Concepts of Health, Disease, Overdiagnosis and Defensive Medicine in Relation to Clinical Practice
Main Article Content
Abstract
Health, disease, overdiagnosis and defensive medicine are interrelated complex concepts that lack formal definitions and a uniform holistic perspective. Functional definitions of these concepts are context-specific and differ in relation to clinical practice, research, medical science and health insurance. In the context of clinical practice that is the focus of this review, having no clear working definitions of health, disease, overdiagnosis and defensive medicine is essential for distinguishing people who need medical intervention from those who do not, for formulating accurate diagnosis and treatment options, and for improving professional communication between clinicians and between clinicians and their patients.
The purpose of this narrative review is to promote the understanding of the concepts of health, disease, overdiagnosis, defensive medicine and their interrelation in the context of clinical practice, with the view of enhancing the quality of healthcare services.
Keywords:
over-testing, diagnosis, overdiagnosis, disease, pseudo-disease, health, disease mongering, defensive medicine, bio-function, normality, naturalism, normativism
Article Details
How to Cite
KHAMMISSA, Razia Abdool Gafaar et al.
Concepts of Health, Disease, Overdiagnosis and Defensive Medicine in Relation to Clinical Practice.
Medical Research Archives, [S.l.], v. 11, n. 9, sep. 2023.
ISSN 2375-1924.
Available at: <https://esmed.org/MRA/mra/article/view/4398>. Date accessed: 16 may 2024.
doi: https://doi.org/10.18103/mra.v11i9.4398.
Section
Research Articles
The Medical Research Archives grants authors the right to publish and reproduce the unrevised contribution in whole or in part at any time and in any form for any scholarly non-commercial purpose with the condition that all publications of the contribution include a full citation to the journal as published by the Medical Research Archives.
References
1. Gartner J-B, Abasse KS, Bergeron F, Landa P, Lemaire C, Côté A: Definition and conceptualization of the patient-centered care pathway, a proposed integrative framework for consensus: a Concept analysis and systematic review. BMC health services research 2022, 22(1):1-24.
2. Schiff GD, Martin SA, Eidelman DH, Volk LA, Ruan E, Cassel C, Galanter W, Johnson M, Jutel A, Kroenke K: Ten principles for more conservative, care-full diagnosis. In., vol. 169: American College of Physicians; 2018: 643-645.
3. Jenniskens K, De Groot JA, Reitsma JB, Moons KG, Hooft L, Naaktgeboren CA: Overdiagnosis across medical disciplines: a scoping review. BMJ open 2017, 7(12):e018448.
4. Catita M, Águas A, Morgado P: Normality in medicine: a critical review. Philosophy, Ethics, and Humanities in Medicine 2020, 15(1):1-6.
5. Larson JS: The conceptualization of health. Medical care research and review 1999, 56(2):123-136.
6. van der Linden R, Schermer M: Health and disease as practical concepts: exploring function in context-specific definitions. Medicine, Health Care and Philosophy 2022, 25(1):131-140.
7. Moynihan R: Disease mongering. The politics of medicine (e-encyclopaedia). In.; 2012.
8. Lea M, Hofmann BM: Dediagnosing–a novel framework for making people less ill. European Journal of Internal Medicine 2022, 95:17-23.
9. McCartney G, Popham F, McMaster R, Cumbers A: Defining health and health inequalities. Public health 2019, 172:22-30.
10. Svalastog AL, Donev D, Kristoffersen NJ, Gajović S: Concepts and definitions of health and health-related values in the knowledge landscapes of the digital society. Croatian medical journal 2017, 58(6):431.
11. Powell R, Scarffe E: Rethinking “Disease”: a fresh diagnosis and a new philosophical treatment. Journal of Medical Ethics 2019, 45(9):579-588.
12. Huber M, Knottnerus JA, Green L, Van Der Horst H, Jadad AR, Kromhout D, Leonard B, Lorig K, Loureiro MI, Van der Meer JW: How should we define health? Bmj 2011, 343.
