Diagnosis and overdiagnosis; rational diagnostics should be the basis
Bindels, P.J.E.
Nederlands Tijdschrift Voor Geneeskunde 158: A7770
2014
ISSN/ISBN: 1876-8784 PMID: 24988172 Document Number: 672722
In clinical reasoning a first working hypothesis is based on clinical history and physical examination. In a significant number of patients, a posterior risk of disease after this first clinical part is either low enough to follow a wait-and-see policy or high enough to start treatment. Only in the case of 'clinical indecision' are additional diagnostic modalities needed. New diagnostic modalities (CT, MRI, ultrasonography) have emerged rapidly in the past decades and their (irrational) use has increased accordingly. Improper use of new or current diagnostic modalities will increase the risk of overdiagnosis and of unnecessary health care costs, and might even cause harm to the patient. A rational utility of additional diagnostic modalities should be the basis of clinical reasoning. Proper use of diagnostic modalities has proven its value in medicine and thus for patients. The use of routine additional diagnostics, however, should raise suspicion in all physicians.