Observations Overdiagnosis

Too much medicine is not just a problem of rich countries

BMJ 2015; 350 doi: https://doi.org/10.1136/bmj.h1095 (Published 03 March 2015) Cite this as: BMJ 2015;350:h1095
  1. Anita Jain, assistant editor, The BMJ, India
  1. ajain{at}bmj.com

South Asia needs better recognition of the manifestations and drivers of overdiagnosis

One memory of medical school stays with me. It was our first day in clinical medicine, and we would be meeting a widely respected and feared professor. “Why have you taken up medicine?” he asked each one of us. Idealistic aspirations of serving the society and making a difference to the world came up.

“A barber does greater service to society than you ever will as a doctor,” he said emphatically. “You are here to make money.”

I found this reality difficult to accept then, but his words ring true as I observe medical practice today. Last year the personal account of an Australian physician volunteering in India blew the lid off the practice whereby doctors receive a commission of 10-30% for referrals to diagnostic centres and to specialists.1 Doctors refer to this “cut practice” as essential to set up shop and run their business, but it has led to rampant abuse of investigations and unnecessary procedures. What makes the situation more deplorable is that patients largely pay for healthcare from their own pockets, and the increased costs are …

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