Over-Diagnosis: When Over-Achieving Isn't Always Good

Tuesday, February 19, 2013 - by Debra Chew

When I was in the first grade my parents learned that my teacher considered me to be an over-achiever.  They found that when I was given my classwork, I was given twice the amount of work the other students received.  That was because I hurried through my work and finished it long before the other students and then I started talking to them.  Yes, I have always talked too much!  

Looking back, I think I was seeking recognition as the fastest and smartest, or maybe trying to achieve some award by doing more than was necessary. Today, I recognize that there are good and not-so-good outcomes as a result of being an “over” anything.  Take MDs, for example.  In their quest to help people, they can, even with the best of intentions, fail to get the desired results from their labors.  Recent studies indicate that the medical field could be regarded as over-achievers, too, when it comes to the over-diagnosis of cancer and other diseases. Diagnosing those who are sick is a big part of a doctor’s job.  One challenge is that a diagnosis may identify something that will never become a serious health problem.  The Dartmouth Institute is studying this issue.  They have announced an international conference later this year on Preventing Overdiagnosis, where they will discuss their research about how overdiagnosis harms people with problems that never needed to be found.   

It’s certainly a “catch 22”:  Overdiagnosis has the potential of making people sick in the pursuit of making them healthy.   But that brings us to the question – what makes someone healthy?  Is it because they have a scan or screening that says they are disease-free?  Then, what makes someone diseased?  Is it because they have a scan or screening that says they have cancer? 

In April of 2012, The New York Times carried an article entitled Endless Screenings Don’t Bring Everlasting Health.  In this article, the physician authors wrote, “But, overdiagnosis – the detection of cancers never destined to cause problems – is arguably the most important harm of screening…..When screening finds these cancers, it turns people into patients unnecessarily.” They went on to say, “People on the receiving end of overdiagnosis can only be harmed – sometimes seriously – by unnecessary surgery, radiation, and chemotherapy.” Even the United States Preventive Services Task Force judged that harms outweighed benefits in P.S.A. screening for prostate cancer, and recommended against its routine use.  They found the tests result in a “disturbing” amount of overdiagnosis.

So, what is someone to do?  Since February is “Wise Health Consumer” month, let’s elaborate on how to make good and wise decisions about screenings, procedures, doctors, etc. Over-screening leads to overdiagnosis, which then often leads to over-medicating, etc.  Too many “overs” for sure. As a result of these reports and findings, physicians, hospitals, the public and agencies that regulate medical care are re-thinking how to avoid this conundrum. If the goal to achieve the “best health outcome” – which it is for all of us – access to such information certainly helps a patient make better health choices.  

People today are choosing a wide variety of approaches to maintaining good, health. More and more, people are discovering that their thought affects their health.  And, studies show medical institutions are now trying to catch up with the public demand for a “whole” – mental, spiritual and physical – approach to health. It’s an approach that definitely flies in the face of a model that uses whatever technology is available to look for the minutest evidence of disease.

And it’s a shift that, to me, speaks to re-discovering some ideas about health that come from the greatest healer the world has ever known, Jesus. His counsel was to:

    • clean up our thinking
    • focus on God (here and now)
    • love our neighbor
    • turn away from the body (food, clothing, etc.)

He just didn’t spend a lot of time diagnosing illness. And, even without a diagnosis or any technology, he healed.

In fact, I think we could say, when it came to healing, he was by all fair measures the right kind of over-achiever.

----

Debra Chew is the media and legislative representative for Christian Science for Tennessee.  She can be contacted at Tennessee@compub.org

 


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