Overdiagnosis group
The overdiagnosis group was set in 2014 to explore and develop thinking around overdiagnosis. This group is an informal Google group which communicates through email. Membership is mainly GPs but also students and trainees, specialists, health care professionals and members of the public. Although mainly UK based, the group also has world-wide members. The group is now over 300 strong and hope you will join us to improve thinking around overdiagnosis. This group encourages cognition and we have all taken up increased critical thinking and ethical skills from the interactions.
Comments and contributions are welcome from anyone, as are ideas and offers of input to make things happen. You are free to read, delete or contribute as you wish. At times there can be a lot of emails so be selective, open-minded and we hope you enjoy the intellectual exchanges. It can help on emails if you briefly put who you are/role under your name. Please join us.
Please note that all members must make a public declaration of their interests. Having a declaration of interest(s) or conflict(s) of interest is not an issue but not declaring it is! Non-doctors can also email Who Pays This Doctor to declare interests and possible conflicts.
There are no 'rules' but we respect confidentiality of posting. The chair or vice chair may intervene if the topic is clearly not related to overdiagnosis or is advertising. Overdiagnosis topics may include optimal diagnosis or under-diagnosis.
New and forthcoming work
In January 2019 the group had a subgroup on optimal testing and a subgroup exploring usual practice in diagnosis and management of insect bites. We will add the work from these groups as it becomes available.
In 2018 Margaret McCartney and Sam Finnikin were appointed as RCGP Fellows for Values and Evidence. These titles reflect the discussions within the Overdiagnosis Group: over diagnosis and over treatment are inherently entangled with risk, shared decision making, evidence and information quality, drivers to testing and treatment, quality of life issues, medicalisation of normality, and conflicts of interest. Below you will find some resources that many professionals and patients may find useful when considering these issues.
International Annual Preventing Overdiagnosis Conference
There is an annual conference around the world which some of us attend and is thoroughly recommended. The next one is in Denmark.
Find out more about the conference.
UK conference
Preventing Overdiagnosis through the Shared Understanding of Medicine (POSSUM) was held in Birmingham, run by Sam Finnikin, in June 2018. We hope to repeat that success with a day talking about the legal ramifications of guidelines, shared decision making (SDM) and evidence based medicine (EBM).
RCGP standing group on overdiagnosis – report to council
This paper examines policy making in relation to overdiagnosis and overtreatment in general practice, and makes recommendations for the future examination of policy, either presented to or created within the RCGP, in order to prevent avoidable harm, via the use of 'tests' to be applied to new policies being considered.
Download a copy of the report:
RCGP standing group on overdiagnosis for shared decisions in healthcare (PDF file, 53 KB)
Join us
Fill in the form to join us: RCGP standing group on overdiagnosis.
Specific contacts
- Chair: Dr David Spitzer
- Vice-chairs: Dr Alice Hodkinson and Dr John Wilmot
Group governance
- The list of members is available on membership in the Google group.
- The group is an informal discussion group by email and so does not have funding or a constitution/terms of reference.
- The chair and two vice chairs moderate the group.
- Last meeting of the chair and vice chairs: 1st Nov 22. There are no regular face to face committee meetings.
Resources
The group has developed some resources that many professionals and patients may find useful when considering overdiagnosis, values and evidence.
Harding Centre for Risk Communication
Fact boxes which provide quick graphical description of relative risks and benefits for some interventions - includes statins for primary prevention, screening, antibiotics for bronchitis.
- Handbook of non drug interventions: Developed by the Royal Australian College of General Practitioners, this is a ‘BNF’ of non drug treatments such as auto inflation for glue ear and exercise for fatigue related to cancer treatments.
- Polypharmacy Guidance - Realistic Prescribing: A helpful booklet with review of issues relating to polypharmacy, charts to guide on cumulative toxicity, and list of numbers needed to treat for many common medications. Also available as a free app.
- RCGP TARGET Antibiotic Toolkit: to assist in antibiotic prescribing.
- Open Prescribing: Compare your practice prescribing to others.
- MedStopper: Canadian resource to rationalise polypharmacy
- The Mystery of General Practice (1995): Iona Heath's John Fry Lecture
- Role of fear in overdiagnosis and over treatment (2014): Iona Heath
- Evidence based medicine: a movement in crisis? (2014): Trish Greenhaulgh, et al.
- Overdiagnosis and Overtreatment - Time for a grassroots revolution (BJGP 2016): Editorial from then chair and vice chair of the Overdiagnosis group, Margaret McCartney and Julian Treadwell
- Overdiagnosis in primary care: framing the problem and finding solutions (2018): Review in the BMJ from US authors
- Evidence and values in the NHS: choosing treatments and interventions well (2018): Editorial from the two RCGP Fellows in Evidence and Values, Margaret McCartney and Sam Finnikin
- A three-talk model for shared decision making: multistage consultation process
- Practicing realistic medicine in Scotland - CMO annual report
- Overdiagnosis and Action to be Taken - WONCA position paper 2018
Aimed at professionals
- International society for evidence Based health care: searchable evidence based resource for teaching students from cartoons, to videos, dance, and Homer Simpson! Worth a few hours of your time.
- RCGP eLibrary
- RCGP eLearning in overdiagnosis: module written by members of the Overdiagnosis group and available on the RCGP eLearning platform to explain the basics of overdiagnosis.
- Module on Communicating potential harms and benefits of treatments: Winton Centre for risk and evidence communication eLearning hub - short course teaching and demonstrating basic statistics relevant to day to day practice.
- Shared decision making online resources: hosted on Health education england’s website, contains several short online courses aimed and designed by GPs. Needs registration with NHS email/Athens giving most access.
- Catalogue of Bias from the Centre for evidence based medicine in Oxford, seeks to describe the biases that can occur when trying to practice evidence-based medicine.
- The Society for Academic Primary Care (SAPC)
Aimed at everyone
- James Lind Library: extensive online library documenting the history of fair tests of interventions in health care.
- Risk of deception tool: online resource from the University of British Columbia to help people identify the likelihood of internet scams.
- Know your chances: free online book by Dartmouth University academics aimed at a wide readership which teaches basic statistical literacy.
Aimed at children
- Informed health choice: This international initiative aims to teach children to spot fake healthcare claims. Includes an evidence based medicine song!
- Facts for Life: Course developed for children in schools teaching about ‘normal’ health and illness. Available on a paid-for basis in the UK.
Other resources - campaigns and conferences
- RCGP policy on overdiagnosis: paper approved by the RCGP council which contains 5 tests which are to be applied to any new RCGP policy.
- Choosing Wisely - UK campaign: part of a global initiative website; contains resources such as posters asking patients to ask doctors the BRAN questions (Benefits/Risks/Alternative/What would happen if I do nothing?)
- AllTrials campaign: many clinical trials go unreported leading to bias - this campaign aims to change that
- Compare-trials campaign: Outcome switching may be legitimate in clinical trials but may increase the risk of bias. Campaign to compare registered and published trial outcomes
Conferences
- Preventing Overdiagnosis 2018 - Denmark
- Preventing Overdiagnosis 2019 - Australia, December 2019
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