13. Rogers WA, Walker MJ: Précising definitions as a way to combat overdiagnosis. Journal of evaluation in clinical practice 2018, 24(5):1019-1025.
14. Thombs B, Turner KA, Shrier I: Defining and evaluating overdiagnosis in mental health: a meta-research review. Psychotherapy and psychosomatics 2019, 88(4):193-202.
15. Armstrong N: Overdiagnosis and overtreatment: a sociological perspective on tackling a contemporary healthcare issue. Sociology of Health & Illness 2021, 43(1):58-64.
16. Perros F, Koumpos A: Overdiagnosis: The silent pandemic of the West? Public Health Toxicology 2022, 2(1):1-4.
17. Gupta P, Gupta M, Koul N: Overdiagnosis and overtreatment; how to deal with too much medicine. Journal of Family Medicine and Primary Care 2020, 9(8):3815.
18. IUDICISSA MS, DEL REAL PT: Disease Mongering (Pseudo-Disease Promotion). 2012.
19. Nature: POLYGENIC RISK: WHAT’S THE SCORE? In.: Nature advertorial; 2019.
20. Singh H, Dickinson JA, Thériault G, Grad R, Groulx S, Wilson BJ, Szafran O, Bell NR: Overdiagnosis: causes and consequences in primary health care. Canadian Family Physician 2018, 64(9):654-659.
21. Greenberg J, Green JB: Over-testing: why more is not better. The American journal of medicine 2014, 127(5):362-363.
22. Housten AJ, Lowenstein LM, Hoffman A, Jacobs LE, Zirari Z, Hoover DS, Stacey D, Pratt G, Bevers TB, Volk RJ: A review of the presentation of overdiagnosis in cancer screening patient decision AIDS. MDM policy & practice 2019, 4(2):2381468319881447.
23. Srivastava S, Koay EJ, Borowsky AD, De Marzo AM, Ghosh S, Wagner PD, Kramer BS: Cancer overdiagnosis: a biological challenge and clinical dilemma. Nature Reviews Cancer 2019, 19(6):349-358.
24. Welch HG, Kramer BS, Black WC: Epidemiologic signatures in cancer. New England Journal of Medicine 2019, 381(14):1378-1386.
25. Hvidt EA, Lykkegaard J, Pedersen LB, Pedersen KM, Munck A, Andersen MK: How is defensive medicine understood and experienced in a primary care setting? A qualitative focus group study among Danish general practitioners. BMJ open 2017, 7(12):e019851.
26. Chiolero A, Paccaud F, Aujesky D, Santschi V, Rodondi N: How to prevent overdiagnosis. Swiss medical weekly 2015, 145.
27. Martin SA, Podolsky SH, Greene JA: Overdiagnosis and overtreatment over time. Diagnosis 2015, 2(2):105-109.
28. Greenes RA: Reducing diagnostic error with computer-based clinical decision support. Adv Health Sci Educ Theory Pract 2009, 14 Suppl 1:83-87.
29. Hofmann B: Back to basics: overdiagnosis is about unwarranted diagnosis. American Journal of Epidemiology 2019, 188(10):1812-1817.
30. Chiolero A, Paradis G, Paccaud F: The pseudo-high-risk prevention strategy. In., vol. 44: Oxford University Press; 2015: 1469-1473.
31. Sniderman AD, D'Agostino RB, Sr., Pencina MJ: The Role of Physicians in the Era of Predictive Analytics. JAMA 2015, 314(1):25-26.
32. Carter SM, Rogers W, Heath I, Degeling C, Doust J, Barratt A: The challenge of overdiagnosis begins with its definition. Bmj 2015, 350.
33. Ereshefsky M: Defining ‘health’and ‘disease’. Studies in History and Philosophy of Science Part C: Studies in History and Philosophy of Biological and Biomedical Sciences 2009, 40(3):221-227.
