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overdiagnosis-in-medicine-causes-and-complications

Overdiagnosis in Medicine: Causes and Complications Expectation that negative experiences represent a symptom of pathology rather than a part normal human experience Profit-motivated industries (e.g pharmaceutical companies) ↑ The number of diagnosed individuals serves to ↑ profits by expanding consumer base for treatments Authors: Davis Maclean Reviewers: Ben Campbell Eddy Lang* *MD at time of publication Unintended consequences of disease screening programs Direct to consumer testing (e.g home medical genetics testing kits) Note: Misdiagnosis ≠ Overdiagnosis Misdiagnosis refers to making an incorrect diagnosis in a symptomatic patient. Defensive medical practices Increased testing to ‘rule out’ pathology and reduce legal liability ↑ Availability of diagnostic tests Technological advancements leading to ↑ sensitivity of diagnostic tests Common public perceptions of health and healthcare Public overestimation of benefit and underestimation of risk modern medical interventions Assumption that more medical information (e.g testing) results in better health ↑ Number of findings on diagnostic tests (e.g Imaging and lab work) Medicalization of normal life experiences Overdetection: Identification of an abnormality that would not have caused any symptoms or harm in the patient’s lifetime if left undiscovered (e.g detection of subsegmental pulmonary embolism) Overdefinition: Lowering thresholds for classification of diseases and what is considered abnormal without net benefit for those diagnosed (this includes people with symptoms but who are more likely to be harmed than benefit from a diagnosis) Overdiagnosis: making an accurate diagnosis in an patient where making the diagnosis does not produce a net benefit for the patient Overtreatment: treatment that occurs in absence of evidence for net benefit to the patient Treatment side effects ↓ Quality of life (e.g nausea and fatigue secondary to chemotherapy) Overtreatment and overutilization are common consequences of overdiagnosis, but can happen in the absence of overdiagnosis Overutilization: ↑ Use of health services and systems without evidence of net benefit ↑ Health system spending Unnecessary testing Testing-related complications (e.g infection of surgical biopsy site) ↑ Risk for other Illness (e.g ↑ risk of infection in the setting of immunotherapy) Indirect costs: (e.g time off work for medical appointment, travel costs) ↑ Individual costs Direct costs: paying for additional tests and treatment (e.g medications) Legend: Pathophysiology Mechanism Sign/Symptom/Lab Finding Complications Published June 30, 2022 on www.thecalgaryguide.com