Hugh Pickens writes writes: "H. Gilbert Welch writes in the LA Times that the threshold for diagnosis has fallen too low with physicians making diagnoses in individuals who wouldn't have been considered sick in the past, raising healthcare costs for everyone. Welch, a a practicing physician and professor of medicine at the Dartmouth Institute for Health Policy and Clinical Practice, says that part of the explanation is technological: diagnostic tests able to detect biochemical and anatomic abnormalities that were undetectable in the past. "But part of the explanation is behavioral: We look harder for things to be wrong. We test more often, we are more likely to test people who have no symptoms, and we have changed the rules about what degree of abnormality constitutes disease (a fasting blood sugar of 130 was not considered to be diabetes before 1997; now it is)." Welch says that the problem is that low thresholds have a way of leading to treatments that are worse than the disease and while clinicians are sued for failure to diagnose or failure to treat, there are few corresponding penalties for overdiagnosis or overtreatment so doctors view low thresholds as the safest strategy to avoid a courtroom appearance. "We are trained to focus on the few we might be able to help, even if it's only 1 out of 100 (the benefit of lowering cholesterol in those with normal cholesterol but elevated C-reactive protein) or 1 out of 1,000 (the benefit of breast and prostate cancer screening)," writes Welch. "But it's time for everyone to start caring about what happens to the other 999.""
Dealing with the problem of pure staff accumulation,
all our researches ... point to an average increase of 5.75% per year.
-- C.N. Parkinson