- You can't know if an individual has been overdiagnosed. You only see it at the aggregate level.
- The decision point is the choice to seek a diagnosis. After that point, overdiagnosis can occur.
- By definition, overdiagnosis will not improve prognosis - it's not going to make you live longer or feel better.
- Overdiagnosis will harm individuals, such as through unnecessary biopsies.
- Overdiagnosis will harm society through costs, including opportunity cost (e.g. spending $1m unnecessarily on a cancer treatment when that money could have gone toward vaccinations).
- The antidote is discussions ("Have a discussion, not a test") that include the possibility of doing nothing.
- Doing nothing needs more respect. We already use the phrase "watch and wait."
- To talk about overdiagnosis, you need to talk about uncertainty. Many people have low tolerance of uncertainty. That can be dangerous when interacting with the healthcare system. "I just want to know" can lead to overtesting and overtreatment.
- Individuals can be presented with information on likely outcomes, based on number needed to treat: "If I had 100 people in your situation, and they all went through the test, this is what would happen to 15 of them," and so forth.
- Remember that the public, in interacting with the healthcare system, has a bias to action. At least that's what they expect.
- Patient decision aids are useful. Check this out.
Source is here.
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