Leading up to the Society of Hospital Medicine Annual Meeting in 2012, Lenny Feldman, MD, FACP, FAAP, MHM, associate professor of medicine and pediatrics at Johns Hopkins Hospital, was asked to give a talk. He obliged, and the talk was called “Things We Do For No Reason.”
Little did he know that he’d be giving similar talks at the conference for the next 13 years, let alone realize that the concept would end up becoming a staple of the Journal of Hospital Medicine for 10 years running.
Today, Things We Do For No Reason is one of the most popular features in the journal. Each article is a review of a common practice that is routine for many hospitalists, but whose value can be questioned upon a close look at the literature, Dr. Feldman said.
Dr. Feldman
“The goal of the series was to question everyday tests and treatments that we order without thinking by focusing on very specific practices that people engage in regularly,” he said. “Often we find evidence that not only refutes the practice but also shows that it can cause harm.”
A few recent examples include avoiding naltrexone in alcohol use disorder in liver disease; checking QT intervals in hospitalized adult patients before giving IV ondansetron; and routinely using stigmatizing language in medical notes.1-3
“We try to target practices that occur frequently enough that they resonate with our hospitalist community,” Dr. Feldman said.
The goal was to publish one of the features every quarter. There have been many more than that.
“If we were doing one a quarter, we’d be at about 40 right now, and instead we are well over 100,” he said. “That’s just because it has been popular—people are excited to talk about the practices that they do or that they see others do that they want to question.”
Anthony Breu, MD, an editor for the series and assistant professor of medicine at Harvard Medical School, said the articles can be an outlet for physicians and can sometimes offer them validation.
Dr. Breu
“I think people enjoy seeing in print things that have bothered them for years and enjoy having the arguments that they have been having with their peers kind of spelled out,” he said. “Sometimes you feel like you’re out on an island shouting into the wind, like, ‘Why are we doing this, why are we doing this?’ And then experts publish an article saying that you’re right. I think that can be really affirming.”
The process for having a piece published in the Things We Do For No Reason series is a bit different from other publication processes. Typically, an idea is proposed, and sometimes editors will ask the potential writer to submit an abstract of about 500 words.
After that, if approved, the proposal will move to a pre-submission stage, a hands-on process in which the editors work with the writers to craft a piece that is likely to survive the peer-review process. The writers aren’t promised that if they make it to the pre-submission stage that the piece will be published, but Dr. Feldman estimated that upwards of 95% of them are actually published.
Dr. Lu
It sounds like it might be a competitive process, but it is not competitive in the traditional sense, said Elise Lu, MD, PhD, assistant professor of pediatrics at Western University, who is the newest editor to work on the series.
“People are not competing against each other,” she said. “We don’t have a limit on how many articles we accept or how many can be going at once. It’s more that we’re selective.”
Sometimes, there just isn’t enough evidence on a topic, even if it clearly seems like something done with little reason. Sometimes, she said, topics that are proposed are issues that wouldn’t resonate throughout the field of hospital medicine.
“You don’t realize when you’re thinking about something from your institution that it may not be something that’s actually relevant for the readership at JHM,” she said.
As popular as the series is, its impact on practice has been mixed, the editors acknowledge. In one piece, Dr. Feldman said, the writers, Aaron Dunn, MD, and Dr. Lu, argued that discharge before noon—often a common goal in hospitals—is not supported by robust evidence, which suffers from confounding issues and external validity concerns. The practice could also cause harm, diverting attention away from patients needing care so that the more stable and discharge-ready patients can be tended to, they argued.4
Nonetheless, discharge before noon keeps recurring as a topic of conversation at medical centers, including his own, Dr. Feldman said.
“History keeps repeating over and over and over again,” he said.
In his first talk at the SHM conference, he covered four things he said were done for no reason: blood transfusions in patients with hemoglobins greater than 7; the daily chest X-ray; using fractional excretion of sodium (FENa) to try to evaluate whether a patient has pre-renal azotemia or acute tubular necrosis; and nasogastric lavages in those with a possible upper GI bleed to determine whether they do in fact have an upper GI bleed.
While the NG lavages have gone away, the daily chest X-ray and FENa continue to be done, while the blood transfusions are a mixed bag, the editors said.
“What’s hard about the series is we don’t do implementation practice—we don’t then take that article and then go to hospitals and say ‘You’ve got to change this,’” Dr. Breu said. “The hope is that people will take that article as proof and go to their administration or go to their peer group and try to make a change.”
He added, “By definition, if it’s in the series, it’s because it’s something that’s been hard to change and it’s part of the culture. Culture is exceedingly difficult to turn.”
The editors said that the nature of medicine is such that they are not likely ever to run out of topics—there will always be things that are done for no reason. There are always new treatments and methods, and some of them are bound to catch on even without strong evidence backing, Dr. Lu said.
“Implementation is always easier than de-implementation,” she said. “You get the cool new thing that has a couple of studies to back it up and might help, and you roll it out really quickly—and then it takes years of studies to prove that it wasn’t actually as helpful as you thought it was.”
Tom Collins is a medical writer based in South Florida.
References
Kee DP, et al. Things We Do for No Reason™: Avoiding naltrexone for alcohol use disorder in liver disease. J Hosp Med. 2025;20(7):768-771. doi: 10.1002/jhm.13569.
Kaushik R, et al. Things We Do for No Reason™: Checking QTc on hospitalized adult patients before intravenous ondansetron administration. J Hosp Med. 2025;20(5):505-508. doi: 10.1002/jhm.13488.
Caton JB, et al. Things We Do for No Reason™: Routine use of “denies” and other stigmatizing language in medical documentation. J Hosp Med. 2025 ;20(6):623-627. doi: 10.1002/jhm.13527.
Dunn AN, Lu EP. Things We Do for No Reason™: Discharge before noon. J Hosp Med. 2024;19(12):1174-1176. doi: 10.1002/jhm.13367.