- •Diagnosing constitutes a substantial part of healthcare work and triggers a wide range of actions.
- •Dediagnosing is proposed as a novel framework for removing diagnoses that do not contribute to reducing the persons’ suffering and should be introduced to make people less ill.
- •Dediagnosing comes together with other efforts to reduce overuse, such as deimplementation and deprescribing.
- •As diagnoses may influence identity construction and social rights, dediagnosing must be conducted in close collaboration with the patient and through shared decision making.
- Marshall M.
1. Diagnosing is a substantial part of healthcare
2. Diagnoses and their effects
3. Dediagnosing to stop the unwarranted disease expansion
4. Why dediagnosing?
Engineering, and Medicine.
|Medicalization||The condition is an ordinary life phenomenon that does not benefit persons in making it a diagnosis|
|Condition is not correct||Diagnostic errors, false-positive test result|
|Correct diagnostics, but the condition is not a disease||The condition is only a risk factor, precondition, or a precursor of disease|
|Unwarranted inference from “can do” to “will do”||The condition is considered to be a diagnosis because we have a treatment|
|Disease mongering||A condition is diagnosed because money can be earned|
|The person needs help||Healthcare may not be the best institution to handle the condition (e.g., homelessness)|
|Activity-generating (self-reinforcing) system||The condition reinforces professional or system performance or justification|
|Resolved condition||The condition has resolved, and diagnosis and treatments should be removed|
|Esthetic condition||The condition only has esthetical and not functional characteristics (in the medical sense)|
|Aging process||The condition is due to ordinary aging processes|
5. Introducing a framework for dediagnosing
- Sallin K.
- Lagercrantz H.
- Evers K.
- Engström I.
- Hjern A.
- et al.
|Example 1||Example 2||Example 3|
|Patient description||Boy, 20 years old, diagnosed with ADHD in his childhood.||Woman, 56 years old, diagnosed with diabetes mellitus type 2 four years ago.||Woman 94 years old, diagnosed with osteoporosis decades ago.|
|Dediagnosing||Step 1||As a 20-year-old, he has no ongoing symptoms that would indicate ADHD. The ADHD diagnosis is not valid anymore.||Since the time of diagnosis, she has started exercising, improved her diet and lost weight. HbA1c has now dropped to <6.5% without antidiabetic drugs. The diabetes mellitus type 2 diagnosis is not valid anymore.||The diagnostic criterion is still present since the woman has experienced several osteoporotic fractures.|
|Step 2||a) The boy prefers not to have the ADHD diagnosis anymore.|
b) The ADHD diagnosis trigger special attention regarding the driver's license and stigmatizes.
c) The ADHD diagnosis is considered not to be beneficial for the boy, but rather to harm him, see points 2a and 2b.
|a) The woman prefers not to have the diabetes mellitus diagnosis anymore. She thinks the diagnosis is stigmatizing.|
b) The diabetes mellitus diagnosis can trigger prescription of drugs, however, the woman does not need such drugs anymore. The diagnosis also triggers stigmatization.
c) The diabetes mellitus diagnosis is considered to harm the patient due to stigmatization.
|a) The woman express worries and uncertainty as a result of the osteoporosis diagnosis and the accompanying risk of fractures.|
b) The osteoporosis diagnosis triggers prescription of non-osteoporotic drugs. However, since life expectancy is considered to be short, non-osteoporotic drugs are deprescribed now.
c) The osteoporosis diagnosis is considered to harm the woman due to worries about the risk of fractures.
|Conclusion||ADHD can be dediagnosed.||Diabetes mellitus type 2 can be dediagnosed.||Osteoporosis can be dediagnosed.|
6. Dediagnosing supporting other measures to reduce overuse
- Wolf E.R.
- Krist A.H.
- Schroeder A.R.
- •“I was told to take this until I die. Are you saying I'm about to die?”
- •“But won't I get sick without the tablet?”
- •“But my other doctor told me I should never stop this drug. Are you saying (s)he was wrong? Do you know what you're doing?”
7. Moving forward
8. Contributors and sources
Declaration of Competing Interest
Data sharing statement
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