"open","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[1357,14769],"tags":[],"class_list":["post-34222","post","type-post","status-publish","format-standard","hentry","category-us-health-care","category-william-cayley"],"yoast_head":"\nWilliam Cayley: Less is more - The BMJ<\/title>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link rel=\"canonical\" href=\"https:\/\/blogs.bmj.com\/bmj\/2015\/05\/18\/william-cayley-less-is-more\/\" \/>\n<meta property=\"og:locale\" content=\"en_US\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"William Cayley: Less is more - The BMJ\" \/>\n<meta property=\"og:description\" content=\"Both seasoned clinicians and learners in today\u2019s medical environment receive both explicit and unspoken messages that the best medicine involves advanced technology, the latest medications, and highly specialized care. Evidence [...]More...\" \/>\n<meta property=\"og:url\" content=\"https:\/\/blogs.bmj.com\/bmj\/2015\/05\/18\/william-cayley-less-is-more\/\" \/>\n<meta property=\"og:site_name\" content=\"The BMJ\" \/>\n<meta property=\"article:publisher\" content=\"https:\/\/www.facebook.com\/bmjdotcom\/\" \/>\n<meta property=\"article:published_time\" content=\"2015-05-18T15:57:31+00:00\" \/>\n<meta property=\"article:modified_time\" content=\"2015-09-22T13:24:02+00:00\" \/>\n<meta property=\"og:image\" content=\"https:\/\/blogs.bmj.com\/bmj\/files\/2014\/07\/bill_cayley_2-243x300.jpg\" \/>\n<meta name=\"author\" content=\"BMJ\" \/>\n<meta name=\"twitter:card\" content=\"summary_large_image\" \/>\n<meta name=\"twitter:creator\" content=\"@bmj_latest\" \/>\n<meta name=\"twitter:site\" content=\"@bmj_latest\" \/>\n<meta name=\"twitter:label1\" content=\"Written by\" \/>\n\t<meta name=\"twitter:data1\" content=\"BMJ\" \/>\n\t<meta name=\"twitter:label2\" content=\"Est. reading time\" \/>\n\t<meta name=\"twitter:data2\" content=\"3 minutes\" \/>\n<script type=\"application\/ld+json\" class=\"yoast-schema-graph\">{\"@context\":\"https:\\\/\\\/schema.org\",\"@graph\":[{\"@type\":\"Article\",\"@id\":\"https:\\\/\\\/blogs.bmj.com\\\/bmj\\\/2015\\\/05\\\/18\\\/william-cayley-less-is-more\\\/#article\",\"isPartOf\":{\"@id\":\"https:\\\/\\\/blogs.bmj.com\\\/bmj\\\/2015\\\/05\\\/18\\\/william-cayley-less-is-more\\\/\"},\"author\":{\"name\":\"BMJ\",\"@id\":\"https:\\\/\\\/blogs.bmj.com\\\/bmj\\\/#\\\/schema\\\/person\\\/ba3da426ed20e8f1d933ca367d8216fe\"},\"headline\":\"William Cayley: Less is more\",\"datePublished\":\"2015-05-18T15:57:31+00:00\",\"dateModified\":\"2015-09-22T13:24:02+00:00\",\"mainEntityOfPage\":{\"@id\":\"https:\\\/\\\/blogs.bmj.com\\\/bmj\\\/2015\\\/05\\\/18\\\/william-cayley-less-is-more\\\/\"},\"wordCount\":566,\"commentCount\":0,\"publisher\":{\"@id\":\"https:\\\/\\\/blogs.bmj.com\\\/bmj\\\/#organization\"},\"image\":{\"@id\":\"https:\\\/\\\/blogs.bmj.com\\\/bmj\\\/2015\\\/05\\\/18\\\/william-cayley-less-is-more\\\/#primaryimage\"},\"thumbnailUrl\":\"https:\\\/\\\/blogs.bmj.com\\\/bmj\\\/files\\\/2014\\\/07\\\/bill_cayley_2-243x300.jpg\",\"articleSection\":[\"US