Clinical Inertia: The Role of Physicians in Diabetes Outcomes

Abstract

Concordance in goals and interventions between physicians and patients is essential to achieve the expected results of diabetes care; lack of patient adherence and clinical inertia are two main threats. The first one has been recognized since ancient times and for physicians’ convenience has put the blame on patients. Clinical inertia was recently described, but physicians’ resistance, unwillingness, and/or inability to follow clinical practice guidelines or evidence-based recommendations has been described years before receiving its current name. Clinical inertia has been defined as the physicians’ inability to have patients achieve the goals of treatment after repeated medical visits, to initiate or intensify therapy when indicated, and to treat to target or prescribing in disagreement with clinical guidelines, as legitimate efforts to safeguard patients or as the preference to maintain the professional status quo. Clinical inertia has been described in the outpatient and inpatient management of chronic diseases and also in other medical disciplines from dentistry to organ transplantation. Professional characteristics associated with clinical inertia include “soft reasons” (overestimating the benefits of treatment, personal experience, or expertise), reluctance, fallacious reasoning, and professional deficiencies in education and training; structural deficiencies include workload, lack of staff, medications, or equipment. Clinical inertia is also professional reaction for the benefit of patients, based on evidence demonstrating the negative outcomes of aggressive control of diabetes and hypertension. Clinical inertia is more important than deficiencies of patients to comply or adhere to medical recommendations on clinical outcomes, and educational interventions focused on patients have delivered superior results.