Overdiagnosis is a serious medical problem


Overdiagnosis is a serious medical problem


We have a big problem in the medical world today.

I think of it as the Carpenter Problem, because it reminds me of that old saying—when all you have is a hammer, everything looks like a nail.

That’s the way most doctors treat their patients. They have a few tools—and by golly, they’re going to use them.

Even when they are ill-suited to the task at hand.

In fact, a new study just published in JAMA found that doctors chronically overdiagnose a number of maladies, leading to millions of unnecessary and potentially harmful treatments every year.

That’s a breathtaking number. It’s no wonder medical malpractice is such a hot topic.

In today’s environment, it’s very important to know when you’re in danger of being overdiagnosed, and overtreated.

And knowing what your alternatives are could save you a world of pain and heartache.

What happens when you get too much medicine

Cancers of the thyroid, breast, prostate, and ovaries are the most likely to be overdiagnosed. And the most likely to be overtreated.

A number of “Stage 0” breast cancers are entirely benign, and treating with surgery, radiation, or chemo are all more dangerous than the lump in the tissue.

Meanwhile, most prostate cancers are harmless. Indeed, past 75, nearly every man will have a benign form of prostate cancer. One so mild, he’s almost guaranteed to die of something else before the cancer becomes a threat.

Yet thousands of men have their prostate irradiated or removed every year, causing a whole host of problems. Not least of which are urinary incontinence and losing the ability to have sex.

And it’s not just an overdiagnosis and overtreatment problem. It’s that hammer trying to turn everything into a nail and fit it into a nail-sized hole.

The truth is, very few doctors bother thinking about the why. They are busy trying to fit symptoms into a box.

When you do that, you wind up making lots of mistakes.

In other words, a lot of the overdiagnosis we’re seeing is simultaneously a problem of misdiagnosis. And in that case, not only is “treatment” of the wrong disease useless, and potentially harmful. But the real problem is allowed to fester.

Missing the most obvious

A while ago, I heard about a woman in her 50s who was miserable. She’d seen about 20 doctors over the past few months, and she was a mess. One told her she had multiple sclerosis. Another said she had Crohn’s Disease. Those are just the highlights.

She was on too many medicines to count, and they were causing nearly as many problems as her sicknesses.

But her symptoms didn’t quite fit her diagnoses.

So she took a drug holiday and started a paleo diet, rich in fat, protein, and vegetables.

Within a month, her health was back. She had never had MS or Crohn’s. Hers was a problem of nutrition.

A friend recently was complaining about atrial fibrillation. About once a week, she was getting serious heart palpitations.

Her doctor had her on some strong drugs, with severe side effects. But I suspected something else was at work.

I had just read a study linking allergens in the lower intestines to AFib. So I suggested she ask her doctor to do a food allergy screen, and found out that she was allergic to dairy and eggs.

Once she got off those foods, her AFib “miraculously” disappeared.

We forget—our bodies are run by our foods. And if we have a problem with that food, we’re basically poisoning ourselves.

How to avoid overdiagnosis or misdiagnosis

The majority of doctors completely ignore lifestyle factors, even though they are usually the root cause of illness.

Even most cancers are diseases caused by lifestyle choices.

So, if you are having any issue and receive a diagnosis, make sure you ask your doctor—is there a chance that this is being caused by something else?

Could this be a nutritional or diet problem?

In almost every case—save purely genetic diseases—lifestyle can be a factor. It’s usually the most important one.

So a good doctor will work with you to screen out potential trouble spots. They’ll work on diet and exercise before resorting to drugs or surgery.

One that immediately jumps to the worst possible conclusion and aggressive treatment is, in most cases, simply being lazy.

Don’t work with a doctor who only uses a hammer.

And, most importantly, get involved and take control of the decisions about your own health. Except in matters of specialized, serious illness, it can be helpful to think of a doctor as a trusted advisor, instead of a health dictator.

After all, when it comes to your body, there is no greater expert than you. Your doctor won’t know if you suddenly started eating a lot of cheese, and that could be causing your gastrointestinal distress. That knowledge is limited to one person in this world.

So take responsibility for yourself. And show willingness to follow good advice. Many doctors skip talking about lifestyle changes not because they are unaware of the implications, but because patients ignore them.

Show a willingness to alter what you eat, and change how you behave—and make sure your doctor will work with you on root causes, instead of just jumping to labels and treating symptoms.

References

 

Last Updated: November 21, 2018
Originally Published: January 29, 2016