34. Doust J, Jean Walker M, Rogers WA: Current dilemmas in defining the boundaries of disease. Journal of Medicine and Philosophy 2017, 42(4):350-366.
35. Lerner H, Berzell M: Reference values and the problem of health as normality: a veterinary attempt in the light of a one health approach. Infection Ecology & Epidemiology 2014, 4(1):24270.
36. Feller L, Lemmer J, Nemutandani MS, Ballyram R, Khammissa RAG: Judgment and decision-making in clinical dentistry. Journal of International Medical Research 2020, 48(11):300060520972877.
37. Amoretti MC, Lalumera E: Wherein is the concept of disease normative? From weak normativity to value-conscious naturalism. Medicine, Health Care and Philosophy 2022, 25(1):47-60.
38. Doust J, Vandvik PO, Qaseem A, Mustafa RA, Horvath AR, Frances A, Al-Ansary L, Bossuyt P, Ward RL, Kopp I: Guidance for modifying the definition of diseases: a checklist. JAMA internal medicine 2017, 177(7):1020-1025.
39. Pearl J: Bayesianism and causality, or, why I am only a half-Bayesian. In: Foundations of bayesianism. edn.: Springer; 2001: 19-36.
40. Bhise V, Rajan SS, Sittig DF, Morgan RO, Chaudhary P, Singh H: Defining and measuring diagnostic uncertainty in medicine: a systematic review. Journal of general internal medicine 2018, 33(1):103-115.
41. Castaneda C, Nalley K, Mannion C, Bhattacharyya P, Blake P, Pecora A, Goy A, Suh KS: Clinical decision support systems for improving diagnostic accuracy and achieving precision medicine. Journal of clinical bioinformatics 2015, 5(1):1-16.
42. Graber ML, Rencic J, Rusz D, Papa F, Croskerry P, Zierler B, Harkless G, Giuliano M, Schoenbaum S, Colford C: Improving diagnosis by improving education: a policy brief on education in healthcare professions. Diagnosis 2018, 5(3):107-118.
43. Graber ML: Reaching 95%: decision support tools are the surest way to improve diagnosis now. In., vol. 31: BMJ Publishing Group Ltd; 2022: 415-418.
44. Graber ML, Holmboe E, Stanley J, Danielson J, Schoenbaum S, Olson AP: A call to action: next steps to advance diagnosis education in the health professions. Diagnosis 2021.
45. Olson A, Rencic J, Cosby K, Rusz D, Papa F, Croskerry P, Zierler B, Harkless G, Giuliano MA, Schoenbaum S: Competencies for improving diagnosis: an interprofessional framework for education and training in health care. Diagnosis 2019, 6(4):335-341.
46. 4Croskerry P: Adaptive expertise in medical decision making. Medical teacher 2018, 40(8):803-808.
47. Croskerry P: The rational diagnostician and achieving diagnostic excellence. JAMA 2022, 327(4):317-318.
2. Schiff GD, Martin SA, Eidelman DH, Volk LA, Ruan E, Cassel C, Galanter W, Johnson M, Jutel A, Kroenke K: Ten principles for more conservative, care-full diagnosis. In., vol. 169: American College of Physicians; 2018: 643-645.
3. Jenniskens K, De Groot JA, Reitsma JB, Moons KG, Hooft L, Naaktgeboren CA: Overdiagnosis across medical disciplines: a scoping review. BMJ open 2017, 7(12):e018448.
4. Catita M, Águas A, Morgado P: Normality in medicine: a critical review. Philosophy, Ethics, and Humanities in Medicine 2020, 15(1):1-6.
5. Larson JS: The conceptualization of health. Medical care research and review 1999, 56(2):123-136.
6. van der Linden R, Schermer M: Health and disease as practical concepts: exploring function in context-specific definitions. Medicine, Health Care and Philosophy 2022, 25(1):131-140.
