1 Introduction

Four Perspectives
References

2 Definitions

Clinical Inertia
Therapeutic Inertia and Clinical Inertia
Clinical Practice Guidelines
Evidence-Based Medicine
Evidence Practice Gap
Medical Error
What Is Not Clinical Inertia
Formal Definition of Clinical Inertia
Definition: Physician Behavior Falls Under Clinical Inertia
If and Only If
References

3 The Evidence: The Gap Between Guidelines and Clinical Reality

Introduction: Highlighting the Existence of the Phenomenon and Its Consequences
Consequences of Clinical Inertia
Analysis of Clinical Inertia in Different Diseases
Diabetes
Hypertension
Hyperlipidemia
Cardiovascular Risk Prevention
Other Conditions Where One Can Highlight the Clinical Inertia Phenomenon
References

4 Determinants and Explanatory Models of Clinical Inertia

Determinants of Clinical Inertia
Initial Explanations: Denial, Exaggerated Use of '‘Soft Reasons” and Physician Lack of Training on the Principle of Titration
Competing Demands
The Effect of Uncertainty
Poor Appreciation of the Actual Situation of the Patient.
Characteristics of the Physician
The Effect of Belonging to an Ethnic Minority and Being Disadvantaged
The Doctor, Her Patient and the Health Care System
Physician Clinical Inertia and Patient Nonadherence
Theoretical Explanatory Models of Clinical Inertia
The Knowledge-Attitude-Behavior-Result Model
The Awareness-Agreement-Adoption-Adherence Model
A Symmetrical Model Involving Physician and Patient: The Management of Dyslipidemia in Women
Physician Guideline Compliance Model
Another Psychological Model Applied to Comprehension of Clinical Inertia: The Regulatory Focus Theory
References

5 The Physician and Evidence-Based Medicine

A New Way to Practice Medicine
Objectives of Evidence-Based Medicine
Data and Guidelines: Different Levels of Evidence
What Is Not Evidence-Based Medicine
Evidence-Based Medicine: Clinical Practice Assisted by the Development of Clinical Practice Guidelines
Evidence-Based Medicine, Medicine Practiced Within a Context of Uncertainty
Evidence-Based Medicine: A Change of Paradigm?
SchrOdinger’s Cat and Einstein’s Boxes
A Critique of Evidence-Based Medicine
The Physician Faced with a New Medicine
Theoretical Critiques of Evidence-Based Medicine
Epistemological Critique of the Concept of Evidence-Based Medicine
From an Evidence-Based Medicine to a Practice-Based Medicine By Way of Provisional Conclusion: Guidelines or “Mindlincs"?
References

6 To Do or Not to Do: A Critique of Medical Reason

Definition
The Context of Uncertainty Which Surrounds All Medical Activities, and the Concept of Risk
The Notion of Heuristics and Bias
Different Heuristics Used in Human Judgment Within a Context of Uncertainty
Sources of Bias in Decisions Under Risk
Heuristics Are Necessary and Do Not Necessarily Have an Adverse Effect
Heuristics, Principles of Evidence-Based Medicine, and Medical Behavior: Coming Back to Clinical Inertia
Role of Emotions in Medical Decisions
Emotions in Mental Life
Emotions in Medical Decisions
Emotions and Cognition: Two Components of Reason
Emotions as Notification of the Feeling of Risk
Relationship Between Emotions and Behavior: Rather Than Causation, a Feedback Dynamic
Chagrin and Regret: Application to the Issue of Clinical Inertia.
Emotions in the Interaction Between Physician and Patient, and in the Relationship Between Clinical Inertia and Nonadherence
Or Not to Do: Psychology of the Status Quo and the Difficulty of Making a Decision
References

7 Overcoming True Clinical Inertia

Education
Initial Training of Physicians
Continuing Medical Education
Role of “Opinion Leaders”
Reminder and Feedback Systems
Facilitators
Simplify Treatments, Use Treatments Having Fewer Side Effects
Overcoming Decisional Uncertainty Through Protocols
Organizational Aspects
Reinforcement
Incentive by Public Authorities: Pay for Performance
Incentive by Patients
Incentive by Others: Peers. Pharmacists and Nurses
Physician Self-Incentive: An Explanation Through Philosophy of Mind
Force of Habit
Can One Avoid Cognitive Biases?
Emotional Reversal: Using Emotions to Overcome Clinical Inertia
Concern: The Philosophical Dimension of Care
Implementing Positive Emotions: Emotional Reversal
Physician Optimism and Pessimism
Trust. Pride and Self-Approval
References