De-adopting Ineffective or Harmful Clinical Practices

De-adopting Ineffective or Harmful Clinical Practices

Although a fair amount is known about diffusion and adoption of new ideas and practices, less is known about the abandonment of practices that are ineffective or harmful (“undiffusion”). We want to draw your attention to a recent editorial that address this issue [Davidoff].

Here are some of the take-home points:

  • People frequently have difficulty discontinuing familiar practices because of “aversion to loss” which appears to be at least partially explained by—
    • Comfort with what is familiar;
    • Embarrassment for having adopted ineffective or inappropriate practices;
    • Reluctance to abandon practices that may have required investment of energy, dollars and time to implement;
    • Economic considerations; and,
    • Inertia.
  • We lack an adequate model for explaining “undiffusion” or fostering the abandonment of ineffective or harmful practices.

Some of the interesting concepts, examples and case studies explored in the editorial include—

  • Tight glycemic control in ICUs and the role of “negative evidence” in the process of undiffusion;
  • Rapid adoption (without sufficient evidence) of noninvasive preoperative screening for coronary disease in patients who are undergoing noncardiac surgery; and,
  • Continued specialty society support for current medical practices with sufficient evidence to support their undiffusion.

Delfini Comment
This thoughtful editorial nicely illustrates the complex problem of the health care universe quickly adopting “innovative” practices which have been advanced without sufficient evidence to assure net benefit or value and how difficult it is for undiffusion (aka discontinuation, deadoption, deimplementation, reversal, rejection, withdrawal) to occur.


Davidoff F. On the Undiffusion of Established Practices. JAMA Intern Med. 2015 Mar 16. doi: 10.1001/jamainternmed.2015.0167. [Epub ahead of print] PubMed PMID: 25774743.

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