By Dr Jonathan Shurlock
Senior Editor: Dr Saadia Aslam
Healthcare systems around the world are in crisis, with increased demand, high burden of chronic disease, escalating costs and diminishing workforce capacity. Waiting lists for cardiovascular services are also growing in the UK.
Professor Thomas Khulein and colleagues recently published an opinion article on “overdiagnosis in medicine” in the BMJ. Whilst they support increasing investment and capacity in healthcare, they also make the argument for ‘being open to the possibility of excess healthcare’. Increasing disease prevalence is related to overdiagnosis and treatment, with an estimate that up to 30% of healthcare provision is low value, providing no benefit or causing harm [1,2]. Solutions are likely complex and controversial. However, points to consider include: teaching of the “overdiagnosis” concept early in medical education, enhancing continuity of care in the community, re-evaluation of current screening programmes and decommissioning of services which are of low value.
The full article should be read to appreciate the complexities of this discussion. The identification of this issue is important to frame the discussion of future directions of healthcare provision. There is no reason to assume that cardiovascular services across the UK are immune from this trend. Further research is needed to determine the extent of this issue in the UK.
1. Glasziou PP, Jones MA, Pathirana T, Barratt AL, Bell KJL. Estimating the magnitude of cancer overdiagnosis in Australia. Med J Aust 2020;212:-8. doi: 10.5694/mja2.50455
2. Braithwaite J, Glasziou P, Westbrook J. The three numbers you need to know about healthcare: the 60-30-10 Challenge. BMC Med 2020;18:doi: 10.1186/s12916-020-01563-4