Avoiding Overdiagnosis
Avoiding Overdiagnosis
February 1, 2025
Joy Stepinski, MSN, RN-BC
In an earlier article, we discussed consequences that may occur when lab values are changed so that more diseases are diagnosed. The U.S. News & World Report published an article with good advice [1]. Knowing the kinds of questions to ask your healthcare provider can put you in the driver’s seat so that you can make informed decisions about your care.
First, if your healthcare provider wants to order lab tests, find out the names of the tests and the reason their results would be important. Minor laboratory abnormalities may deter healthcare providers from addressing the patient’s overall health picture [2]. For example, prescribing medication that can cause the patient significant side effects to address minor lab results may not be the best solution when the focus could first be weight loss, exercise, and other lifestyle changes. Ask the healthcare provider “What would we do differently with this information?”
Second, providers may only pay attention to surrogate outcomes [1]. Surrogate markers are used to monitor disease progression [3], yet the markers are not disease. The markers may not even represent all the risk factors that play a role. For example, if cholesterol is high, the healthcare provider may order a medication, such as a statin cholesterol-lowering agent. With known heart disease, a statin only benefits 4% of people [4]. The known adverse effects of the medication include diabetes and muscle damage. If your healthcare provider prescribes a medication, ask about the benefits and potential harm of the drug. Consider if the benefits outweigh the risks. Lifestyle choices (such as a low-fat plant-centered diet) can prevent, reverse, or halt heart disease as with Dr. Caldwell Esselstyn’s practice [5].
Most importantly, ask questions and be as involved as possible in your care. As the article states [1], the American culture has a longstanding belief that “the doctor knows best” and “more treatment is better.” Questions can lead to decisions on what you feel is best for your care, the crux of informed decision-making!
References:
1. Schroeder, M. O. (2015, August 18). Signs of overtreatment: How to avoid unnecessary care. U.S. News & World Report. https://health.usnews.com/health-news/patient-advice/articles/2015/08/18/signs-of-overtreatment-how-to-avoid-unnecessary-care
2. Welch, H. G. (2015). Less medicine, more health: 7 assumptions that drive too much medical care. Beacon Press.
3. Cohn, J. N. (2004). Introduction to surrogate markers [Supplemental Material]. Circulation, 109, 25, S1, IV 20 – IV 21. https://doi.org/10.1161/01.CIR.0000133441.05780.1d
4. The NNT. (2022). Statins Given for 5 Years for Heart Disease Prevention (With Known Heart Disease). https://thennt.com/nnt/statins-for-heart-disease-prevention-with-known-heart-disease/
5. Esselstyn Jr, C. B. (2007). Prevent and reverse heart disease: The revolutionary, scientifically proven, nutrition-based cure. Penguin.