7. Moynihan R: Disease mongering. The politics of medicine (e-encyclopaedia). In.; 2012.
8. Lea M, Hofmann BM: Dediagnosing–a novel framework for making people less ill. European Journal of Internal Medicine 2022, 95:17-23.
9. McCartney G, Popham F, McMaster R, Cumbers A: Defining health and health inequalities. Public health 2019, 172:22-30.
10. Svalastog AL, Donev D, Kristoffersen NJ, Gajović S: Concepts and definitions of health and health-related values in the knowledge landscapes of the digital society. Croatian medical journal 2017, 58(6):431.
11. Powell R, Scarffe E: Rethinking “Disease”: a fresh diagnosis and a new philosophical treatment. Journal of Medical Ethics 2019, 45(9):579-588.
12. Huber M, Knottnerus JA, Green L, Van Der Horst H, Jadad AR, Kromhout D, Leonard B, Lorig K, Loureiro MI, Van der Meer JW: How should we define health? Bmj 2011, 343.
13. Rogers WA, Walker MJ: Précising definitions as a way to combat overdiagnosis. Journal of evaluation in clinical practice 2018, 24(5):1019-1025.
14. Thombs B, Turner KA, Shrier I: Defining and evaluating overdiagnosis in mental health: a meta-research review. Psychotherapy and psychosomatics 2019, 88(4):193-202.
15. Armstrong N: Overdiagnosis and overtreatment: a sociological perspective on tackling a contemporary healthcare issue. Sociology of Health & Illness 2021, 43(1):58-64.
16. Perros F, Koumpos A: Overdiagnosis: The silent pandemic of the West? Public Health Toxicology 2022, 2(1):1-4.
17. Gupta P, Gupta M, Koul N: Overdiagnosis and overtreatment; how to deal with too much medicine. Journal of Family Medicine and Primary Care 2020, 9(8):3815.
18. IUDICISSA MS, DEL REAL PT: Disease Mongering (Pseudo-Disease Promotion). 2012.
19. Nature: POLYGENIC RISK: WHAT’S THE SCORE? In.: Nature advertorial; 2019.
20. Singh H, Dickinson JA, Thériault G, Grad R, Groulx S, Wilson BJ, Szafran O, Bell NR: Overdiagnosis: causes and consequences in primary health care. Canadian Family Physician 2018, 64(9):654-659.
21. Greenberg J, Green JB: Over-testing: why more is not better. The American journal of medicine 2014, 127(5):362-363.
22. Housten AJ, Lowenstein LM, Hoffman A, Jacobs LE, Zirari Z, Hoover DS, Stacey D, Pratt G, Bevers TB, Volk RJ: A review of the presentation of overdiagnosis in cancer screening patient decision AIDS. MDM policy & practice 2019, 4(2):2381468319881447.
23. Srivastava S, Koay EJ, Borowsky AD, De Marzo AM, Ghosh S, Wagner PD, Kramer BS: Cancer overdiagnosis: a biological challenge and clinical dilemma. Nature Reviews Cancer 2019, 19(6):349-358.
24. Welch HG, Kramer BS, Black WC: Epidemiologic signatures in cancer. New England Journal of Medicine 2019, 381(14):1378-1386.
25. Hvidt EA, Lykkegaard J, Pedersen LB, Pedersen KM, Munck A, Andersen MK: How is defensive medicine understood and experienced in a primary care setting? A qualitative focus group study among Danish general practitioners. BMJ open 2017, 7(12):e019851.
26. Chiolero A, Paccaud F, Aujesky D, Santschi V, Rodondi N: How to prevent overdiagnosis. Swiss medical weekly 2015, 145.
27. Martin SA, Podolsky SH, Greene JA: Overdiagnosis and overtreatment over time. Diagnosis 2015, 2(2):105-109.
28. Greenes RA: Reducing diagnostic error with computer-based clinical decision support. Adv Health Sci Educ Theory Pract 2009, 14 Suppl 1:83-87.
