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What is Medical Minimalism?

We have all heard the phrase "Less is More." However, many patients I speak with are dissatisfied with how many medicines they are prescribed. A step further, some folks question whether they are taking one medication to treat the side effects of another medication. On the flip-side, most folks are interested in being on less pharmaceuticals and instead desire to place more emphasis on lifestyle modifications and pursue more "natural" therapies.


In 2022, I am amazed by all of the technologies we have. We have no shortage of medications, surgeries, etc. targeted to alleviate many ailments and symptoms. Like many other aspects of our world, sometimes I worry that our ability to safely and effectively apply these therapies has not caught up with the technology.


One of my favorite quotes/principles is Loeb's Rules of Medicine:

  1. If what you're doing is working, keep doing it

  2. If what you're doing isn't working, stop doing it

  3. If you don't know what you're doing, do nothing

  4. Never make the treatment worse than the disease

I generally believe this framework helps both physician and patient avoid unproven, ineffective or harmful therapies--all with the the patient's opinions and outcomes in the center of care.


To the same effect, I have created "The Pyramid of Medical Inocuousness," pictured here:




The prime objective of the pyramid is to identify medical therapies that are safer than others. The higher you go up the pyramid, the more consideration should be given to the necessity of the therapy selected. For example, it is generally acknowledged that topical NSAID cream (ie Aspercreme, Voltaren) is potentially just as effective as oral NSAID (ie Motrin, Aleve) without many undesired side effects. Also, we know that broad-spectrum "big gun" antibiotics save lives everyday, but nobody would recommend taking them everyday for basic conditions. Inversely, the items at the bottom of the pyramid are not only the safest but also most likely to promote sustainable, long-term health and wellness.


Medical Minimalism is the idea that by first removing unnecessary or excessive therapies, doctor and patient can mindfully and intentionally start to rebuild a treatment plan with fewer high-value inputs. The goal is to restore wellness and minimize exposure to side effects, allowing the body to carry out its most natural ability--heal.


Call us today or come by the office to engage in a conversation about your health goals and how we can help you maximize your health.


Jarrod Couch, DO

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