Overdiagnosis

It is understandable with emphasis on early diagnosis and screening in general practice, accompanied by fear of missed diagnosis or misdiagnosis, that the concept of overdiagnosis has less traction in our shared decision making with individual patients. In this edition, Chiara Zaffaroni considers overdiagnosis with some thought-provoking insights that may help us balance the benefits and harms that can emerge from our pursuit and achievement of a diagnosis. Indeed, shared decision making may be enhanced by sharing uncertainties and these insights with our patients. A more sympathetic ear may be found in discussions with colleagues invested in managing limited resources. It behoves us all to consider the benefits and harms of every type of intervention made in the pursuit of diagnosis.

Overdiagnosis is an important consideration in cancer screening programmes testing for very early cancers or cancer precursors in people without symptoms. Unfortunately, it is not always clear which cancers need treatment to save lives, and which can be left alone without causing harm. Overall, the benefits of breast, bowel, cervical and targeted lung cancer screening outweigh the harms, according to the UK National Screening Committee. However, diagnosing a condition that does not require treatment is of no benefit to the patient and risks harm, both physical and psychological, while using up valuable resources.

As busy GPs we are often drawn to practical guidance and articles – this month does not disappoint. William Tan et al. consider interstitial lung disease in children. This is a rare lung disorder and challenging to diagnose in general practice as there is of course considerable overlap with more common respiratory diseases. Prompt diagnosis is important to maintain lung function. Apurva More et al. provide a systematic, evidence-based triage pathway for the assessment of haematuria in children. Hypertension is a ‘red flag’ mandating immediate referral because of the risk of acute kidney injury. Nishalini Ravindran and Rajesh Varma promote precision in the treatment of the menopause by careful consideration of the cardiometabolic changes that accompany menopause. Charlotte Tomlison updates us with a practical guide to prescribing the progesterone-only pill. The article considers many of the dilemmas that can complicate prescribing and gives clear advice and information to help us and our patients. Sarah Glynne, an expert clinician and researcher in the treatment of menopause, provides guidance on prescribing testosterone. GPs often lack confidence and experience in prescribing testosterone, but this article clarifies the benefits with practical guidance and an update on research informing the guidance.

General practice offers patients the benefits of continuity of care, something we usually appreciate more as we gain experience. Early on in our training these benefits are less evident, but those of you venturing out as newly qualified GPs will no doubt become more aware of why continuity of care is associated with better health outcomes, higher levels of patient satisfaction and less harm from overdiagnosis. An article on continuity of care is needed, detailing the evidence to support this distinctive feature of general practice. It is important to understand how it has been eroded and why the benefits may now be less evident. Please submit your articles in the usual way or share your article ideas with us. We are keen to hear from you and to offer help and advice on writing for InnovAiT, whether as new or experienced authors. Articles on non-clinical topics are particularly welcome, and we can offer suggestions for topics and titles.

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