Preventing Overdiagnosis – Where are we now?
October 24, 2016
This guest blog was written by Dr David Warriner, a Cardiology Registrar, who has attended each Preventing Overdiagnosis conference since its inception in 2013. Here, he reflects on how the conference and its message has evolved.
It was once said that a journey of a thousand miles begins with a single step, and in Dartmouth, New Hampshire on 10th September 2013, #PODC2013 was very much the first real step in winding back the harms of “too much medicine”, a term first coined by Ray Moynihan and Richard Smith over a decade earlier.
Having attended many medical conferences over the years, Preventing Overdiagnosis is unique, not just because of the refreshing absence of big pharma (the sandwiches still taste just fine to me), but also because of the breadth of scope. There are seminars on cardiology, workshops on terminology, posters on oncology, and keynote lectures on pharmacology. It’s less of a soulless conference of delegates and more of a living movement with a common sense of purpose. This movement has acquired many names (see figure), such as “choosing wisely”, “too much medicine”, and “prudent practice”, and has necessarily coined its own language, with terms such as undiagnosis, disease mongering, diagnostic creep, and deprescribing.
Figure 1: Some of different names of the preventing overdiagnosis movement (Thanks to Dr Jess Otte, available at www.lessismoremedicine.com)
However, over the 4 years it has become clear that overdiagnosis is just one end of a spectrum, and whilst too much medicine is bad for you, we mustn’t lose sight of the fact that too little medicine is no better. So rightly, the Goldilocks question is now being considered – just how much medicine is the right amount? This of course depends on your perspective, either patient or physician, but as a result of this movement, shared decision-making and evidence-based medicine are being used to bridge this chasm of uncertainty.
What is consistent during the conferences is that every break is a chance to connect with like-minded individuals and have challenging and stimulating talks about the big issues in medicine, such as “What is a Disease”, rather than divulging diagnostic minutiae solely in our specialist silos. For example, during one lunchtime in Oxford at #PODC2014, I met a German radiologist, a Brazilian GP and an Australian orthopaedic surgeon, and we talked about the usefulness of labels such as osteopenia, the risks of overtreating childhood reflux, and the challenge of address conflicts of interest, financial or otherwise.
On a personal note, my only regret is the apparent lack of specialists who attend these conferences; to date I’ve met 3 other cardiologists but I can’t vouch for any specialties. The generalists are not only already converted; they are even doing the preaching, yet the specialists still remain very much part of this problem, and therefore solution. This is no criticism of the conference, but I feel we must seek to engage with more specialists, encourage attendance, and by doing so, demonstrate that by focusing on smaller and smaller areas of pathology, the risk of losing sight of the whole patient grows larger and larger.
So, Happy 4th Birthday Preventing Overdiagnosis, and I look forward to joining you next year in Quebec for the 5th instalment of #PODC2017.
Dr David Warriner can be found on Twitter here. For further information on Preventing Overdiagnosis, please visit www.preventingoverdiagnosis.net/.
Image courtesy of Dr Jessica Otte – www.lessismoremedicine.com.