healthcare\",\"William Cayley\"],\"inLanguage\":\"en-US\",\"potentialAction\":[{\"@type\":\"CommentAction\",\"name\":\"Comment\",\"target\":[\"https:\\\/\\\/blogs.bmj.com\\\/bmj\\\/2015\\\/05\\\/18\\\/william-cayley-less-is-more\\\/#respond\"]}]},{\"@type\":\"WebPage\",\"@id\":\"https:\\\/\\\/blogs.bmj.com\\\/bmj\\\/2015\\\/05\\\/18\\\/william-cayley-less-is-more\\\/\",\"url\":\"https:\\\/\\\/blogs.bmj.com\\\/bmj\\\/2015\\\/05\\\/18\\\/william-cayley-less-is-more\\\/\",\"name\":\"William Cayley: Less is more - The BMJ\",\"isPartOf\":{\"@id\":\"https:\\\/\\\/blogs.bmj.com\\\/bmj\\\/#website\"},\"primaryImageOfPage\":{\"@id\":\"https:\\\/\\\/blogs.bmj.com\\\/bmj\\\/2015\\\/05\\\/18\\\/william-cayley-less-is-more\\\/#primaryimage\"},\"image\":{\"@id\":\"https:\\\/\\\/blogs.bmj.com\\\/bmj\\\/2015\\\/05\\\/18\\\/william-cayley-less-is-more\\\/#primaryimage\"},\"thumbnailUrl\":\"https:\\\/\\\/blogs.bmj.com\\\/bmj\\\/files\\\/2014\\\/07\\\/bill_cayley_2-243x300.jpg\",\"datePublished\":\"2015-05-18T15:57:31+00:00\",\"dateModified\":\"2015-09-22T13:24:02+00:00\",\"breadcrumb\":{\"@id\":\"https:\\\/\\\/blogs.bmj.com\\\/bmj\\\/2015\\\/05\\\/18\\\/william-cayley-less-is-more\\\/#breadcrumb\"},\"inLanguage\":\"en-US\",\"potentialAction\":[{\"@type\":\"ReadAction\",\"target\":[\"https:\\\/\\\/blogs.bmj.com\\\/bmj\\\/2015\\\/05\\\/18\\\/william-cayley-less-is-more\\\/\"]}]},{\"@type\":\"ImageObject\",\"inLanguage\":\"en-US\",\"@id\":\"https:\\\/\\\/blogs.bmj.com\\\/bmj\\\/2015\\\/05\\\/18\\\/william-cayley-less-is-more\\\/#primaryimage\",\"url\":\"https:\\\/\\\/blogs.bmj.com\\\/bmj\\\/files\\\/2014\\\/07\\\/bill_cayley_2.jpg\",\"contentUrl\":\"https:\\\/\\\/blogs.bmj.com\\\/bmj\\\/files\\\/2014\\\/07\\\/bill_cayley_2.jpg\",\"width\":551,\"height\":680},{\"@type\":\"BreadcrumbList\",\"@id\":\"https:\\\/\\\/blogs.bmj.com\\\/bmj\\\/2015\\\/05\\\/18\\\/william-cayley-less-is-more\\\/#breadcrumb\",\"itemListElement\":[{\"@type\":\"ListItem\",\"position\":1,\"name\":\"Home\",\"item\":\"https:\\\/\\\/blogs.bmj.com\\\/bmj\\\/\"},{\"@type\":\"ListItem\",\"position\":2,\"name\":\"William Cayley: Less is more\"}]},{\"@type\":\"WebSite\",\"@id\":\"https:\\\/\\\/blogs.bmj.com\\\/bmj\\\/#website\",\"url\":\"https:\\\/\\\/blogs.bmj.com\\\/bmj\\\/\",\"name\":\"The BMJ\",\"description\":\"Helping doctors make better decisions.