Too Much, Too Mild, Too Early: Diagnosing the Excessive Expansion of Diagnoses

Bjørn Hofmann

doi:10.2147/IJGM.S368541

Too Much, Too Mild, Too Early: Diagnosing the Excessive Expansion of Diagnoses

Int J Gen Med. 2022 Aug 6:15:6441-6450. doi: 10.2147/IJGM.S368541. eCollection 2022.

Author

Bjørn Hofmann^{1

2}

Affiliations

¹ Institute for the Health Sciences, Norwegian University of Science and Technology, Gjøvik, Norway.
² The Centre of Medical Ethics, Faculty of Medicine, the University of Oslo, Oslo, Norway.

Abstract

Tremendous scientific and technological advances have vastly improved diagnostics. At the same time, false alarms, overdiagnosis, medicalization, and overdetection have emerged as pervasive challenges undermining the quality of healthcare and sustainable clinical practice. Despite much attention, there is no clarity on the classification and handling of excessive diagnoses. This article identifies three basic types of excessive diagnosing: too much, too mild, and too early. Correspondingly, it suggests three ways to reduce excess and advance high value care: we must stop diagnosing new phenomena, mild conditions, and early signs that do not give pain, dysfunction, and suffering.

Keywords: diagnosis; excess; expansion; overdiagnoses; overtreatment.