Department of Family Medicine, Dan and Tel Aviv Districts, Clalit Health Services, Ramat Gan, Israel.
Department of Family Medicine, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
Isr Med Assoc J. 2022 Jun;24(6):399-402.
Too much healthcare is prevalent, wasteful, and harmful. It consists of two separate phenomena: overdiagnosis and overuse. Overdiagnosis is the labeling of a person with a disease or abnormal condition that would not have caused the person harm if left undiscovered. Individuals derive no clinical benefit from overdiagnosis, although they may experience physical, psychological, or financial harm. It has been found that 15-30%, 20-50%, 0-67%, and 50-90% of people with screen detected breast, prostate, lung, and thyroid cancer, respectively, are overdiagnosed. Since many screening tests have trade-off between benefit and harm, a shared decision-making approach is essential. Incidental findings are very common and may also cause overdiagnosis. Overdiagnosis is recognizable in populations and not at the individual level. However, overuse is recognizable at the level of the individual practitioner. Choosing Wisely, an intervention directed at reducing low value care, now faces the challenge of developing interventions that go beyond recommendations. While some of the drivers of overdiagnosis and overuse are similar, different and parallel strategies are needed in order to reduce them. This is one of the major challenges to our health care system.
过度的医疗保健普遍存在、浪费且有害。它由两种独立的现象组成：过度诊断和过度治疗。过度诊断是指对没有被发现就不会造成伤害的人进行疾病或异常情况的标记。虽然过度诊断不会给个体带来临床获益，但他们可能会遭受身体、心理或经济上的伤害。研究发现，分别有 15-30%、20-50%、0-67%和 50-90%的乳腺癌、前列腺癌、肺癌和甲状腺癌患者存在过度诊断。由于许多筛查测试的获益与危害之间存在权衡，因此需要采用共同决策的方法。偶然发现也很常见，也可能导致过度诊断。过度诊断在人群中是可识别的，但在个体层面则无法识别。然而，过度治疗在个体医生层面是可识别的。旨在减少低价值医疗保健的明智选择（Choosing Wisely）干预措施现在面临着开发超越建议的干预措施的挑战。虽然过度诊断和过度治疗的一些驱动因素相似，但需要采取不同且并行的策略来减少它们。这是我们医疗保健系统面临的主要挑战之一。