\",\"publisher\":{\"@id\":\"https:\\\/\\\/blogs.bmj.com\\\/bmj\\\/#organization\"},\"potentialAction\":[{\"@type\":\"SearchAction\",\"target\":{\"@type\":\"EntryPoint\",\"urlTemplate\":\"https:\\\/\\\/blogs.bmj.com\\\/bmj\\\/?s={search_term_string}\"},\"query-input\":{\"@type\":\"PropertyValueSpecification\",\"valueRequired\":true,\"valueName\":\"search_term_string\"}}],\"inLanguage\":\"en-US\"},{\"@type\":\"Organization\",\"@id\":\"https:\\\/\\\/blogs.bmj.com\\\/bmj\\\/#organization\",\"name\":\"The BMJ\",\"url\":\"https:\\\/\\\/blogs.bmj.com\\\/bmj\\\/\",\"logo\":{\"@type\":\"ImageObject\",\"inLanguage\":\"en-US\",\"@id\":\"https:\\\/\\\/blogs.bmj.com\\\/bmj\\\/#\\\/schema\\\/logo\\\/image\\\/\",\"url\":\"https:\\\/\\\/blogs.bmj.com\\\/bmj\\\/files\\\/2018\\\/05\\\/The-BMJ-logo.jpg\",\"contentUrl\":\"https:\\\/\\\/blogs.bmj.com\\\/bmj\\\/files\\\/2018\\\/05\\\/The-BMJ-logo.jpg\",\"width\":852,\"height\":568,\"caption\":\"The BMJ\"},\"image\":{\"@id\":\"https:\\\/\\\/blogs.bmj.com\\\/bmj\\\/#\\\/schema\\\/logo\\\/image\\\/\"},\"sameAs\":[\"https:\\\/\\\/www.facebook.com\\\/bmjdotcom\\\/\",\"https:\\\/\\\/x.com\\\/bmj_latest\"]},{\"@type\":\"Person\",\"@id\":\"https:\\\/\\\/blogs.bmj.com\\\/bmj\\\/#\\\/schema\\\/person\\\/ba3da426ed20e8f1d933ca367d8216fe\",\"name\":\"BMJ\",\"image\":{\"@type\":\"ImageObject\",\"inLanguage\":\"en-US\",\"@id\":\"https:\\\/\\\/secure.gravatar.com\\\/avatar\\\/b4d8f39281bcae118348a1c027347b8e53b82d42520e774a8b50dd9a6ac6c01d?s=96&d=mm&r=g\",\"url\":\"https:\\\/\\\/secure.gravatar.com\\\/avatar\\\/b4d8f39281bcae118348a1c027347b8e53b82d42520e774a8b50dd9a6ac6c01d?s=96&d=mm&r=g\",\"contentUrl\":\"https:\\\/\\\/secure.gravatar.com\\\/avatar\\\/b4d8f39281bcae118348a1c027347b8e53b82d42520e774a8b50dd9a6ac6c01d?s=96&d=mm&r=g\",\"caption\":\"BMJ\"},\"sameAs\":[\"https:\\\/\\\/blogs.bmj.com\\\/\"],\"url\":\"https:\\\/\\\/blogs.bmj.com\\\/bmj\\\/author\\\/admin\\\/\"}]}<\/script>\n<!-- \/ Yoast SEO plugin. -->","yoast_head_json":{"title":"William Cayley: Less is more - The BMJ","robots":{"index":"index","follow":"follow","max-snippet":"max-snippet:-1","max-image-preview":"max-image-preview:large","max-video-preview":"max-video-preview:-1"},"canonical":"https:\/\/blogs.bmj.com\/bmj\/2015\/05\/18\/william-cayley-less-is-more\/","og_locale":"en_US","og_type":"article","og_title":"William Cayley: Less is more - The BMJ","og_description":"Both seasoned clinicians and learners in today\u2019s medical environment receive both explicit and unspoken messages that the best medicine involves advanced technology, the latest medications, and highly specialized care. Evidence [...]More...","og_url":"https:\/\/blogs.bmj.com\/bmj\/2015\/05\/18\/william-cayley-less-is-more\/","og_site_name":"The BMJ","article_publisher":"https:\/\/www.facebook.com\/bmjdotcom\/","article_published_time":"2015-05-18T15:57:31+00:00","article_modified_time":"2015-09-22T13:24:02+00:00","og_image":[{"url":"https:\/\/blogs.bmj.com\/bmj\/files\/2014\/07\/bill_cayley_2-243x300.jpg","type":"","width":"","height":""}],"author":"BMJ","twitter_card":"summary_large_image","twitter_creator":"@bmj_latest","twitter_site":"@bmj_latest","twitter_misc":{"Written