Intended for healthcare professionals


Too much medicine; too little care

BMJ 2013; 347 doi: (Published 02 July 2013) Cite this as: BMJ 2013;347:f4247

Re: Too much medicine; too little care

It is actually difficult to think of a condition where overdiagnosis is not a potential problem, since most medical diagnoses represent arbitrary points of change in definition along a spectrum of biological variables. People may move backwards and forwards along this spectrum, moving in and out of disease categories. In general practice, asthma, Type 2 diabetes, mental health problems and hypertension (really a risk factor rather than a disease) spring to mind.

I quite agree with my colleagues Julian Treadwell and Kevin Barraclough that we are subjected to the tyranny of the expert guideline. These are written by those whose livelihoods depend on making their own particular interest an industry for the rest of us. They are used as standards against which we are judged, and they drive the problem of overdiagnosis forward.

The whole issue of too much medicine and overdiagnosis is a huge issue that causes a colossal and tragic waste of resources at a time of financial crisis, yet it appears to be completely ignored by the politicians and NHS establishment. Congratulations must go to the BMJ to raising our awareness of this. When it comes to discussions about how to reform the NHS it is not so much the elephant in the room as the brontosaurus.

Competing interests: No competing interests

13 July 2013
Jonathan D Sleath
General Practitioner
Kingstone Surgery
Hereford, HR2 9HN.