Overdiagnosis: When It’s Better Not to Know

As physicians, one of our most challenging (and intellectually rewarding) tasks is making a diagnosis. Sometimes it’s easy, but it can also require enormous amounts of time, money, and mental energy. Often, making a diagnosis demands blood draws, radiation exposure, or a surgical biopsy.

Sometimes, diagnosis is a good thing. Like if you find something that you can fix (and that wouldn’t have gone away on its own). Or even if you rule out something dangerous that would have required intervention. But other times, you find things you didn’t want to see.

It may be a lab value that’s a little higher than you expected. Or a funky spot on a chest x-ray that you can’t quite explain. These findings can demand extensive workup, which can have huge physical, psychological, and financial implications. And usually, at the end of it all, it didn’t really matter.

This has been a recognized problem in adult medicine for some time. There has been an enormous amount of controversy surrounding mammograms and prostate cancer screenings for the past several years. There is an excellent book on this topic by Dr. Gilbert Welch called Overdiagnosed: Making People Sick in the Pursuit of Health. He makes a great case for choosing not to look for abnormalities that may never cause symptoms.

In pediatrics, there hasn’t been a lot of buzz about the topic. But there should be. We over-test and over-treat every day, just like our adult counterparts. And now, this problem seems to be getting some attention. I just read a great article from the November 2014 issue of Pediatrics. (Just click on the link above and click on “Full Text.” It’s available for free.) It does a great job explaining why we may be overdiagnosing things like infant reflux, high cholesterol, food allergies, ADHD, sleep apnea, jaundice, urinary tract infections, and even some kinds of cancer (that tend to resolve on their own).

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As always, your comments are welcomed (even if you happen to disagree). I'll get back to you as soon as I can. Please try to keep it civil--I reserve the right to delete comments that are offensive or off-topic.

2 thoughts on “Overdiagnosis: When It’s Better Not to Know

    • Thanks Elizabeth–sorry you had to learn the hard way. All too often, doctors take that decision out of a patient’s hands without even considering that they might not want to know.

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