Department of Family Medicine, Atrium Health, Charlotte, North Carolina, USA
Department of Family Medicine, University of North Carolina, North Carolina, USA.
BMJ Evid Based Med. 2021 Apr;26(2):46-48. doi: 10.1136/bmjebm-2019-111247. Epub 2019 Aug 23.
Overdiagnosis and overtreatment-overuse-is gaining wide acceptance as a leading nosocomial intervention in medicine. Not only does overuse create anxiety and diminish patients' quality of life, in some cases it causes harm to both patients and others not directly involved in clinical care. Reducing overuse begins with the recognition and acceptance of the potential for unintended harm of our best intentions. In this paper, we introduce five cases to illustrate where harm can occur as the result of well-intended healthcare interventions. With this insight, clinicians can learn to appreciate the critical role of probability-based, evidence-informed decision-making in medicine and the need to consider the outcomes for all who may be affected by their actions. Likewise, educators need to evolve medical education and medical decision-making so that it focuses on the hierarchy of evidence and that what 'ought to work', based on traditional pathophysiological, disease-focused reasoning, should be subordinate to what 'does work'.
过度诊断和过度治疗——过度使用——作为一种主要的医院干预措施在医学领域得到了广泛认可。过度使用不仅会引起焦虑，降低患者的生活质量，在某些情况下还会对患者和其他未直接参与临床护理的人造成伤害。减少过度使用始于认识和接受我们的良好意愿可能带来意外伤害的可能性。在本文中，我们介绍了五个案例，说明善意的医疗干预措施可能会导致伤害。有了这种洞察力，临床医生可以学会欣赏基于概率、基于证据的决策在医学中的关键作用，并需要考虑所有可能受到其行为影响的人的结果。同样，教育者需要改进医学教育和医疗决策，使其专注于证据的层次结构，以及基于传统病理生理学、以疾病为中心的推理“应该有效”的东西，应该服从于“确实有效”的东西。
