You believe that your doctor knows best. But haven’t there been instances when you wondered if the treating hospital was fleecing you or over treating you?
“Overdiagnosis” or “high medicalisation” are no longer vague concepts or terminologies that have suddenly come into vogue.
In August this year, public health experts, specialists and policy makers got together at Quebec in Canada for the fifth Preventing Overdiagnosis conference, following global consensus that “overdiagnosis and overtreatment are legitimate areas of concern” that need immediate attention.
It all began with the American Board of Internal Medicine (ABIM) launching the Choosing Wisely campaign in 2012, to raise awareness and dialogue amongst patients and doctors about the overuse of diagnostic tests and procedures.
Overused
Since then, nearly 100 medical specialty societies in the US have joined in and have listed more than 475 tests and procedures that they say are overused and inappropriate. It is estimated that in the US, at least 30% of tests ordered across all specialties are a waste of time and money
Medical journals such as BMJ (Too Much Medicine), JAMA Internal Medicine (Less is More) and The Lancet (Right Care) too have been in the forefront, campaigning for the judicious use of medicine and technology for patient safety, to bring down cost of healthcare spending and to make sure that valuable medical resources are not wasted.
In India, the Society for Less Investigative Medicine (SLIM) came into being in 2015, with similar objectives.
Overdiagnosis
“It is a fact that overdiagnosis and over-investigations have become the face of medical practice today. On the one side, it is because of the availability of and over-dependence on high-end medical diagnostic technology. On the other, it is the desire of doctors not to “miss” anything, to be sure that they have ruled out all probabilities of finding something amiss. I do not deny that other external considerations like “kick backs”, practice of defensive medicine and helping corporate hospitals generate profits, etc., are also involved,” says R.V. Jayakumar, renowned senior consultant in Endocrinology, currently at Aster Medicity.
When it is comes to medicine, more isn’t always better.
Avoiding unnecessary investigations is important for providing cost-efficient care and it is up to the patient and the physician to sit together, communicate and take an informed decision.
Clinician’s dilemma
“The clinician’s dilemma is missing a rare disease if the spectrum of investigation is narrowed and the prospect of high cost of care and exposure risk if the spectrum is widened,” says C. Jayan, Addtl Prof. Of Surgery, Thiruvananthapuram Medical College.
Overdiagnosis is defined as the diagnosis of a disease that would never have become clinically apparent in a person’s lifetime and would never have caused him any harm even if it was detected through a medical test.
People have been led to believe that screening tests for cancer, which enables early detection. are always good.
However, overdiagnosis is emerging as a significant concern at least in some areas, especially breast, thyroid or prostate cancers.
Apart from the anxiety and stress of the diagnosis, patients are also put through unnecessary treatment.
Technology can be a double-edged sword and as diagnostic tests improve, even perfectly benign tumours or abnormalities or “lesions of uncertain significance” are picked up .
Even if the surgeon is convinced that this could never become harmful, when it comes to cancer, a decision is not simple.
Many women, after a mammogram, thus undergo mastectomy and radiation treatment, often unnecessarily.
A lot of unnecessary thyroid surgeries are also happening because even tiny thyroid nodules, which might very well be left alone, are further investigated and treated.
Teaching medicine
Dr. Jayakumar feels the way medicine is taught today has also a lot to do with the way it is practised today .
“I was taught to focus on the patient’s clinical history. Physiology and anatomy has fallen behind and with technology taking over, the clinical experience of doctors is coming down.
For the younger generation of doctors, putting together the clinical history of a patient and ordering only the appropriate and necessary investigations is a fine balance that they have to acquire through experience,” says Dr. Jayakumar.
C. Maya
