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. 2022 Aug 6:15:6441-6450.
doi: 10.2147/IJGM.S368541. eCollection 2022.

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

Bjørn Hofmann  1   2
Affiliations

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

Bjørn Hofmann. Int J Gen Med. .

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.

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Conflict of interest statement

I certify that there is no conflict of interest in relation to this manuscript, and there are no financial arrangements or arrangements with respect to the content of this manuscript with any companies or organizations.

Figures

Figure 1
Figure 1
Expansion in the number of diagnoses in the International Classification of Disease (ICD).
Figure 2
Figure 2
Too mild and too early diagnoses in terms of wellbeing and suffering over time. The four lines indicate four different life trajectories: Too early (red), too mild (Orange), too late (blue) and appropriate (green). The trajectories are of cases without medical interaction.
Figure 3
Figure 3
Illustration of cases where there would have been too much, too mild, and too early diagnosis compoared to a case where early diagnosis would have been appropriate.
Figure 4
Figure 4
Illustration of the relationship between the three types of diagnoses expansion including other diagnostic errors.
See this image and copyright information in PMC

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