“Overdiagnosis is a danger to our patients and the health system” (article in Irish Examiner newspaper by a GP)

Dolphin

Dolphin

Senior Member (Voting Rights)
For what it is worth:

Overdiagnosis is a danger to our patients and the health system​

Over-screening and over-testing fuel patient anxiety and divert resources from those who need it most, writes GP Mike Thompson

Unnecessary testing can use up vital resources and clinician time and — despite sometimes being partly driven by patient expectations — can cause that patient undue anxiety. Stock picture
TUE, 19 AUG, 2025 - 01:05
MIKE THOMPSON

General practice is one of the cornerstones of healthcare, providing continuity of care, managing undifferentiated presentations, offering large-scale population screening, and long-term management of chronic disease and preventative services. So far so good.

The spectre of underdiagnosis is obvious to all but, in recent years, the concept of overdiagnosis has gained increasing attention in clinical care.

www.irishexaminer.com

Overdiagnosis is a danger to our patients and the health system

Over-screening and over-testing fuel patient anxiety and divert resources from those who need it most, writes GP Mike Thompson
www.irishexaminer.com www.irishexaminer.com

Archived version:

It ends:
“For a further dive into this I would recommend books by two Irish medics and authors — Suzanne O’Sullivan’s The Age of Diagnosis, and Seamus O’Mahony’s Can Medicine Be Cured?”
 
Forgot to say, it includes this:
“We must also guard against disease-mongering by vested interests in the health arena. Pharmaceutical companies and other agencies (including doctors) create overmedicalisation of normal spectrum physiology. This can include increasingly diagnoses around social anxiety, chronic fatigue, weight control, addictions, and certain behaviours.”
 
I do think there is some truth to the idea that overdiagnosis is a problem for some conditions, but I can see why ME patients would scoff at it because we’re more likely to go undiagnosed. I can’t recall the details of this exactly, but on the autism side of a particular social media platform, I read an account from someone who was diagnosed by filling out a form and sending it to a doctor. She was clearly not properly evaluated. I also had a friend who got ADHD medication without a proper evaluation. This kind of thing can cause problems for the patient, and it reflects badly on other patients when people start to doubt whether people who say they have these conditions are telling the truth. I think this is the sort of thing some doctors have in mind when they talk about overdiagnosis.

That said, I don’t know that ME is one of the conditions that are being over diagnosed right now. If someone thinks it is, that itself could cause a problem for us.
 
I’ll add that I was incorrectly diagnosed with all kinds of absurd things things by an alternative doctor as a (relatively healthy) child, so I might have a very different perspective on this than someone who couldn’t get an ME diagnosis for a decade.
 
The article throws out lots of ideas around over diagnosis without fully distinguishing between them:
  • Misdiagnosis, where false positives are a form of over diagnosis
  • Over testing, where testing provides no additional guide to further useful action
  • Over testing because of a doctors fear of litigation
  • Over diagnosis, representing medicalisation of outliers in normal variation
  • Over diagnosis of benign conditions
  • Diagnostic creep, extending definitions beyond clinically useful range
  • Disease mongering by big Pharma that may or may not overlap with one or more of the above
  • Diagnosis for patient’s personal benefit, either/both psychological or financial (eg state benefits)
  • Cost effectiveness of testing
In how many of these is an unspoken ‘in the opinion of the clinician’ lurking in the wings? Raising the spectres of both medical timidity and medical hubris.
 
Inappropriate diagnosis is far more of a concern to me.

Disease mongering by big Pharma...​

What about psycho-social pathology mongering by the psych lobby? that is a far more insidious problem, in no small part because it is orders of magnitude more difficult to measure accurately. Which is very convenient for the psych lobby.

Interesting how when governments and the insurance industry want excuses to not deliver needed services there is always a ready supply of 'experts' to provide them with the convenient testimony for it.

And by 'interesting' I mean utterly appalling. :mad:
 
Yann04 said:
How about under diagnosis! Most deadly cancers wouldn’t kill if they were caught earlier!
Click to expand...
I don't think I've ever seen a single profession discussion of this. Always over-diagnosis. Never under. Even though over-diagnosis is entirely an imaginary problem, in that the resulting problems are purely hypothetical. "Patient anxiety" is a lie, no one cares about that, they only care about the "diverting resources" part, and "patient anxiety" only matters here if it leads to health care utilization. Even though health care is always under-utilized, because it's highly rationed, and there is almost never a reliable way to tell whether something should not have been done, the very idea of screening and testing comes with the notion that most will be negative. If most tests were positive it would mean massive under-testing!

But the whole thing about "diverting resources" is even more absurd when you consider how much resources are completely wasted on nonsense in health care, especially over pretending that those made-up problems are more of a problem than real, actual, measured problems, or even worse with the obsession over "mind-body" magic that has diverted resources, directly and indirectly, on a mass scale.

Because it's not diverting resources that is a concern, it's how they are used in the end. Most MDs seem to find zero problem with the massive waste of resources surrounding psychosomatic ideology and the mass psychologization that has stifled progress for decades. They find it smarter to have us getting stuck in loops that don't work, thus wasting resources, mostly indirectly because we don't get our health back, than actually do something to fix the problem. So it's all a matter of judgment, and most people's judgment is, frankly, very poor.

This is just the health version of "moral panics", where imaginary problems are elevated to matters of national security, while real problems are completely ignored by governments. It's the exact same thing, like obsessing over Dungeons & Dragons ruining the youth while ignoring mass unemployment or natural disasters.
 
Last edited:
Dolphin said:
Forgot to say, it includes this:
“We must also guard against disease-mongering by vested interests in the health arena. Pharmaceutical companies and other agencies (including doctors) create overmedicalisation of normal spectrum physiology. This can include increasingly diagnoses around social anxiety, chronic fatigue, weight control, addictions, and certain behaviours.”
Click to expand...
We know for a fact that it's massively under-diagnosed. This is a fact! They literally refuse to make most diagnoses, it's well-documented and -studied. Facts don't matter when people are vibing with feelings. This is not a way to run any professional anything!
 
I get very angry about the fact that I had a very simple health problem throughout most of my life that was almost never recognised or was considered trivial and didn't need treatment or needed very little treatment (i.e. here's one prescription, now go away because you aren't going to get another one). I fixed it myself in my 50s and early 60s, initially just by accident. I started fixing the triggering complaint and discovered that in doing so I also fixed two other problems that doctors had never managed to help me with.

The triggering complaint was very low levels of iron and ferritin. When I started to fix my levels myself (which took a very, very long time because of poor absorption) I discovered my long-term depression and anxiety vanished. Doctors had always, always, always assumed that most or all of my problems were caused by poor mental health, hypochondria, and drug-seeking, and they just repeatedly threw anti-depressants at me which didn't fix anything and gave me side effects. I was also aware that many prescribed anti-depressants are addictive which would have just made my entire life worse.
 
There is an issue with doing too many tests: the cost involved and the chance of false positives.

But I suspect the BPS-approach is a much bigger issue.

And if anyone are concerned about costs, they can look at the rehab industry first.
 
You must log in or register to reply here.
Back
Top Bottom