Your Call: Overdiagnosis Or Appropriate Caution?
Wednesday, November 4, 2020
In a Medscape article, Kenny Lin (a identify unit of measurement physician at Georgetown University School of Medicine) asks, "Can Patients Understand the Concept of Overdiagnosis?" He suggests:
In my opinion, doctors are non doing nearly plenty to inform patients virtually the possibility of overdiagnosis, too nosotros actually demand to produce more. One survey of people aged 50-69 years establish that solely 9.5% of patients were told virtually the possibility of overdiagnosis when cancer screening was discussed. Given the results of around other survey that shows that patients' tolerance levels for overdiagnosis tin vary widely, it is absolutely essential that nosotros include a give-and-take of overdiagnosis inward shared decision-making virtually cancer screening.
I had an sense that mightiness illustrate the difficulty of discussions virtually this topic. A recent CT scan picked upwards incidental findings inward my lung. The radiologist reported equally follows:
New left lower lobe peribronchiolar opacities too correct lower lobe v mm nodule from 2013, which may relate to aspiration/infection. Since these findings are unable to endure visualized on the ticker images, follow-up breast CT inward vi weeks is recommended to document resolution.
With the concurrence of my main attention doctor--who is passionate virtually avoiding over-testing--a follow-up scan occurred a few weeks later, when an aspiration or infection would probable accept a conduct chances to clear up. There was goodness news:
Non-contrast breast CT was performed acquiring sequential axial images from the thoracic inlet through the adrenal glands. Thin department axial, coronal, sagittal too axial MIP's were too obtained.
There has been substantial interval clearing of previous bilateral lower lobe ground-glass opacities. There are no novel ground-glass opacities, consolidations or nodules. No endobronchial lesion or pleural abnormality is identified.
IMPRESSION: Resolving bilateral lower lobe aspiration or infection.
Here's the enquiry for my medical experts reading this. I'm non shout out for you lot to instant gauge my PCP's judgment. I'm shout out for whether you, inward your clinical practice, would accept judged the initial findings worthy of the instant CT scan, alongside the added radiations exposure? (Here at that topographic point was no personal or identify unit of measurement history of lung disease.)
More importantly, whichever agency you lot thin on this question, how would you lot address Dr. Lin's point, i.e., how would you lot hash out the pro's too con's of the additional diagnostic testing alongside your patient?
In my opinion, doctors are non doing nearly plenty to inform patients virtually the possibility of overdiagnosis, too nosotros actually demand to produce more. One survey of people aged 50-69 years establish that solely 9.5% of patients were told virtually the possibility of overdiagnosis when cancer screening was discussed. Given the results of around other survey that shows that patients' tolerance levels for overdiagnosis tin vary widely, it is absolutely essential that nosotros include a give-and-take of overdiagnosis inward shared decision-making virtually cancer screening.
I had an sense that mightiness illustrate the difficulty of discussions virtually this topic. A recent CT scan picked upwards incidental findings inward my lung. The radiologist reported equally follows:
New left lower lobe peribronchiolar opacities too correct lower lobe v mm nodule from 2013, which may relate to aspiration/infection. Since these findings are unable to endure visualized on the ticker images, follow-up breast CT inward vi weeks is recommended to document resolution.
With the concurrence of my main attention doctor--who is passionate virtually avoiding over-testing--a follow-up scan occurred a few weeks later, when an aspiration or infection would probable accept a conduct chances to clear up. There was goodness news:
Non-contrast breast CT was performed acquiring sequential axial images from the thoracic inlet through the adrenal glands. Thin department axial, coronal, sagittal too axial MIP's were too obtained.
There has been substantial interval clearing of previous bilateral lower lobe ground-glass opacities. There are no novel ground-glass opacities, consolidations or nodules. No endobronchial lesion or pleural abnormality is identified.
IMPRESSION: Resolving bilateral lower lobe aspiration or infection.
Here's the enquiry for my medical experts reading this. I'm non shout out for you lot to instant gauge my PCP's judgment. I'm shout out for whether you, inward your clinical practice, would accept judged the initial findings worthy of the instant CT scan, alongside the added radiations exposure? (Here at that topographic point was no personal or identify unit of measurement history of lung disease.)
More importantly, whichever agency you lot thin on this question, how would you lot address Dr. Lin's point, i.e., how would you lot hash out the pro's too con's of the additional diagnostic testing alongside your patient?