Let‘s Face the Problem: We Doctors Do Too Much
DOI: 10.3238/zfa.2017.0245-0249german translation / full article
Summary: A growing frustration of clinical medicine is that we are now so busy managing the proliferation of risk factors, incidentalomas, and the worried well that we lack sufficient time to properly care for the seriously ill. As we expand the definitions of psychiatric disorders, diabetes, kidney disease, and coronary risk, those in crisis are lost in outpatient queues expanded by those who now find themselves on the wrong side of a shifted biochemical boundary. Too much medicine is harming both the sick and well. Much of the growth in apparent illness has occurred by stealth. This apparent increase is best explained by our improved diagnostic tools. „Epidemics“ have occurred in areas where we have been more deliberately screening. But perhaps the largest growth has been in the disorders where we have changed the definition of who does and doesn‘t have the condition. Small changes in the boundaries have expanded the proportion of the population with those disorders. What can clinicians do? There are strategies that may be helpful. To minimize the chances of over-detection and incidentalomas, investigation and screening should be very selective and targeted. Unexpected abnormal findings should be integrated with the clinical picture, and generally repeated or verified before diagnosis. Finally, we need to improve at sharing the information and consequences of options with the patient – a shared decision making approach.