Over-Diagnosis - Ascension of the Luddites

Technology in medicine has dramatically altered the landscape of care through its ability to contribute to the diagnosis of complicated medical problems.  But as technology improves, results that containing more complex data require nuanced interpretation.  While the sensitivity of tests has increased, those tests that cast wider nets often bring specificity into question.

Luddites were 19th- century English textile artisans who protested against newly developed labor-saving machinery from 1811-1817.  During the Industrial Revolution, artisans were threatened to be replace with less-skilled, low-wage laborers, leaving them without work.  The modern day Luddites are concerned about the cost and possible harm (radiation, more tests, more surgeries) that more high-tech tests can generate.

Underneath apprehensions about over-diagnosis lies the foundational issue of controlling costs as the technology exponentially improves.  A justifiable concern is the ordering of tests when results will not alter or impact the treatment or outcome of the problem.  In a vast majority of cases, providers place such orders in the showdown of a malpractice threat that dwells just beneath the surface, subconsciously informing most every clinical interaction.

The term over-diagnosis attributes too much psychological power to the physician, who might thereby assume knowing just how much data the patient needs to know.  In my home, my wife would want to know every detail and decide for herself, rightly or wrongly, whether she's been subject to over-diagnosis or the findings represent important data.

Emergency physicians generally have a highly trained level of diagnostic accuracy.  The concept of over-diagnosis is therefore fundamentally contrary to how ED docs intuitively function, especially since emergency medicine rapidly accepts and adopts new technology into treatment guideline.  The question becomes how much technology should the provider unleash on the patient.  The Luddites lost in the 19th century and will again lose in modern times.

A problem always arises when ordering newer tests in  the first place and learning to live with the results if ordered.  This is so at least until some experience is gained.  A new name should be created to become the buzz word for the concept, perhaps--Intelligent Ordering.  Optimally, one would be judged not only on the amount of resources used, but also outcome. 

Technology is advancing rapidly.  The concern over radiation will be severely diminished with the new scanners.  Medicine has evolved realty since I began in 1975.  Back then, changes took decades to settle in.  The new time frame for gaining traction for a test is 3-5 years.  We should embrace technology, but use it judiciously.