Overdiagnosis and overtreatment as a quality problem

Overdiagnosis and overtreatment are increasingly highlighted as a significant problem in contemporary healthcare. While not necessarily straightforward to define,1 overdiagnosis and any subsequent overtreatment are terms generally used about instances in which a diagnosis is ‘correct’ according to current standards but the diagnosis or associated treatment has a low probability of benefitting the patient, and may instead be harmful.2 While initially used largely in the context of cancer screening, more recently concerns about overdiagnosis and overtreatment have spread to a wide range of clinical activities.3 4 The potential consequences of overdiagnosis and overtreatment may be significant and include such harms as the psychological and behavioural effects of disease labelling, physical harms and side effects of unnecessary tests or treatments, unnecessary treatment negatively affecting quality of life, increased financial costs to individuals and wasted resources and opportunity costs to the health system.2 5 6

Overdiagnosis and overtreatment are attracting attention from a range of different disciplines and perspectives,7–9 but one way to understand them is as a quality problem, not least because many of these different perspectives arguably reflect dimensions of quality (eg, the avoidance of harm, waste or inappropriate use). Looked at in this way, a concern with overuse is not so new. Those working in healthcare quality have long been concerned about problems of overuse and inappropriate use; one view being that all quality problems can be categorised in terms of either underuse, overuse or misuse.10 One implication from the many studies showing large variations in practice is that for interventions lacking good evidence of effectiveness, a substantial proportion of such activity is likely to have been at best unnecessary and at worst has caused avoidable harm.11 Therefore, while arguably more attention has been placed on problematic underuse since publication of the …