The Hunger for Diagnoses.

In Editorial, Opinion by Edmund Kwok1 Comment

I cannot count how many times patients have arrived in the ER with a predetermined mindset that they are suffering from a severe disease. Some are genuine fears, and we do our best to investigate and treat – most of these patients are relieved when we find nothing dangerous, even though in many instances a clear-cut diagnosis is not possible at that moment.

Some however, will insist on endless and extravagant investigations until a diagnosis is made; it almost seems like they are desperately trying to get labeled with a disease to explain vague symptoms (and sometimes no symptoms at all!).

In an age where everything is medicalized, patients and physicians alike have been striving for greater and greater diagnoses. No longer are we responsible for maintaining our own health…it is the “fault” of the diseases: Borderline high blood pressure? Well I’ll just take a pill for that, forget regular exercise and a good diet! Chronic knee pain and arthritis? Well let’s just get a knee replacement, forget losing that extra 100 pounds! Low back pain from years of poor posture and muscular strain? Well give me some pain meds, forget the tough work of physiotherapy! Everything gets a diagnosis, and patients expect a miraculous medical fix.

Why are we so hungry for being diagnosed? And is there a downside to all this?

It seems we are finally recognizing the harm of overdiagnosis. A wonderful article was just published this year in the BMJ exploring the harms of diagnosing and treating diseases that never go on to cause real symptoms/mortality in patients, such as unnecessary labeling, unneeded tests and therapies, and the opportunity costs of wasted healthcare resources that could’ve been redirected to genuine diseases. The authors cite a number of well known examples:


They also go on to postulate why there is such a tremendous drive towards overdiagnosis:


I find this article a refreshing new shift in the medical community, where over the past decades we have had our heads down and striving relentlessly to find diseases. The negative effects of underdiagnosis are easily understood, but we are only starting to measure and evaluate the harms of overdiagnosis – something that is a lot more difficult to grasp and less intuitive to understand, especially in cases such as the early diagnosis of certain types of cancers.

As a patient, what do you think? Is it better to have a medical diagnosis given to you (along with the tests, procedures, etc.), even if it never would have caused you long term harm or death in the first place?

Edmund Kwok

Edmund Kwok

Emergency Medicine. Quality Improvement. Patient Safety. Change Management. Healthcare Administration.

Frontdoor 2 Healthcare

Frontdoor2Healthcare, founded by Dr. Edmund Kwok in 2012, provides editorial and commentary on issues affecting Canadian healthcare from the emergency department’s “front door” perspective. Frontdoor posts allow for open sharing of the diverse opinions and perspectives of emergency physicians from across the country.

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