“The demands of the public for definitive wellness are colliding with the public’s belief in a diagnostic system that can find only disease. A public in dogged pursuit of the unobtainable, combined with clinicians whose tools are powerful enough to find very small lesions, is a setup for diagnostic excess. And false positives are the arithmetically certain result of applying a disease-defining system to a population that is mostly well. … If the behavior of doctors and the public continues unabated, eventually every well person will be labeled sick. Like the invalids, we will all be assigned to one diagnosis-related group or another. How long will it take to find every single lesion in every person? Who will be the last well person?”
Dr. Clifton Meador in his 1994 essay “The Last Well Person“
We have been discussing efficiency in medicine for decades, only recently have policy wonks been aggressively addressing the issue. The 2008 release of the book Knowing What Works in Health Care by the Institute of Medicine placed additional focus on this issue. Since this time a series of policy and legislative actions have occurred around the issue of efficiency in medicine. Including but not limited to the recent health care reform law. Kenneth Lin’s post Book Review: “Overdiagnosed” and the Paradox of Cancer Survivorship highlight some of these concerns.
An old saying in salesmanship is, “If the need is not there (for your given product) then create the need (for your given product)” Could our medical providers be the best sales people ever?