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Over-diagnosis

View profile for Kimmo Boote
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This is a relatively new phenomenon in which a right diagnosis is made but subsequently harm arises. This may seem like an odd concept, though there are times when the impact of treating a condition is less beneficial than not treating it.

The first examples of over-diagnosis were found in the screening for prostate cancer. A male aged over 70 years of age is likely to have a small localized cancer within the prostate that most probably would not have any effect on that individual during his lifetime. The risk to remove and/or treat that person’s prostate cancer would involve a greater risk of side effects occurring and causing greater harm to the patient than allowing the cancer to remain.

An extremely worrying example in paediatrics (and young people) in the USA is that of the diagnosis of attention deficit hyperactivity disorder (ADHD).

In 2011, the diagnosis of ADHD was made in 11% of children aged between 4 to 17 years of age, with 6.4 million children diagnosed with ADHD and 4.2 million taking psychostimulants (medication).

Over 30 years ago, that figure was 3-5%, but since 2003-2011, there has been an increase by over 1/3 again, without there being any levelling out of the numbers being diagnosed.

This means that 1 in 5 high school males have ADHD with an increasing number of young people being prescribed psychostimulants

Reasons for over-diagnosis

There is a drive to make a diagnosis in patients and it has proven difficult for doctors and other healthcare clinicians to understand the need, depending on circumstances, to:

‘Don’t just do something; stand there’ (quote from an actor and producer Martin Gabel).

The essential concept is that the making of a diagnosis should relate to the circumstances, and a risk/benefit judgement about what should be done, once that diagnosis is made.

There have been studies about why clinicians are keen to make a diagnosis (and thereby initiate treatment which could cause harm), and the reasons given are as follows:

  • It is hard to ignore information.
  • Most people believe the more information, the better.
  • Accepted wisdom and common sense are hard to overturn.
  • Most people are convinced that it is always in people’s interest to detect

Health problems early, even though the data say otherwise.

  • There is a common belief that early detection is cost-effective, even

          Though the data show it actually ends up costing more.

  • We find it hard to tolerate uncertainty.
  • Commercial interests benefit from screening and over diagnosis.
  • Doctor’s fear being sued if they omit tests.
  • Anecdotes about lives saved are emotionally persuasive.

MEDICOLEGAL ASPECTS

More work is required to look into how individuals can be kept safe, especially in screening programs that may correctly have picked up an abnormality. This requires establishing the advantages and disadvantages of treatment, and an explanation to the patient about the significance of the result. This is of absolute importance so that the individual is not converted to becoming a fearful patient, but is a person with an informed view on the positive result of the test.

If you want further information about this particular topic, or wish to discuss the possibility of bringing a claim for Clinical Negligence - or indeed any other type of injury, please contact the Dutton Gregory Clinical Negligence Team on (01202) 315005, or email k.marden@duttongregory.co.uk  

NB This article does not constitute legal advice and should not be relied on as such. No responsibility for the accuracy and/or correctness of the information and commentary set out in the article or for any consequences of relying on it, is assumed or accepted by any member of Dutton Gregory LLP.