Overdiagnosis:An unrecognised and growing worldwide problem in healthcare

Overdiagnosis is the diagnosis of deviations, abnormalities, risk factors, and pathologies that in themselves would never cause symptoms (this applies only to risk factors and pathology), would never lead to morbidity, and would never be the cause of death. Therefore, treating an overdiagnosed condition (deviation, abnormality, risk factor, pathology) cannot, by definition, improve the patient’s prognosis, and can therefore only be harmful

How to conduct research on overdiagnosis:A keynote paper from the EGPRN May 2016, Tel Aviv

Overdiagnosis is a growing problem worldwide. Overdiagnosis is the diagnosis of deviations, abnormalities, risk factors, and pathologies that in themselves would never cause symptoms (this applies only to risk factors and pathology), would never lead to morbidity, and would never be the cause of death. Overdiagnosis is often misinterpreted as overutilization or overtreatment. Overutilization, overtreatment, and overdiagnosis are interrelated but three distinct topics. Overutilization (establishment of standard practice that does not provide net benefit) does not have to lead to overdiagnosis or overtreatment, but the risk exists. Treatment of overdiagnosed conditions is one category of overtreatment. Another is when the best available evidence shows that the treatment has no beneficial effect. Overdiagnosis can be caused by overutilization and is nearly always followed by overtreatment. Treating an overdiagnosed condition cannot improve the patient’s prognosis, and therefore can only be harmful. At the individual level, we can never be sure if the person is overdiagnosed. However, experiences and thoughts of individuals who are most likely overdiagnosed can be explored in qualitative interviews, e.g. men with a small screening detected abdominal aortic aneurism. In longitudinal surveys, the degree and length of psychosocial consequences associated with overdiagnosis can be estimated. In high-quality RCTs, the magnitude of overdiagnosis can be quantified, and in cohort studies, we can find indications of overdiagnosis. Finally, we can conduct research about the consequences of overdiagnosis in at least eight different areas: financial strain, hassles/inconveniences, medical costs, opportunity costs, physical harms, psychological harms, societal costs and work-related costs

Why several truths can be true

In this paper, we offer a perspective on complementarity, acknowledging that it is not possible for human perception and cognition to grasp reality with unambiguous concepts or theories. Therefore, multiple concepts and perspectives are valid when they are not exaggerated beyond reasonable limits and do not claim exclusive validity. We recommend a humble stance enabling respectful dialogue between different perspectives in medical science and practice.publishedVersio

Consequences of Screening in Lung Cancer: Development and Dimensionality of a Questionnaire

AbstractObjectiveThe objective of this study was to extend the Consequences of Screening (COS) Questionnaire for use in a lung cancer screening by testing for comprehension, content coverage, dimensionality, and reliability.MethodsIn interviews, the suitability, content coverage, and relevance of the COS were tested on participants in a lung cancer screening program. The results were thematically analyzed to identify the key consequences of abnormal and false-positive screening results. Item Response Theory and Classical Test Theory were used to analyze data. Dimensionality, objectivity, and reliability were established by item analysis, examining the fit between item responses and Rasch models.ResultsEight themes specifically relevant for participants in lung cancer screening results were identified: “self-blame,” “focus on symptoms,” “stigmatization,” “introvert,” “harm of smoking,” “impulsivity,” “empathy,” and “regretful of still smoking.” Altogether, 26 new items for part I and 16 new items for part II were generated.These themes were confirmed to fit a partial-credit Rasch model measuring different constructs including several of the new items.ConclusionIn conclusion, the reliability and the dimensionality of a condition-specific measure with high content validity for persons having abnormal or false-positive lung cancer screening results have been demonstrated. This new questionnaire called Consequences of Screening in Lung Cancer (COS-LC) covers in two parts the psychosocial experience in lung cancer screening. Part I: “anxiety,” “behavior,” “dejection,” “sleep,” “self-blame,” “focus on airway symptoms,” “stigmatization,” “introvert,” and “harm of smoking.” Part II: “calm/relax,” “social network,” “existential values,” “impulsivity,” “empathy,” and “regretful of still smoking.

A study of anti-fat bias among Danish general practitioners and whether this bias and general practitioners' lifestyle can affect treatment of tension headache in patients with obesity

Objectives: The study investigated whether treatment options for episodic tension-type headache vary among general practitioners (GPs) in Denmark depending on the patients’ weight status and gender, and whether these decisions can be explained by the GPs’ own anti-fat bias and lifestyle. Methods: A cross-sectional questionnaire study with responses from 240 GPs on measures of anti-fat bias, healthiness of GPs’ lifestyles, and reported patient treatment decisions. Results: GPs tended to exhibit negative explicit and implicit anti-fat bias. There were no differences in choice of medical treatment for patients with obesity and those of a normal weight. GPs were more likely to advise a general health check to a patient with obesity (p < 0.001). GPs treating a male patient with obesity were less likely to believe that their patient would comply with the advised treatment compared to those with a male patient of normal weight. Compared with other patient types (4.4–7.7%), GPs who treated a male patient with obesity (27.9%) were more likely to advise a general health check only and no diary-keeping or follow-up consultation (p < 0.001). This was explained by the healthiness of the GPs’ lifestyles (Spearman’s ρ = 0.367; p < 0.01). Conclusion: Despite the presence of clear anti-fat bias, there were no differences in medical treatment, and GPs managed the general health of patients with obesity proactively. The fact that the GPs’ own lifestyle influenced the likelihood that they would recommend diary-keeping and follow-up consultations for male patients with obesity is remarkable and requires further investigation