Is Medicine Diagnosing Us to Death? Understanding Over-diagnosis

In the 21st century, medical science has given us incredible tools to understand our bodies. From genetic testing to advanced imaging, we can diagnose thousands of conditions with precision. But is our obsession with labeling every symptom making us sicker instead of healthier? Dr. Suzanne O’Sullivan, an Irish neurologist and author of The Age of Diagnosis, argues that medicine has an over-diagnosis problem—and it’s causing real harm. Here’s what you need to know about this growing issue and how we can address it.

What Is Over-diagnosis?

Over-diagnosis happens when a condition is correctly identified, but it would never have caused symptoms or harm if left undetected. Unlike misdiagnosis (a wrong diagnosis) or false positives (abnormal test results that turn out to be harmless), over-diagnosis involves a true medical condition that doesn’t need treatment. For example, advanced imaging might detect tiny, slow-growing cancers that would never progress, yet patients undergo stressful and risky treatments anyway.

O’Sullivan highlights startling statistics: autism diagnoses in the UK surged by 787% from 1998 to 2018, Lyme disease has an estimated 85% over-diagnosis rate in some regions, and cancer screening programs often detect abnormalities that don’t reduce death rates. These numbers suggest we’re labeling more people as “sick” without always improving their health.

Why Is Over-diagnosis Happening?

Several factors drive this trend:

• Patient Demand for Certainty: People want clear answers from medicine—black-and-white labels like “you have this disease” or “you don’t.” But many conditions, like autism, long COVID, or chronic Lyme disease, have fuzzy boundaries, and diagnosis is often subjective. Patients push for names for their symptoms, even when tests alone can’t provide the full picture.
• Doctors’ Fear of Missing Something: Physicians face pressure to avoid malpractice or blame, so they err on the side of diagnosing and treating, especially with advanced tools that detect even minor abnormalities.
• Technology’s Double-Edged Sword: New imaging and genetic tests can spot minuscule issues, but we often can’t predict which ones matter. For instance, cancer screening catches slow-growing tumors that might never cause harm, leading to unnecessary surgeries or radiation.
• Cultural and Systemic Pressures: The medical system, influenced by pharmaceutical companies and performance incentives, sometimes broadens disease definitions (e.g., lowering blood pressure thresholds), turning healthy people into patients overnight.

O’Sullivan also points to a psychological factor: the nocebo effect. Labeling someone with a diagnosis, even if it’s mild, can make them hyper-focused on their symptoms, worsening their mental and physical health. For example, telling a child they have mild autism might harm their self-esteem without providing clear benefits.

The Harm of Over-diagnosis

Over-diagnosis isn’t just a neutral label—it can hurt people in multiple ways:

• Psychological Stress: Being told you have a condition, like a small, non-threatening cancer, can cause anxiety and depression, even if no treatment is needed.
• Unnecessary Treatments: Over-treatment, a common result of over-diagnosis, brings risks like drug side effects, surgical complications, or financial strain. In the US, over $200 billion is wasted annually on unnecessary treatments.
• Stigma and Identity Impact: Labels like ADHD or chronic kidney disease can alter how people see themselves, especially children, potentially affecting their confidence and social interactions.
• Resource Drain: Over-diagnosis diverts healthcare resources from those with genuine, urgent needs, contributing to system-wide inefficiencies.

A Case for “Slow Medicine”

O’Sullivan advocates for a “slow medicine” approach to counter over-diagnosis. This means:

• Building Doctor-Patient Relationships: Taking time to understand a patient’s story, rather than relying solely on tests, leads to more accurate diagnoses. Diagnosis is an art, not just a science, requiring clinicians to contextualize symptoms.
• Monitoring Symptoms: Instead of rushing to label, doctors and patients can adopt a “watchful waiting” strategy, tracking symptoms over time to see if they progress. For example, some men with early prostate cancer choose monitoring over immediate treatment.
• Educating Patients: Shared decision-making, where doctors explain the risks of over-diagnosis and the uncertainty of some conditions, empowers patients to make informed choices.
• Re-evaluating Screening: Not all screening programs are beneficial. O’Sullivan notes that many cancer screenings don’t reduce mortality rates as expected, suggesting we need to reassess their value.

Balancing Progress and Caution

O’Sullivan is clear: she’s not against medical advancements. Genetic testing for rare brain diseases, for instance, is a game-changer. But we need to balance these innovations with caution. Doctors should communicate the uncertainty of diagnoses, and patients should resist the urge to demand a label for every symptom. Policymakers, too, must address systemic drivers like overly broad disease definitions and financial incentives that fuel over-diagnosis.

What Can You Do?

Next time you’re at the doctor’s office, consider these steps to avoid over-diagnosis:

• Ask about the necessity of tests or screenings. What are the benefits versus the risks?
• Discuss “watchful waiting” if a condition seems mild or unclear.
• Be open to uncertainty. Not every symptom needs a name right away.
• Seek a second opinion for significant diagnoses, especially if treatment seems aggressive.
• Consider visiting an Integrative Medicine provider.

What is Integrative Medicine?

Integrative medicine providers combine conventional medical treatments with evidence-based complementary therapies, offering a holistic approach to healthcare. Here are key reasons to consider one:

• Whole-Person Care: They focus on physical, mental, emotional, and spiritual health, addressing root causes rather than just symptoms. This can lead to more personalized treatment plans.
• Evidence-Based Complementary Therapies: They incorporate practices like acupuncture, nutrition counseling, or mindfulness, which studies show can help manage chronic pain, stress, or conditions like IBS or anxiety. For example, a 2020 study in Pain Medicine found acupuncture reduced chronic pain by up to 50% in some patients.
• Preventive Focus: Integrative providers emphasize lifestyle changes—diet, exercise, sleep—to prevent disease. The CDC notes that 60% of chronic diseases are preventable through lifestyle interventions.
• Collaborative Approach: They often work alongside conventional doctors, ensuring treatments complement existing medical care, like coordinating with oncologists for cancer patients using meditation to reduce treatment-related stress.
• Patient Empowerment: They educate patients to take active roles in their health, which can improve outcomes. A 2019 Journal of General Internal Medicine study showed patients in integrative care reported higher satisfaction and better adherence to treatment plans.
• Chronic Condition Management: For conditions like diabetes or fibromyalgia, integrative approaches (e.g., diet changes, yoga) can improve quality of life when standard treatments fall short.

Considerations: Not all therapies are covered by insurance, and costs can vary. Ensure the provider is licensed and uses evidence-based practices—check credentials through boards like the American Board of Integrative Medicine. If you’re dealing with a specific condition or seeking preventive care, they can tailor a plan, but discuss with your primary doctor to avoid treatment conflicts.

The Bottom Line

Medicine’s ability to diagnose has outpaced our ability to understand what those diagnoses mean. Over-diagnosis is a real problem, turning healthy people into patients and causing harm through stress, over treatment, and wasted resources.

By embracing “slow medicine” and fostering open conversations between doctors and patients, we can ensure diagnoses serve our health, not undermine it. As O’Sullivan puts it, sometimes less testing and diagnosing is the healthiest choice of all.