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You can find the current article at its original source at https://www.theguardian.com/society/2018/sep/11/medicine-fix-society-ills-overdiagnosis-harm
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| Medicine isn’t a quick fix for society’s ills. Overdiagnosis can cause more harm | Medicine isn’t a quick fix for society’s ills. Overdiagnosis can cause more harm |
| (about 1 month later) | |
| There are many patients who live on in doctors’ memories. Lily was one such patient – a widow in her 80s with a spring in her step and a ready smile. An infrequent visitor to the consulting room, she was mostly found in her garden, tending to her flowers and vegetables. An accidental fall led to a head injury. A subsequent CT scan excluded a bleed on her brain, but showed a small tumour in the temporal lobe, a part of the brain processing sensory input. “It is slow growingand unlikely to cause any foreseeable problems,” her neurosurgeon said. | There are many patients who live on in doctors’ memories. Lily was one such patient – a widow in her 80s with a spring in her step and a ready smile. An infrequent visitor to the consulting room, she was mostly found in her garden, tending to her flowers and vegetables. An accidental fall led to a head injury. A subsequent CT scan excluded a bleed on her brain, but showed a small tumour in the temporal lobe, a part of the brain processing sensory input. “It is slow growingand unlikely to cause any foreseeable problems,” her neurosurgeon said. |
| Ditch the pills. We’ve found a better medicine for old age | Stewart Dakers | Ditch the pills. We’ve found a better medicine for old age | Stewart Dakers |
| Lily was not reassured. She worried incessantly about the cancer, and how quickly and painfully it would kill her. She no longer went out, refused all help and stopped eating. She died six months later, from a chest infection that she was too frail to fight. | Lily was not reassured. She worried incessantly about the cancer, and how quickly and painfully it would kill her. She no longer went out, refused all help and stopped eating. She died six months later, from a chest infection that she was too frail to fight. |
| Should she have been told about her brain tumour? Yes, but in her case the diagnosis was unhelpful. Overdiagnosis is defined as “too much medicine”. It includes identification of incidental abnormalities that were never destined to bother us through the natural course of our lives, as in Lily’s case. Overdiagnosis has become common, through more sensitive tests, and widening definitions of conditions – such as caffeine withdrawal, which is now defined as a mental health disorder. As doctors we are taught to medicalise conditions. This creates an expectation of treatment or cure. We become less tolerantof variants of normal existence – a minor headache becomes a “migraine”, a common cold “sinusitis” and forgetfulness “early dementia”. Although some incidental findings like an abdominal aortic aneurysm are important and require intervention, as if it ruptures it can lead to death, many are forms of overdiagnosis. It is up to the doctor to explain to the patient what is significant or what is not. | Should she have been told about her brain tumour? Yes, but in her case the diagnosis was unhelpful. Overdiagnosis is defined as “too much medicine”. It includes identification of incidental abnormalities that were never destined to bother us through the natural course of our lives, as in Lily’s case. Overdiagnosis has become common, through more sensitive tests, and widening definitions of conditions – such as caffeine withdrawal, which is now defined as a mental health disorder. As doctors we are taught to medicalise conditions. This creates an expectation of treatment or cure. We become less tolerantof variants of normal existence – a minor headache becomes a “migraine”, a common cold “sinusitis” and forgetfulness “early dementia”. Although some incidental findings like an abdominal aortic aneurysm are important and require intervention, as if it ruptures it can lead to death, many are forms of overdiagnosis. It is up to the doctor to explain to the patient what is significant or what is not. |
| Doctors are influenced by fear of medical uncertainty, of missing something (and litigation), or patients’ need for reassurance. We are given financial incentives to identify medical conditions and to prescribe drugs. Hospitals are paid by generating patient traffic. It would appear that over-medicalisation is almost needed for modern-day healthcare to survive. | Doctors are influenced by fear of medical uncertainty, of missing something (and litigation), or patients’ need for reassurance. We are given financial incentives to identify medical conditions and to prescribe drugs. Hospitals are paid by generating patient traffic. It would appear that over-medicalisation is almost needed for modern-day healthcare to survive. |
| NHS should expand 'social prescribing', says health secretary | NHS should expand 'social prescribing', says health secretary |
| But there is no cure for every symptom in the consulting room. We do not have all the answers. Our job is to listen, exclude and treat (if appropriate), not offer unhelpful medical hypotheses. There are many medically unexplained symptoms, such as tiredness, pain or non-epileptic attacks. These symptoms are not a figment of a patient’s imagination. They can be very real and distressing. But this does not mean that they can always be treated. When complex health problems have their triggers in social and economic issues, it is difficult to find effective solutions. Thus problems are medicalised and given names of “anxiety” or “depression” instead of poverty or homelessness. Every week I write letters of support for housing or for those appealing against benefit cuts. Or I prescribe an antidepressant for my patient who is low in mood and facing eviction from her home. | But there is no cure for every symptom in the consulting room. We do not have all the answers. Our job is to listen, exclude and treat (if appropriate), not offer unhelpful medical hypotheses. There are many medically unexplained symptoms, such as tiredness, pain or non-epileptic attacks. These symptoms are not a figment of a patient’s imagination. They can be very real and distressing. But this does not mean that they can always be treated. When complex health problems have their triggers in social and economic issues, it is difficult to find effective solutions. Thus problems are medicalised and given names of “anxiety” or “depression” instead of poverty or homelessness. Every week I write letters of support for housing or for those appealing against benefit cuts. Or I prescribe an antidepressant for my patient who is low in mood and facing eviction from her home. |
| We like to make patients better and happy. It makes us feel capable as doctors and human beings. But prescribing medicine when there is no evidence-based intervention is wrong. It not only won’t cure the patient, it diverts resources from necessary healthcare, and leads to less self-care and resilience. It feeds a need for consumerism. The patient becomes a customer being sold a health commodity of dubious benefit. However, it is getting harder to challenge patients’ demand for medicine, especially in a 10-minute session. When I have, it has occasionally caused upsetor even broken our relationship. | We like to make patients better and happy. It makes us feel capable as doctors and human beings. But prescribing medicine when there is no evidence-based intervention is wrong. It not only won’t cure the patient, it diverts resources from necessary healthcare, and leads to less self-care and resilience. It feeds a need for consumerism. The patient becomes a customer being sold a health commodity of dubious benefit. However, it is getting harder to challenge patients’ demand for medicine, especially in a 10-minute session. When I have, it has occasionally caused upsetor even broken our relationship. |
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| People’s powerlessness to fix society’s ills makes individuals strive to fix themselves instead. But doctors do not have all the answers when it comes to making people physically and emotionally better. There are limits to modern healthcare and too much medicine can lead to harm. As a society we need to be wary of overdiagnosis and become better at managing medical uncertainty. | People’s powerlessness to fix society’s ills makes individuals strive to fix themselves instead. But doctors do not have all the answers when it comes to making people physically and emotionally better. There are limits to modern healthcare and too much medicine can lead to harm. As a society we need to be wary of overdiagnosis and become better at managing medical uncertainty. |
| • Zara Aziz is a GP in inner-city Bristol | • Zara Aziz is a GP in inner-city Bristol |
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