Michael Vianin
Overdiagnosis is one of the most harmful and costly problems in modern healthcare. Musculoskeletal care has been plagued by over-detection, overdiagnosis, and overtreatment of structural anomalies to try to manage patients’ complaints.
Overdiagnosis is defined as “the labeling of a person with a disease or abnormal condition that would not have caused the person harm if left undiscovered, creating new diagnoses by medicalizing ordinary life experiences, or expanding existing diagnoses by lowering thresholds or widening criteria without evidence of improved outcomes. Individuals derive no clinical benefits from overdiagnosis, although they may experience physical, psychological or financial harm".
A recently published article sheds some light on some of the drivers involved in overdiagnosis. These drivers can be divided into five key interrelated domains: pervasive financial incentives (health systems), increasingly sensitive diagnostic tests (health policy), expanding disease definitions (health professionals), over-reliance on medical tests (patients and public), and faith in early detection (culture).
Vigna, M., Vigna, C. & Lang, E.S. Overdiagnosis in the emergency department: a sharper focus. Intern Emerg Med (2022). https://doi.org/10.1007/s11739-022-02952-8
Overdiagnosis can result in low-value and harmful treatment of patients, and impact quality of life. Overcoming overdiagnosis and moving towards value-base care requires changes in the basic underlying assumptions of the medical model. Such foundational changes can lead to patient-centered care, guideline-concordant integrated care, improved patient experience and outcomes, and cost-effectiveness, which are the hallmarks of value-based care.
References:
Woloshin, S., & Kramer, B. (2021). Overdiagnosis: it’s official. BMJ, n2854. doi: 10.1136/bmj.n2854
Vigna, M., Vigna, C. & Lang, E.S. Overdiagnosis in the emergency department: a sharper focus. Intern Emerg Med (2022). https://doi.org/10.1007/s11739-022-02952-8