The potential burden of overdiagnosis and how to prevent it

The problem with overdiagnosis, beyond the anxiety that it can provoke for people like Omar, is the burden it can place on people. This treatment burden in people with multiple comorbidities can reduce their capacity to collaborate in their care¹.

Many people are already living with multiple long-term health conditions. Add another diagnosis to their list and this is likely to come with further advice on lifestyle changes, medications, investigations and appointments for specialist reviews. Travelling to appointments and managing new medication regimes can be time consuming, incur an expense and be stressful.

Healthtalk is a website on which thousands of people have shared their real life experiences of living with chronic health problems². The selection of quotes from people with long-term conditions below, reminds us that the impacts of illness and treatment are more than biomedical. Over-diagnosis and over-treatment can have wider impacts on work, income and housing, social activities, emotional health and expectations from life.

Figure 1: Quotes to demonstrate the wide-ranging impacts of living with a long-term condition².

Dahlgren and Whitehead³, highlight how healthcare is just one factor people need to consider working on to maintain the health they need as a resource for daily living.

It’s important to also consider how everyone experiences illness differently. Whilst some are resilient and integrate their chronic illness into their daily life, some see it as an added burden, whilst others may feel overwhelmed by it⁴. We know that shared decision making tools and encouraging ‘buy in’ can help improve adherence to treatment plans as people become burdened by multiple conditions. Expert generalists are perfectly placed to facilitate the required whole-person centred approach to care.

So what can you do to prevent overdiagnosis and reduce treatment burden?

There are many potential barriers to preventing overdiagnosis. The word cloud below highlights a few that you may have already considered. However, we should already have helped to overcome some of these with the tools we have introduced such as the flipped consultation, the generalist gatekeeper role and the SAGE Consultation Model.

Figure 2: Barriers to Preventing Overdiagnosis

You can help further by sharing the message of expert generalism!

There are also a range of further resources you could explore to help you to prevent overdiagnosis. The RCGP has a special interest group on overdiagnosis which you could consider joining⁵. In addition, you could look at the BMJ’s ‘Too Much Medicine’ initiative, which was established to highlight the threat to human health posed by overdiagnosis and the resources being wasted on unnecessary care⁶.

Further articles and websites of interest on this topic are listed below for you to explore.

In the next steps, we’ll consider when you might use the generalist gatekeeper model, compared to when you might follow a purely biomedical approach to consulting.

Further reading

Websites

• https://www.choosingwisely.org/
• https://www.preventingoverdiagnosis.net/

Articles

• https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1122814/
• https://ebm.bmj.com/content/23/1/1
• https://www.bmj.com/content/346/bmj.f1271.full
• https://bjgp.org/content/66/644/116

References

1. May C, Montor VM, Mair FS. We need minimally disruptive medicine. BMJ. 2009; 339: b2803. DOI: 10.1136/bmj.b2803
2. DIPEx. Health Talk. Real People. Real Life Experiences. 2019. https://healthtalk.org/ [Accessed 27/02/2022]
3. Dahlgren G, Whitehead M. Policies and Strategies to Promote Social Equity in Health. Stockholm: Institute for the Futures Studies; 1991.
4. Reeve J, Cooper L. Rethinking how we understand individual healthcare needs for people living with long-term conditions: a qualitative study. Health Soc Care Community. 2016; 24(1): 27-38. DOI: 10.1111/hsc.12175
5. RCGP. Overdiagnosis Group. 2014. https://www.rcgp.org.uk/clinical-and-research/about/special-interest-groups/overdiagnosis-group.aspx [Accessed 27/02/2022].
6. BMJ. Too much medicine. 2022. https://www.bmj.com/too-much-medicine [Accessed 27/02/2022]