One of the things occupying the minds of physicians, in countries where physicians have minds, is overdiagnosis. Overdiagnosis is not the same as misdiagnosis. Both are things that doctors want to avoid but they are different. Misdiagnosis is when a physician makes a diagnosis that is incorrect. A child with asthma gets a chest x-ray, (usually for all the wrong reasons).
The x-ray may show some findings suggestive of pneumonia (quite common in asthma). A wrong diagnosis of bacterial pneumonia is made and the kiddie started on useless antibiotics. That's a misdiagnosis which started because an unnecessary test was done.
Overdiagnosis would be obtaining that same chest x-ray and diagnosing a minor collapse of a segment of a lung, another frequent finding in children with asthma and which is of little significance. Trying to treat it will not improve anything. The finding doesn't change the treatment.
However this child will now get admitted to hospital, put on continuous pulse oximetry (that's when you continuously measure the level of oxygen in the patient's bloodstream), the level will be lower than normal, even when the child has clinically improved and the child will get stuck in the hospital until the level goes back up to "normal."
Jaundice is commonly overdiagnosed. Most newborn babies get some degree of jaundice. It's natural. It's expected. Some jaundice is actually good. The chemical that causes the yellowish tint to the eyes and skin actually protects against infection. It's common in breastfed babies, the normal way to feed babies and fits in with the general protective effect of human milk.
In T&T, jaundice seems to make doctors panic parents. Tests are done. Results are scanned. Parents are advised to take the baby out into the sun and to return in 24 or 48 hours for further testing. Hospitalisation is mentioned. Why?
Is it harmful to overdiagnose jaundice? Yes. Apart from the risk of physical damage (multiple needle sticks, risk of infection, tissue necrosis, falls from the hospital bed etc), we know that children who have been diagnosed with jaundice can suffer psychological harm later on, such as interference with maternal bonding and increased parental anxiety, with potential development of the vulnerable child syndrome: parents who believe their children are vulnerable and are more likely to label subsequent minor illnesses as severe.
Another disease that is being overdiagnosed is "gastroesophageal reflux disease" or GERD. This, like Chikungunya, was an unknown disease in children up to ten years ago. Unlike ChikV it is a jokey disease. If you label a child who's spitting up as having GERD, instead of just describing the symptoms as a "problem," doctors are much more likely to give medication.
If you don't call it GERD but explain that this is a normal physiologic occurrence in babies, and that as long as the baby is putting on weight there is no problem, nothing needs to be done.
Overdiagnosis does not only cause psychological harm. Personal and collective financial harm must also be considered. Healthcare is expensive. To the parents, but also when unnecessary tests that are a waste of time are done, the doctor potentially denies care or services to other patients.
Unnecessary care, is unethical. It takes away precious time which could be better spent diagnosing real conditions and assisting those in need. It wastes people's money which could be better spent educating their children. It wastes lab technicians' time when they could be involved in testing for serious problems.
Why do doctors overdiagnose then? Perhaps the major cause in T&T (not necessarily elsewhere where fear of malpractice is an issue) is fear of not appearing to keep up with the doctor over on the other street. Lab tests are relatively new to T&T. People are accustomed to seeing TV movies where the brilliant doctor is the one who orders some new fangled test startling everyone with his laboratory acumen, quite unlike the real situation where clinical astuteness is all important.
So doctors do not want to diagnose ChikV or dengue unless a "test" is done. But, despite people's belief that advances in science and technology are always good, many "test's are bad, 50 to 60 per cent inaccurate or unreliable. This is especially true in T&T where there are no standards for laboratories and anyone can open up a "lab." Then there is the level of comfort that doctors can handle. Different doctors have different levels of comfort with uncertainty.
Good, experienced clinicians can become more comfortable with not having the answer all the time. As long as the child is improving then we don't always need to know the answer. Sometimes, the search for that answer can result in finding things that do not benefit the patient and lead to excessive care. But one needs lots of experience to be comfortable with that philosophy. New doctors (less than ten years experience) do not have that. What's the solution?
Communication, the forgotten duty (and pleasure) of doctoring. People need to know the potential risks of health care. We're very good at telling patients and families when we are about to prescribe a drug, how this medication is going to be a benefit. But the other side, how this diagnostic test, this imaging study, or this medication may actually cause harm is seldom explained.
When I tell parents that a CT of the skull is in effect the equivalent of x-raying the child's head one hundred times in a day, they often gasp. No one ever told them that. But there's no free lunch. The fact that the technology is there does not mean that every child who falls and goes in to A&E needs a CT scan.
Doctors do not do a good job of explaining why they take certain decisions. That is the major reason why people complain of the health care in hospitals. Little communication. No time is no answer. A doctor must make the time to talk to her patient.