Overdiagnosis and overtreatment: generalists — it’s time for a grassroots revolution

Mapping the drivers of overdiagnosis to potential solutions

“…Avoid certain tests or screening tests 11 35 Less frequent screening tests Targeted screening tests (eg, limit screening to well defined high risk population) 9-35 - [37][38][39][40] Inform patients of benefits and harms of screening 3-36 Raise threshold for "positive" screen or recall and biopsy [26][27][28][29][30][31][32][33][34][35][36][37][38][39] Change radiological advice 35 …”

“…Avoid certain tests or screening tests 11 35 Less frequent screening tests Targeted screening tests (eg, limit screening to well defined high risk population) 9-35 - [37][38][39][40] Inform patients of benefits and harms of screening Raise threshold for "positive" screen or recall and biopsy [26][27][28][29][30][31][32][33][34][35][36][37][38][39] Change radiological advice drivers of overdiagnosis and overuse 9 23 overdiagnosis and overuse frequency and best methods to quantify the problem undiagnosing and deprescribing 3 deliberative and qualitative methods (including community juries) to inform policy and other decisions [23][24][25][26][27][28][29][30][31][32][33][34][35][36] evaluating responses to overuse, including communication …”

Prediabetes Screening and Treatment in Diabetes Prevention: The Impact of Physician Attitudes

“…2,8,[11][12][13] We evaluated demographics and current diabetes prevention practices. The attitudinal outcomes of interest were physicians' responses to questions related to their attitudes toward diabetes prevention and perceived barriers to diabetes prevention.…”

“…It has been suggested that identifying and labeling patients as having a "predisease," in particular prediabetes, is overdiagnosis. 12,13 We sought to use a set of potential attitudes as a discriminator for practice patterns regarding prediabetes. Understanding why prediabetes is not acknowledged and why treatment plans are infrequently provided is critical for successful interventions to improve diabetes prevention.…”

Incidental findings on imaging

“…Although making a careful risk assessment with patients before pursuing an investigation is a central part of every clinician’s job, incentives that reward overactivity might confound this optimal approach 716. Discussion about the prevalence of incidentalomas before an imaging test is likely to be beneficial in many scenarios, particularly where clinicians are under pressure to investigate 11…”