by":"BMJ","Est. reading time":"3 minutes"},"schema":{"@context":"https:\/\/schema.org","@graph":[{"@type":"Article","@id":"https:\/\/blogs.bmj.com\/bmj\/2015\/05\/18\/william-cayley-less-is-more\/#article","isPartOf":{"@id":"https:\/\/blogs.bmj.com\/bmj\/2015\/05\/18\/william-cayley-less-is-more\/"},"author":{"name":"BMJ","@id":"https:\/\/blogs.bmj.com\/bmj\/#\/schema\/person\/ba3da426ed20e8f1d933ca367d8216fe"},"headline":"William Cayley: Less is more","datePublished":"2015-05-18T15:57:31+00:00","dateModified":"2015-09-22T13:24:02+00:00","mainEntityOfPage":{"@id":"https:\/\/blogs.bmj.com\/bmj\/2015\/05\/18\/william-cayley-less-is-more\/"},"wordCount":566,"commentCount":0,"publisher":{"@id":"https:\/\/blogs.bmj.com\/bmj\/#organization"},"image":{"@id":"https:\/\/blogs.bmj.com\/bmj\/2015\/05\/18\/william-cayley-less-is-more\/#primaryimage"},"thumbnailUrl":"https:\/\/blogs.bmj.com\/bmj\/files\/2014\/07\/bill_cayley_2-243x300.jpg","articleSection":["US healthcare","William Cayley"],"inLanguage":"en-US","potentialAction":[{"@type":"CommentAction","name":"Comment","target":["https:\/\/blogs.bmj.com\/bmj\/2015\/05\/18\/william-cayley-less-is-more\/#respond"]}]},{"@type":"WebPage","@id":"https:\/\/blogs.bmj.com\/bmj\/2015\/05\/18\/william-cayley-less-is-more\/","url":"https:\/\/blogs.bmj.com\/bmj\/2015\/05\/18\/william-cayley-less-is-more\/","name":"William Cayley: Less is more - The BMJ","isPartOf":{"@id":"https:\/\/blogs.bmj.com\/bmj\/#website"},"primaryImageOfPage":{"@id":"https:\/\/blogs.bmj.com\/bmj\/2015\/05\/18\/william-cayley-less-is-more\/#primaryimage"},"image":{"@id":"https:\/\/blogs.bmj.com\/bmj\/2015\/05\/18\/william-cayley-less-is-more\/#primaryimage"},"thumbnailUrl":"https:\/\/blogs.bmj.com\/bmj\/files\/2014\/07\/bill_cayley_2-243x300.jpg","datePublished":"2015-05-18T15:57:31+00:00","dateModified":"2015-09-22T13:24:02+00:00","breadcrumb":{"@id":"https:\/\/blogs.bmj.com\/bmj\/2015\/05\/18\/william-cayley-less-is-more\/#breadcrumb"},"inLanguage":"en-US","potentialAction":[{"@type":"ReadAction","target":["https:\/\/blogs.bmj.com\/bmj\/2015\/05\/18\/william-cayley-less-is-more\/"]}]},{"@type":"ImageObject","inLanguage":"en-US","@id":"https:\/\/blogs.bmj.com\/bmj\/2015\/05\/18\/william-cayley-less-is-more\/#primaryimage","url":"https:\/\/blogs.bmj.com\/bmj\/files\/2014\/07\/bill_cayley_2.jpg","contentUrl":"https:\/\/blogs.bmj.com\/bmj\/files\/2014\/07\/bill_cayley_2.jpg","width":551,"height":680},{"@type":"BreadcrumbList","@id":"https:\/\/blogs.bmj.com\/bmj\/2015\/05\/18\/william-cayley-less-is-more\/#breadcrumb","itemListElement":[{"@type":"ListItem","position":1,"name":"Home","item":"https:\/\/blogs.bmj.com\/bmj\/"},{"@type":"ListItem","position":2,"name":"William