Dangerous Diagnosis
A threshold for a diagnosis is important
since it determines whether an individual is
sick, however a low threshold can introduce
many problems. According to Dr. Welch, "physicians are now making diagnoses in individuals who wouldn't have been considered sick in the past." This has become a big problem due to many individuals who feel well, becoming ill as a result of a low threshold for diagnosis and treatment. Many patients are given medication that could make them feel worse. A lower threshold also causes more people to be screened for possible illnesses that are highly unlikely in them.
So who is at fault? The major cause of this problem is money. According to Dr. Welsh, “The easiest way to make more money is to encourage lower thresholds and turn more people into patients… while clinicians are sued for failure to diagnose or failure to treat, there are few corresponding penalties for over-diagnosis or over-treatment. Doctors view low thresholds as the safest strategy to avoid a courtroom appearance.”
However, part of the blame is technology. Technology is now able to detect certain biochemical and anatomic abnormalities that were undetectable in the past. For example: A fasting glucose level of 130 was not considered to be diabetic before 1997, however, it is now.
The other part of the blame is behavioral. It has become part of human nature to look harder for things to be wrong. In recent years it has become more likely to test a person with no symptoms. According to Dr. Welsh, “We test more often,” in time this could make the ‘patient’ worse and increase health care cost. A lower threshold can sometimes cause the medication to be even worse than the disease.
Doctors need to raise their diagnosis threshold along with their treatment threshold to lower health costs and return “…millions of Americans to normal, healthy lives,” says Dr. Welch. A higher threshold could improve the health of many Americans.
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