Dhruv Khullar on overdiagnosis

Robert Bell rmsbell200 at YAHOO.COM
Thu Nov 15 04:58:49 UTC 2018


 Thanks Sherrill, more good points. 
Let me add a further thought to the mix.  
Do single payer systems, in general, help or hinder diagnoses?
Any comments from those with single payer systems?
Rob Bell, M.D.
    On Wednesday, November 14, 2018, 1:06:59 PM MST, Sherrill Franklin <sfranklin131 at gmail.com> wrote:  
 
 Thoughtful questions, Dr. Bell and all,  
And is the opposite situation a problem?  In other words, are there pressures and incentives to withhold testing or other investigation as a way of saving money?  My patient experience includes living a miserable existence with undiagnosed Graves disease for 10 years.   Not one of the five endocrinologists I saw (including several at academic institutions) did a full thyroid panel that included autoimmune factors.  When is not testing and not investigating a common cause of misdiagnosis?
Would a diagnosis take too much time with little financial return from insurers—again a money problem?  Are women’s autoimmune problems too subtle and complex? Was there push-back from insurers when certain tests were performed?  Again and again I was told, “Hey, you look fine” and I was dismissed. It was clear there was no malice involved, these physicians were respected and well-meaning.  I often wondered if there were subtle or not-so-subtle incentives to not investigate?
My thyroid surgeon —who had heard many tales of misdiagnosis--thought that everyone (esp. women) over the age of 40 should have a full thyroid panel done. With that in mind, how can medical societies rewrite guidelines to insure maximum likelihood of a diagnosis for this or other problems?  And of course, one wonders, are guidelines ever influenced by insurance company pressure? 

Sherrill Franklin






On Nov 14, 2018, at 2:11 PM, Robert Bell <0000000296e45ec4-dmarc-request at LIST.IMPROVEDIAGNOSIS.ORG> wrote:
 Thanks Helen,
Important post.
Is money a driver for any of these diagnoses?
Which brings up the argument as to how big an issue money is in the diagnostic process. 
Many years ago there used to be concerns in the medical community about certain surgical procedures being done so frequently by some.
Is there literature that discusses the influence of money on diagnosis and has SIDM ever considered it in their positions and writings?
Rob Bell M.D.


    On Wednesday, November 14, 2018, 9:04:11 AM MST, Helen Haskell <haskell.helen at GMAIL.COM> wrote:  
 
 https://www.nytimes.com/2018/11/06/well/live/a-profusion-of-diagnoses-thats-good-and-bad.html
"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/

"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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