By Dr. Ronald S. Dubin
Guest Columnist

Ever wonder why some people you talk to have so many healthcare problems that it would take a gigabyte of memory just to store that information. Makes you kind of wonder how the intricate complex homeostasis of the human body can attack these on multiple fronts. In many instances, these conditions are caused by “Overdiagnosis.”

The term applies to a diagnosis of a medical condition that would never have caused any symptoms or problems. Many of these conditions come from newer technology used in medicine that is capable of looking at a patient with such fine detail that it makes a glass surface look like a Martian crater! Some of it comes from the increasing ability for patients to self-test themselves until they find a condition they feel explains what they feel or experience. Sometimes it comes from commercial incentives like the many commercials we watch on TV. They want to sell you a product or a drug so bad that they scheme their commercials to make you believe you need what they’re selling.

This also comes from over testing with expensive and unnecessary blood draws, and the use of CT and MRI scans. It is through these advanced tests that your doctor can find some conditions we, in the profession, call “incidentaloma” or findings that are benign and inconsequential and were found “incidentally”.

Overdiagnosis is not misdiagnoses. The latter is making a wrong diagnosis while Overdiagnosis makes the right diagnosis but amplifies it from a benign condition which requires no further treatment to a more ominous condition that results in more expensive and usually unnecessary care.

Overselling is similar to overdiagnosing except that this involves using common ailments and expanding the definition to more ambiguous or mild symptoms.  Insomnia, for example, is a sleep disorder affecting millions of people. The vast majority do not require treatment. Overselling moves the bar from normal to abnormal in order to capture those temporary sleep  patterns which occurred from only mild and temporary factors.

Overdiagnosis is also a costly problem in today’s healthcare field which tends to capture more expensive testing, procedures, and drug therapy. Not only that, many people’s psychological and behavioral patterns are negatively impacted due to the over diagnosing errors. A good example is the term “degenerative disc” or spinal stenosis in the neck or back. Almost everyone older than 45 years of age will have these diagnoses on their MRI. To me this is a normal finding, kind of like grey hair, tooth cavities, or facial wrinkles in the aging population.

Bulging discs are also very common in people over 50. So naturally come the uneducated doctors who notice the spinal stenos and bulging discs on the MRI study and then end up referring the patient to a spine surgeon where in many instances they will undergo surgery. Yet, no cause and effect relationship was ever established.

Now the question is how you really establish a cause and effect for back pain. Ah, the million dollar question which I will answer in a future article. This cause and effect relationship in back pain is extremely important and few doctors ever look beyond the MRI. If surgery is performed then poor results can happen. I think we all know many people who have had a bad outcome from spinal surgery and wish they never had it in the first place.