Cayley: Less is more"}]},{"@type":"WebSite","@id":"https:\/\/blogs.bmj.com\/bmj\/#website","url":"https:\/\/blogs.bmj.com\/bmj\/","name":"The BMJ","description":"Helping doctors make better decisions.","publisher":{"@id":"https:\/\/blogs.bmj.com\/bmj\/#organization"},"potentialAction":[{"@type":"SearchAction","target":{"@type":"EntryPoint","urlTemplate":"https:\/\/blogs.bmj.com\/bmj\/?s={search_term_string}"},"query-input":{"@type":"PropertyValueSpecification","valueRequired":true,"valueName":"search_term_string"}}],"inLanguage":"en-US"},{"@type":"Organization","@id":"https:\/\/blogs.bmj.com\/bmj\/#organization","name":"The BMJ","url":"https:\/\/blogs.bmj.com\/bmj\/","logo":{"@type":"ImageObject","inLanguage":"en-US","@id":"https:\/\/blogs.bmj.com\/bmj\/#\/schema\/logo\/image\/","url":"https:\/\/blogs.bmj.com\/bmj\/files\/2018\/05\/The-BMJ-logo.jpg","contentUrl":"https:\/\/blogs.bmj.com\/bmj\/files\/2018\/05\/The-BMJ-logo.jpg","width":852,"height":568,"caption":"The BMJ"},"image":{"@id":"https:\/\/blogs.bmj.com\/bmj\/#\/schema\/logo\/image\/"},"sameAs":["https:\/\/www.facebook.com\/bmjdotcom\/","https:\/\/x.com\/bmj_latest"]},{"@type":"Person","@id":"https:\/\/blogs.bmj.com\/bmj\/#\/schema\/person\/ba3da426ed20e8f1d933ca367d8216fe","name":"BMJ","image":{"@type":"ImageObject","inLanguage":"en-US","@id":"https:\/\/secure.gravatar.com\/avatar\/b4d8f39281bcae118348a1c027347b8e53b82d42520e774a8b50dd9a6ac6c01d?s=96&d=mm&r=g","url":"https:\/\/secure.gravatar.com\/avatar\/b4d8f39281bcae118348a1c027347b8e53b82d42520e774a8b50dd9a6ac6c01d?s=96&d=mm&r=g","contentUrl":"https:\/\/secure.gravatar.com\/avatar\/b4d8f39281bcae118348a1c027347b8e53b82d42520e774a8b50dd9a6ac6c01d?s=96&d=mm&r=g","caption":"BMJ"},"sameAs":["https:\/\/blogs.bmj.com\/"],"url":"https:\/\/blogs.bmj.com\/bmj\/author\/admin\/"}]}},"_links":{"self":[{"href":"https:\/\/blogs.bmj.com\/bmj\/wp-json\/wp\/v2\/posts\/34222","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/blogs.bmj.com\/bmj\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/blogs.bmj.com\/bmj\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/blogs.bmj.com\/bmj\/wp-json\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/blogs.bmj.com\/bmj\/wp-json\/wp\/v2\/comments?post=34222"}],"version-history":[{"count":0,"href":"https:\/\/blogs.bmj.com\/bmj\/wp-json\/wp\/v2\/posts\/34222\/revisions"}],"wp:attachment":[{"href":"https:\/\/blogs.bmj.com\/bmj\/wp-json\/wp\/v2\/media?parent=34222"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/blogs.bmj.com\/bmj\/wp-json\/wp\/v2\/categories?post=34222"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/blogs.bmj.com\/bmj\/wp-json\/wp\/v2\/tags?post=34222"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}