Cultivating the courage to resist ‘too much medicine’

Talk Code: 
Stefan Hjorleifsson and Deborah Swinglehurst
Author institutions: 
University of Bergen, Norway Queen Mary University London

Aim and intended outcome 

Where do generalist health care professionals turn to find the factual knowledge, critical reasoning, human sensitivity and moral courage that is needed to avoid medical overactivity? This workshop will explore some core writings of generalist medicine that describe principles and practices which may enable clinicians and policymakers to resist medical overactivity. In an era which combines unprecedented belief in the powers of technology with the overwhelming availability of medical (dis)information, developing the capability to resist medical overuse is an urgent priority for practitioners, educators and researchers alike.


The workshop will open with a brief presentation showing how key texts that describe generalist virtues are being used in Scandinavian primary care education settings to nurture ‘courageous’ researchers, clinicians and decision makers. The main focus of the workshop will be group discussions in which participants will be encouraged to develop their own ideas about how key generalist texts might be incorporated into practice and into educational settings in order to encourage awareness of - and capability to avoid  - the potential harms of medical overactivity.  A summary of key learning points will conclude the workshop.   


A daunting task for future doctors will be a requirement to help people navigate an ocean of possibilities in terms of monitoring, testing, diagnoses and interventions. We postulate that competent adherence to a ‘less is more’ strategy (which may sometimes mean ‘wise inaction’) can safeguard genuine medical needs in a socially accountable manner, containing cost and preventing harm. Such a strategy does not materialise from clinical epidemiological analyses of the harm accruing from unwarranted medical action alone. A renaissance for the medical generalist who sees the patient as a person, interacts shrewdly with different forms of ‘evidence’ and is equipped to deal with the fundamental uncertainty of human existence requires a range of intellectual and moral qualities. Inspiration for the development of these qualities can be found in the generalist medical literature, which is too often overlooked in general practice training. Examples of texts that instil courage and promote good doctoring include the writings of Julian Tudor Hart, Julian McCormick, Iona Heath, Trish Greenhalgh, Gilbert Welch, Atul Gawande, Peter Gøtzsche, Michael Marmot, Kirsti Malterud and Per Fugelli. However, our list of key generalist texts against too much medicine is still in the making. The workshop will give ample room for new ideas, questions and reflections. Please join in!   

Intended audience 

Any SAPC participants.

Submitted by: 
Stefan Hjorleifsson