[No SPF Record] [IMPROVEDX] Dhruv Khullar on overdiagnosis

Bertrand H. Vipond Bertrand.H.Vipond at KP.ORG
Wed Nov 14 20:09:12 UTC 2018


The ultimate problem is treatment error.  Diagnostic error is only a problem when it leads to treatment error.
Overdiagnosis, or overmedicalizing, even if a valid diagnosis, can lead to inappropriate treatment!

From: Rory Jaffe <rjaffe at CHPSO.ORG>
Sent: Wednesday, November 14, 2018 9:05 AM
To: IMPROVEDX at LIST.IMPROVEDIAGNOSIS.ORG
Subject: Re: [IMPROVEDX] [No SPF Record] [IMPROVEDX] Dhruv Khullar on overdiagnosis


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Totally agree. In our quest to reduce diagnostic error, we must be careful not to overincentivize indiscriminate pursuit of a diagnosis. There are plenty of situations in which it is better to leave things alone.

An example being that of prostate cancer diagnoses from PSA surveillance in otherwise asymptomatic men. The successful diagnosis and resulting effect on the person may be worse than the disease.

Rory Jaffe, MD MBA, Executive Director, CHPSO<https://urldefense.proofpoint.com/v2/url?u=http-3A__www.chpso.org_&d=DwMGaQ&c=ZMR5nv7DeMA_5yIzV7zEdkSfOjTGya0xwGqp1JcaTq0&r=YXAKagORvM3QHE8HlbKK5LvoafwQgRBw2-gSOaJ2JAc&m=fh7j6Be5gVVyYox8_M4bxKxPwKSihzjmR3veNC0eAno&s=IB7xUwHiYxFvVlFuMCyeDKiHb2WeeAVUk-EsyhzM7BM&e=>
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From: Helen Haskell <haskell.helen at GMAIL.COM<mailto:haskell.helen at GMAIL.COM>>
Sent: Wednesday, November 14, 2018 8:01 AM
To: IMPROVEDX at LIST.IMPROVEDIAGNOSIS.ORG<mailto:IMPROVEDX at LIST.IMPROVEDIAGNOSIS.ORG>
Subject: [No SPF Record] [IMPROVEDX] Dhruv Khullar on overdiagnosis

https://www.nytimes.com/2018/11/06/well/live/a-profusion-of-diagnoses-thats-good-and-bad.html<https://urldefense.proofpoint.com/v2/url?u=https-3A__www.nytimes.com_2018_11_06_well_live_a-2Dprofusion-2Dof-2Ddiagnoses-2Dthats-2Dgood-2Dand-2Dbad.html&d=DwMFaQ&c=hx0HUg_nG-xRkKlwWZeJFCbvzzw0Ym5DwdL_1FKbReI&r=ykcs2wU25yxj5BckI49bSg&m=e_MZgkfPXgLkgob4dJJ980Oytg1vujFOQnxSCR4cizY&s=24RC-QQWG6WAFYqVK3X7uhyZr7yrYcfsiPmYqeFJK-8&e=>

"A central problem is that medicalized diagnoses often come with medicalized treatments: Our penchant for pills outstrips even our desire for diagnosis. Since the 1990s, the number of office visits for sleep problems has doubled, and diagnoses of insomnia have increased sevenfold. But prescriptions for sleep medications have increased more than 30 times.

This is perhaps most concerning for children. About 12 percent of children in America now carry a diagnosis of A.D.H.D, and there was a 40-fold increase in childhood bipolar disorder diagnoses between 1994 and 2003. Five times as many children are now prescribed psychostimulant and antipsychotic medications as were in the 1980s. Today, a quarter of children and teenagers take prescription drugs regularly, and seven percent of older adolescents and young adults report abusing opioids — most of whom were initially prescribed them by a doctor."

Also Lown:
https://lowninstitute.org/news/blog/when-diagnosis-becomes-dangerous-a-taxonomy-of-medicalization/<https://urldefense.proofpoint.com/v2/url?u=https-3A__lowninstitute.org_news_blog_when-2Ddiagnosis-2Dbecomes-2Ddangerous-2Da-2Dtaxonomy-2Dof-2Dmedicalization_&d=DwMFaQ&c=hx0HUg_nG-xRkKlwWZeJFCbvzzw0Ym5DwdL_1FKbReI&r=ykcs2wU25yxj5BckI49bSg&m=e_MZgkfPXgLkgob4dJJ980Oytg1vujFOQnxSCR4cizY&s=ZrLQMdTQ-2L8sb8xDckAmdcaZHijDIC5fBAYLoLHkKA&e=>

"More newly recognized diagnoses is not inherently a good or bad thing. But we need to look deeper at this pattern – who is creating these diagnoses, who they are affecting, and how they are treated – to better understand how some diagnoses can be helpful and others harmful."



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