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

Peggy Zuckerman peggyzuckerman at GMAIL.COM
Thu Nov 15 05:37:45 UTC 2018


To say that "a diagnositic error is only a problem when it leads to
treatment error" is a bit too broadly stated.  A treatment which follows a
poor diagnosis may exacerbate an underlying conditon, and certainly is
likely to delay the proper diagnosis.  That delay can cause an infection to
spread, a tumor to grow, etc.   I am in perfect agreement that an
overdiagnosis or medicalizing a self-limiting condition can lead to
inappropriate treatments.   It seems the greater risk is that of a
misdiagnosis which becomes a barrier to getting proper diagnosis and the
appropriate treatment.
Peggy Zuckerman
www.peggyRCC.com


On Wed, Nov 14, 2018 at 9:16 PM Bertrand H. Vipond <Bertrand.H.Vipond at kp.org>
wrote:

> 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
>
>
>
> *Caution: *This email came from outside Kaiser Permanente. Do not open
> attachments or click on links if you do not recognize the sender.
> ------------------------------
>
> 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=>
>
> 1215 K Street, Suite 930
> Sacramento, CA 95814
> rjaffe at chpso.org
> (916) 552-2600
>
>
>
> [image: CHPSO-logo-tag-outlines]
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> *From:* Helen Haskell <haskell.helen at GMAIL.COM>
> *Sent:* Wednesday, November 14, 2018 8:01 AM
> *To:* 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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Moderator: David Meyers, Board Member, Society to Improve Diagnosis in Medicine


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