The Archives of Internal Medicine has a a recent and insightful editorial and series of reports on this topic.
I have been given a fair amount of thought recently on overtreatment and overdiagnosis in medicine. I am sure that I have been guilty, much like many of my colleagues, on this front.
Often, diagnostic tests are ordered without questioning how the result will or should change patient treatment. Couple an inexperienced or uncertain doctor with an anxious patient and the potential for overtesting and overtreatment seems ripe.
Perhaps the most important point that we can learn from this editorial is that safer ways to reassure patients exist. The authors propose talking with patients as the first choice for reassurance.
Diagnostic tests should be reserved for cases in which the benefits can be reasonably expected to outweigh the risks. The physician should understand the sensitivity, specificity of a test, along with the positive predictive value given the disease's prevalence in the community. These principles are still taught in medical school lecture halls. Somehow, they are forgotten during the course of clinical practice.
Perhaps we should begin to really drill home this message during internship as interns order more tests.
Often, diagnostic tests are ordered without questioning how the result will or should change patient treatment. Couple an inexperienced or uncertain doctor with an anxious patient and the potential for overtesting and overtreatment seems ripe.
Perhaps the most important point that we can learn from this editorial is that safer ways to reassure patients exist. The authors propose talking with patients as the first choice for reassurance.
Diagnostic tests should be reserved for cases in which the benefits can be reasonably expected to outweigh the risks. The physician should understand the sensitivity, specificity of a test, along with the positive predictive value given the disease's prevalence in the community. These principles are still taught in medical school lecture halls. Somehow, they are forgotten during the course of clinical practice.
Perhaps we should begin to really drill home this message during internship as interns order more tests.
