Policy bite: Nordic position paper on Overdiagnosis

In My View ... May 2017

April, 2017

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This month's guest policy bite comes from the Nordic Federation of General Practice (NFGP), and is the recently endorsed Nordic position paper on overdiagnosis and related medical overactivity.

The Paper:

Position Paper: Overdiagnosis and related medical excess

Link to paper

Background:

In 2016, the Norwegian College of General Practice published a position paper on overdiagnosis. Later in the same year, the Nordic Federation of General Practice (NFGP), a collaboration between the Nordic GPs in Denmark, Finland, Iceland, Norway and Sweden, endorsed the paper, thereby making it a Nordic position paper.

The message:

What´s in it for our patients?

The resources and technology of the health services provide considerable opportunities for preventing and treating disease. But when used in excess or inappropriately, medical activity can cause harm, both to patients and the healthcare system.

The Nordic document defines and describes overdiagnosis and related concepts such as medical overactivity, over-investigation, overtreatment, and questionable expansion of disease definitions.

Overdiagnosis may indirectly contribute to underdiagnosis, by allocating limited resources to excessive investigation and medicalization of the worried well, at the expense of those who need medical care the most. In other words, when well-meaning doctors are excessively active, they tend to reinforce social injustice.

Involvement of GPs

The engagement of GPs in the battle to curb overdiagnosis is not coincidental. GPs work closely with the general population – at the nexus between science and society, disease and normality. While they should evidently aim to identify and treat disease as early as possible, they also observe how increasing medicalisation underlies problematic tendencies in the population, among politicians and in the medical community. Overdiagnosis is one of these tendencies.

Development and implementation

The Nordic position paper started as a draft paper by the Norwegian College of General Practice, presented at the 2016 Preventing Overdiagnosis conference in Barcelona and the WONCAEurope conference in Copenhagen. The paper received considerable attention, and was highlighted by Professor Paul Glasziou, Bond University, Australia who suggested we continue our efforts to raise awareness of this problem among our colleagues, stakeholders of health care, politicians and lay people. See video of these comments

The Authors

Nordic Federation of General Practitioners (NFGP) is a forum for collaboration between the Nordic general practitioners in Denmark, Norway, Sweden, Finland and Iceland. NFGP is owned by the five Nordic Colleges of General Practitioners, and is responsible for the publication of the Scandinavian Journal of Primary Health Care and for the coordination of the organization of the Nordic congresses of general practice.