29. Hofmann B: Back to basics: overdiagnosis is about unwarranted diagnosis. American Journal of Epidemiology 2019, 188(10):1812-1817.
30. Chiolero A, Paradis G, Paccaud F: The pseudo-high-risk prevention strategy. In., vol. 44: Oxford University Press; 2015: 1469-1473.
31. Sniderman AD, D'Agostino RB, Sr., Pencina MJ: The Role of Physicians in the Era of Predictive Analytics. JAMA 2015, 314(1):25-26.
32. Carter SM, Rogers W, Heath I, Degeling C, Doust J, Barratt A: The challenge of overdiagnosis begins with its definition. Bmj 2015, 350.
33. Ereshefsky M: Defining ‘health’and ‘disease’. Studies in History and Philosophy of Science Part C: Studies in History and Philosophy of Biological and Biomedical Sciences 2009, 40(3):221-227.
34. Doust J, Jean Walker M, Rogers WA: Current dilemmas in defining the boundaries of disease. Journal of Medicine and Philosophy 2017, 42(4):350-366.
35. Lerner H, Berzell M: Reference values and the problem of health as normality: a veterinary attempt in the light of a one health approach. Infection Ecology & Epidemiology 2014, 4(1):24270.
36. Feller L, Lemmer J, Nemutandani MS, Ballyram R, Khammissa RAG: Judgment and decision-making in clinical dentistry. Journal of International Medical Research 2020, 48(11):300060520972877.
37. Amoretti MC, Lalumera E: Wherein is the concept of disease normative? From weak normativity to value-conscious naturalism. Medicine, Health Care and Philosophy 2022, 25(1):47-60.
38. Doust J, Vandvik PO, Qaseem A, Mustafa RA, Horvath AR, Frances A, Al-Ansary L, Bossuyt P, Ward RL, Kopp I: Guidance for modifying the definition of diseases: a checklist. JAMA internal medicine 2017, 177(7):1020-1025.
39. Pearl J: Bayesianism and causality, or, why I am only a half-Bayesian. In: Foundations of bayesianism. edn.: Springer; 2001: 19-36.
40. Bhise V, Rajan SS, Sittig DF, Morgan RO, Chaudhary P, Singh H: Defining and measuring diagnostic uncertainty in medicine: a systematic review. Journal of general internal medicine 2018, 33(1):103-115.
41. Castaneda C, Nalley K, Mannion C, Bhattacharyya P, Blake P, Pecora A, Goy A, Suh KS: Clinical decision support systems for improving diagnostic accuracy and achieving precision medicine. Journal of clinical bioinformatics 2015, 5(1):1-16.
42. Graber ML, Rencic J, Rusz D, Papa F, Croskerry P, Zierler B, Harkless G, Giuliano M, Schoenbaum S, Colford C: Improving diagnosis by improving education: a policy brief on education in healthcare professions. Diagnosis 2018, 5(3):107-118.
43. Graber ML: Reaching 95%: decision support tools are the surest way to improve diagnosis now. In., vol. 31: BMJ Publishing Group Ltd; 2022: 415-418.
44. Graber ML, Holmboe E, Stanley J, Danielson J, Schoenbaum S, Olson AP: A call to action: next steps to advance diagnosis education in the health professions. Diagnosis 2021.
45. Olson A, Rencic J, Cosby K, Rusz D, Papa F, Croskerry P, Zierler B, Harkless G, Giuliano MA, Schoenbaum S: Competencies for improving diagnosis: an interprofessional framework for education and training in health care. Diagnosis 2019, 6(4):335-341.
46. 4Croskerry P: Adaptive expertise in medical decision making. Medical teacher 2018, 40(8):803-808.
47. Croskerry P: The rational diagnostician and achieving diagnostic excellence. JAMA 2022, 327(4):317-318.