“The delivery of good medical care is to do as much nothing as possible” . That sentence is the 13th law of Samuel Shem’s The House of God , a satirical novel portraying intern life.
Despite the novel’s satirical nature, there is much truth to the statement. Overdiagnosis, overtreatment, and overutilization are issues in modern-day health care delivery and limiting screening, diagnosis, and treatment to those who truly need them should be goals for the health care system.
However, the way things presently stand, overdiagnosis and overtreatment result in more interventions, unintended morbidity, and increased cost. The most widely accepted definition of “overdiagnosis” is “diagnosing a person without symptoms with a disease that will (ultimately) never cause symptoms or death during the person’s lifetime” . It should not be confused with misdiagnosis or false-positive findings, which are completely different entities and outside the scope of this commentary. As the generally accepted definition encapsulates downstream effects (ie, “would otherwise not go on to cause symptoms or death” ), the real issue lies with “overtreatment” of these accurate diagnoses rather than overdiagnosis itself.
Nowhere is this distinction played out better than in the setting of cancer screening. Historically, cancer was considered a terminal diagnosis as patients typically presented to a physician with signs and symptoms of the disease. Technology has since advanced to the point where cancer diagnoses can be made before they cause significant symptoms.
As its diagnosis has improved, so has our understanding of cancer. Physicians now recognize that “cancer” represents “cellular abnormalities” which have variable natural progression: “some grow rapidly, others do so more slowly, others stop growing completely, and some even regress” . It is because this variable disease course and our incomplete understanding resulting in the overtreatment of cancer rather than its overdiagnosis.
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References
1. Shem S.: The house of god.1978.DellNew York, NY
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