Overdiagnosis, Misdiagnosis, and Overtreatment
Recently, I read in the news that a man with leg pain was diagnosed with brain cancer and he subsequently passed away from his treatment with multiple other health issues. This is not new news to me and it is quite upsetting to read.
Misdiagnosis, Overdiagnosis, and Overtreatment in Musculoskeletal Conditions
Doctors, physiotherapists, chiropractors, or nurses make poor judgement and decisions sometimes but should the patient pay for it?
Often times, I'll receive misdiagnosis from doctors which is not even close to what the patient have. Honestly, I have no idea how these doctors made the diagnosis since they are qualified specialist! This misdiagnosis will create fear unnecessarily and the patient might overthink the diagnosis and this can lead to depression/dependence.
On a different note, some clinicians base their diagnosis on medical imaging without considering the patient's medical history, physical examination or function. Medical imaging can also overdetect. For example, a patient with a suspected lumbar disc prolapse can return with a MRI scan that shows lumbar dis prolapse, joint degeneration and foraminal narrowing. On top of that, the X-ray is reported as having mild scoliosis. So, the patient will now be diagnosed with lumbar disc prolapse, lumbar spondylosis, lumbar stenosis and scoliosis. How awful is that? You saw the doctor for one issue and left the consultation room with multiple issues!!!
Next, clinicians will normally perform a variety of physical examination and they will list down all the "dysfunctions" that is related to posture, joint alignment/position and muscle tightness. They will mention that "your neck is tilted to one side, your pelvis is immobile on one side, your iliopsoas is too tight and you have flat feet." This is another form of overdetection.
Now, the patient will feel like a failed design from God when the diagnosis from medical imaging and clinical findings are combined. So, what good is there in finding out what's "wrong" when it doesn't help the situation/patient at all?
Is it necessary to find all the flaws in the human body? Are we able to change anything structurally even if there is something "wrong"?
Broadly, overdiagnosis means making people into patients unnecessarily. We identify, test and find out "problems" that are not likely to cause harm.
Unnecessary, excessive or receiving treatment too frequently (more than 3 times a week). Some clinicians would prescribe their patients with lots of different types of medication or supplement that is claimed to improve their condition. Some would recommend surgery in extreme cases.
Others would recommend big packages (more than 12 sessions per package) or frequent treatment visits. Again, claiming that the patient needs that frequency to improve their condition. Honestly speaking, logically thinking. Is it really necessary to have that much treatment before one improves? There is a form of healing called natural history which means that time helps with healing in certain instances!
1. Ask questions. It's true that some clinicians have limited time to answer questions but if they are truly there to help you and if they truly care for your well-being; they will make time.
2. Get a second opinion. Every clinician have their own unique thought processes. Find one that gives you a good reason to trust.
3. Do your own research. I normally don't encourage patients to do their own research because some of the information available is unreliable or invalid. However, you are free to discuss the information with your clinician.
1. Clinicians should be ethical in prescribing medications and treatment. They shouldn't only protect their own interests (revenue). They are dealing with lives; not objects.
2. They should keep updated with current research and challenge their own biases. Their current practice can be unethical or out-dated so they have got to reflect on it.
3. Clinicians should be more human. What patients want is to be heard and to be understood. They don't need any more worries in life. I understand that they may need treatment but not unnecessarily!
4. Lastly, the Hippocratic oath and medical ethics have strongly stated that clinicians should do no harm and they should put the patient's best interest ahead of everything else. In my opinion, using nocebic language or creating fear/worry from pointing flaws of the patient is a form of harm. It affects/harms the patient psychologically!
This blog is not aimed at any particular profession but everyone that treat patients. Although, some professionals are more inclined to fall into the unethical category.
Thank you for reading! Sometimes it really irritates me when I hear the things my patients have gone through. My wish is that the unpleasant experience can be avoided so please share this blog around to create some awareness!