An over-diagnosis epidemic?

“The larger threat posed by American medicine is that more and more of us are being drawn into the system not because of an epidemic of disease, but because of an epidemic of diagnoses. … Medico-legal concerns also drive the epidemic. While failing to make a diagnosis can result in lawsuits, there are no corresponding […]

“The larger threat posed by American medicine is that more and more of us are being drawn into the system not because of an epidemic of disease, but because of an epidemic of diagnoses. … Medico-legal concerns also drive the epidemic. While failing to make a diagnosis can result in lawsuits, there are no corresponding penalties for overdiagnosis. Thus, the path of least resistance for clinicians is to diagnose liberally — even when we wonder if doing so really helps our patients.” (H. Gilbert Welch, Lisa Schwartz and Steven Woloshin, “What’s Making Us Sick Is an Epidemic of Diagnoses”, New York Times, Jan. 2).

6 Comments

  • There is also some other incentives for making a diagnosis even if weakly supported by the data. Firstly patients tend to want a diagnosis, a name to point to. Doctors want to give patients what they want (we tend to have a need to be liked, not to mention that patients can choose to go to someone else). Finally it can be difficult to get insurance companies to pay without a diagnosis code (known as a ICD-9 code). While you can submit a claim based on symptoms (for example “abdominal pain not otherwise specified”) sometimes insurance just doesn’t pay up if you don’t have a definite diagnosis (esp. true for diagnositic procedures).

  • I would estimate that about 20 to 30% of your medical bill and the amount of money we spend on medicine is the product of defensive medical practices. That is that test and procedures are preformed to cover any problem however remote just to keep the legal dogs at bay.

    In addition, Americans are obsessed with their health. Take cholesterol for example, this is likely not associated with coronary artery disease (I am a cardiologist), yet we constantly are bombarded with information on the subject and ways to possibly alter it (none work). Even if there is an association, it barely raises the risk of contracting the disease.

    We need less medicine, not more. We could get by with 50% fewer physicians than present today.

  • Well yes, we could deliver quite fine health care with 50% few docs because much of health care is not needed. But the problem is convincing patients that it is not needed. Everyone thinks their own problem is paramount and wants lots of access to all the specialists and new (expensive) diagnostic and theraputic modalities. The only way to get by on less is to have some sort of iron fisted triage scheme to keep pointless demand at bay. Patients like their diagnoses, it’s a sort of ‘me-too-itis’ thing; it’s better to complain of tennis elbow (or whatever your sport-elbow) than to merely state for the benefit of all present that your elbow hurts when you do this (whereupon some wag will point out that you should stop doing that).

  • An alternative–get rid of tax incentives for companies providing health care. Let consumers bear the cost of their health care/health insurance. There will be less frivolous demand for health care as a result. People will also be less accepting of unnecassary treatments and have less of a desire to be found sick.

  • Doctors have no incentive to tell patients they have no problems, and lots of incentives to tell them they do.
    A doctor who sends a patient home with the advice to take some aspirine and drink lots of orange juice and chicken soup because he just has a cold gets only the fees for the one visit.
    And if the patient does have some hidden serious condition he gets sued for millions.

    If however that doctor orders a CAT scan, blood tests, gives all kinds of pills and other meds, tells patient to visit another doctor, etc. etc. he gets a lot more money AND covers his ass for malpractice suits.
    The patient is also more likely to return to that doctor, secure in the knowledge that doc did everything possible to help them.

    So for a doctor it’s highly lucrative to do lots of tests and diagnose things that aren’t really there.
    – more repeat visits
    – higher income per visit
    – less risky in the long run

  • Well person – a patient whose diagnostic workup is not yet complete.