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Editorials

Focusing on overdiagnosis as a driver of too much medicine

BMJ 2018; 362 doi: https://doi.org/10.1136/bmj.k3494 (Published 17 August 2018) Cite this as: BMJ 2018;362:k3494
  1. John Brodersen, professor of general practice1,
  2. Barnett S Kramer, director2,
  3. Helen Macdonald, head of education3,
  4. Lisa M Schwartz, professor of medicine4,
  5. Steven Woloshin, professor of medicine4
  1. 1Centre of Research and Education in General Practice, Primary Healthcare Research Unit, Department of Public Health, University of Copenhagen
  2. 2Division of Cancer Prevention, National Cancer Institute, Bethesda, MD, USA
  3. 3The BMJ, London WC1H 9JR
  4. 4Center for Medicine and the Media, Dartmouth Institute for Health Policy and Clinical Practice, USA
  1. Correspondence to: J Brodersen jobr{at}sund.ku.dk

Why overdiagnosis is hard to spot and to explain to individuals

Overdiagnosis, sometimes known as “pseudodisease,” turns people into patients unnecessarily.1234 It identifies deviations, abnormalities, risk factors, and pathologies that were never destined to cause harm (such as symptoms, disability, or death).5 Overdiagnosis causes anxiety and other negative consequences of labelling; it leads to wasted resources and side effects as a result of unnecessary treatment. Here we consider overdiagnosis in asymptomatic people. Overdiagnosis also occurs (and causes harm) in symptomatic individuals when expanded disease definitions overmedicalise unpleasant ordinary life experiences, but we do not consider it here due to distinct conceptual differences between the two in terms of driving causes and ability to identify overdiagnosis in individuals.4

Real but elusive trigger of too much medicine

Overdiagnosis is a driver of “too much medicine.” But the uncertainties inherent in overdiagnosis set it apart from other drivers—such as overtesting and overtreatment—making it harder to explain and to tackle.

Overtesting and overtreatment can be identified in a given patient. There is a consensus based on solid evidence that a patient with low back pain but without specific neurological signs or deficits who undergoes magnetic resonance imaging of the spine …

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