Overdiagnosis: a threat to the survival of our health care system
Wednesday 16 August 2017
Dr. Hugo Viens, president of the Québec Medical Association (QMA)
All physicians overdiagnose or overtreat. From 15% to 18% of our prescriptions or treatments have minimal value, are not necessary or may even be detrimental to the health of our patients. I do it, my colleagues do it and patients request it.
In surgery, during our training we are taught that everything that comes out of the human body during a procedure must be sent for a pathological analysis. Nowadays, we should instead be explaining that it is not necessary for a pathologist to prepare a report concluding that the pieces of bone removed during knee replacement surgery had arthrosis. We already know that, the arthrosis is why we were replacing the patient’s knee in the first place…
The science has shown that it is unnecessary, but we continue to do it in our hospitals. In fact, I have already had to appear before management to explain my refusal to send bone fragments to the lab after joint replacement surgeries!
Medicine has evolved
With the advances in technology and research, we know that routine exams and treatments done in some areas are unnecessary! As part of the Choosing Wisely Canada campaign, the Canadian associations of specialists have suggested more than 250 procedures that do not make any improvement to health and can sometimes even harm a patient. And the Canadian Institute for Health Information (CIHI) has recently shown that up to 30% of patients targeted by eight recommendations from this campaign underwent procedures that were potentially unnecessary.
Since the QMA started the movement in 2013, this topic has been garnering increasing interest among physicians in Québec. In addition, more and more of them are acquiring the means to tackle unnecessary care and tests. But it is also up to you, the patients, to do your part.
We are all in this together
If you are over a certain age, you have probably already had a routine blood test, or maybe you see your physician once a year for an annual check-up. If you are a female under 21 or over 70, a routine PAP test may have been recommended. If your shoulder hurts, you may have asked your physician to prescribe an x-ray, or an MRI for your back pain. If you are a young parent, you may have requested antibiotics for your child the last time he or she had an ear infection or sore throat without complications.
All these treatments and tests are no longer recommended. And when we are prescribing them, we cannot see the patients who really need them. Wherever there is overdiagnosis, there is also undertreatment because the exams are no longer available for those who really need them. If we all tackle this issue, not only can we improve the access to care in Québec, we can also ensure the future of our public system. Overdiagnosis incurs costs and is a threat to universal health care.
From August 17 to 19, 2017, specialists from around the world will be meeting in Québec City at the 5th international Preventing Overdiagnosis conference that the QMA is hosting to talk about the actions they are taking at home to reduce unnecessary care and tests. For your part, you can also engage in the discussion with your physician to find out what is really necessary for your health.
Dr. Hugo Viens, B.Sc., M.D., FRCSC
Québec Medical Association