Gaps in practice

January/February 2011

FocusGaps in practice

Why haven’t I changed that?

Therapeutic inertia in general practice

Volume 40, No.1, January/February 2011 Pages 24-28

Patrick D Byrnes


There are multiple gaps between evidence and practice in our health system. The relatively new concept of ‘therapeutic inertia’ is useful to understand why these gaps persist. It is defined as ‘failure of healthcare providers to initiate or intensify therapy when indicated’ and ‘recognition of the problem, but failure to act’.


This article explores the development of therapeutic inertia and its causes, and other concepts useful in closing gaps in general practice, including addressing emotional decisional making by doctors.


Clinical inertia is the original term used to describe gaps in practice; and therapeutic inertia is now used interchangeably with it. The author illustrates his practice’s approach to overcoming therapeutic inertia. The National Institute for Clinical Studies was set up in Australia to get the best available evidence from health and medical research into everyday practice to help close these gaps.

An evidence practice gap is defined as the ‘difference between what we know from best available research evidence and what actually happens in current practice’.1 The relatively new concept of ‘therapeutic inertia’ is useful to understand why these gaps occur. The term first appeared in the MEDLINE indexed literature in a 2004 article2 which referred to the 2001 paper by Phillips et al.3 Although therapeutic inertia is sometimes used to mean failure to use pharmacological agents,4 a 2009 literature review5 found it is used more broadly for all types of therapy and interchangeably with the term ‘clinical inertia’.

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