W13Overdiagnosis and overtreatment – a Norwegian attempt to face the challenge. A position paper from the Norwegian College of General Practice

Author(s): 
Gisle Roksund(1), Morten Laudal(2), Elisabeth Swensen(3), Per Øystein Opdal(4), John Brodersen(5)
(1) Klosterhagen legesenter, Skien, Norway
(2) Brevik legesenter, Son, Norway
(3) Seljord legesenter, Seljord, Norway
(4) University of Bergen, Bergen, Norway
(5) University of Copenhagen, Copenhagen, Denmark
Corresponding author: Dr Gisle Roksund, Nfgp, Plassen 16, Siljan, Norway.
E-mail: gisle.roksund@gmail.com
Text: 
Testing of asymptomatic individuals in order to «prevent disease» or identify «early diagnosis» is increasing in volume in general practice. The fear of hidden disease is flourishing among physicians, patients, politicians and health administrators.  Overdiagnosis is closely related to medicalisation of the borders of normality and treatment of conditions that are either self-healing or untreatable. Overdiagnosis is linked to the false conception that it is an error not to diagnose at the first modest symptom which could be seen to indicate serious disease, but which in most cases is innocent and transitory.  The first imperative of medicine is to do no harm. Overdiagnosis is harmful both to public health and to the individual. Public health deteriorates when resources are shifted away from the patients with chronic diseases and the poor to the well and the rich. The individual is harmed by being defined as sick and perceiving herself as sick.  In 2001 the Norwegian College of General Practice stated the principle of «giving the most to those who have the greatest needs». This principle is just as important today.  With this background, the College decided to develop a position paper on overdiagnosis and overtreatment.  In this workshop the process of shaping the paper and the paper itself will be presented and discussed; including the history of the drivers of overdiagnosis in the Norwegian context, examples of overdiagnosis in (Norwegian) general practice, and finally proposals to limit overdiagnosis in the time to come.