In September I was lucky enough to attend the Preventing Overdiagnosis conference in Oxford, UK. I learned about new resources and people that I could connect with, changed some of my beliefs, and generated even more questions for myself/the health care system.
In my reflection, 7 major themes emerged:
Nomenclature
- under-use is as much an issue as over-use
- like food, we want our medicine neither over- nor under-cooked [David Haslam]
- how do we define the problem? what terms are being used to describe this/similar issues? [see glossary for some] can we create a common term?
- causes of overdiagnosis are on a spectrum
- good intentions -- wishful thinking -- vested interests [Stacy Carter]
- good intentions -- wishful thinking -- vested interests [Stacy Carter]
- under-use is as much an issue as over-use
Cognitive/Labeling Biases = Problematic
- flawed thinking: doing something better than nothing, "more is better"
- the more resources exist, the more they are used
- actions motivated by fear (of death, illness, uncertainty)
- labeling bias
- is there any other way we can see patients besides by labeling them with diagnoses? [William House, Andrew Morrice]
- creating a "WAR ON CANCER" galvanizes people, breeds an ideology and creates fundamentalists
- flawed thinking: doing something better than nothing, "more is better"
It Is about conversations, not certainties
- mostly grey areas, no blanket rule for everyone; evidence, guidelines, recommendations must be interpreted for each patient
- pathology is a continuum, never/rarely yes or no
"correct" is not always effective
use existing skepticism/understanding to inform others
eg. people have begun to understand the harms of the overuse of antibiotics; parlay that into other areas
Individuals vs. populations
- for Patient X to not have a stroke, 76 other people have to be on statins
- it is not possible to know at an individual level if something is overdiagnosis
- evidence often does not apply to the person sitting in front of you
Health Care delivery is flawed
- changing the way we delivery primary care might be the heart of the solution
- "consumer"-driven Predictive, Preventive, Personalized, Participatory (P4) medicine is scary & narcissistic [Henrik Vogt]
- neo-paternalism may have a role
- industry is scary
- for-profit medicine is the biggest enemy of "Less is More Medicine"
- this drives the medicalization of normal life, which makes us sicker!
- the technology for genetic-based medicine is a long way off from being helpful
Screening fails in ways we never imagined
- patients equate screening with access to care [Laura Batstra]
- "why is screening exempt from the ethical responsibilities to do no harm?" [Alexander Barratt]
- preventative medicine has disappointing outcomes [Linn Getz]
Evidence is lacking
- it's not just a lack of quantity or quality
- do we really need clinical trials to prove the obvious? can't we just do the right, ethical thing? [Dan Mayer]
Did you take away the same points as I did? Something completely different?
I'm already looking forward to the conference next year, in Bethesda, USA.