Is overdiagnosis a problem in medicine today?

I have written a few times about the soaring costs of our healthcare system. It seems clear that some fairly major changes are necessary if we are going to maintain quality sustainable and universal health care for everyone – especially as our population ages.

At least one expert in the US is writing about how technology and our low diagnostic thresholds for many diseases could be over-burdening an already taxed system while also not really helping people that much.

Gilbert Welch, a physician and professor of medicine at the Dartmouth Institute for Health Policy and Clinical Practice, talks about it in his book Overdiagnosed: Making People Sick in the Pursuit of Health.

Welch’s general theme is that today we are diagnosing people who would not have been considered sick in the past and he believes the thresholds in many areas of medicine have fallen too low.

There are a few reasons why we are finding more sickness than ever before. First, our incredible technological advances over the past decades have made it easier to detect even minor abnormalities. We also do a lot more testing for a myriad of things – and we test for them in younger patients and more frequently than in the past. Most of us are screened on a routine basis for a variety of conditions even when we don’t have any symptoms.

This isn’t all bad – doctors are trained not to miss things and want to provide help as quickly as possible to ensure a disease remains treatable and to reduce the likelihood of disability or premature death.

As our technology and knowledge have increased, we have also lowered the levels at which we consider disease to be present. Diabetes is a good example – the fasting blood sugar threshold for diagnosis keeps falling.

As a result of these low diagnostic levels, we end up treating a lot of people – even when they don’t feel sick. According to Welch, this not only contributes to soaring healthcare costs, but also subjects a lot of people to treatments that may be worse than the condition being treated.

Patients on the borderline for many disorders are less likely to receive much benefit from treatments, yet still put themselves at risk of the treatment’s side effects. Our legal culture has also affected this as physicians are much more likely to be sued over illnesses left untreated than over those they do treat.

I think all of this is an important observation – for which the solution will be complicated and culturally sensitive. It won’t do to simply paint broad brush strokes over all of medicine and assume all diagnosis is tainted by thresholds lower than they should be.

Judgement and collaboration between doctor and patient are necessary in order to decide when treatment is appropriate and what course is best. Not everything that can be diagnosed should be treated.

 

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