TY - JOUR T1 - Overtreatment and undertreatment: time to challenge our thinking JF - British Journal of General Practice JO - Br J Gen Pract SP - 442 LP - 443 DO - 10.3399/bjgp17X692657 VL - 67 IS - 663 AU - Matt Kearney AU - Julian Treadwell AU - Martin Marshall Y1 - 2017/10/01 UR - http://bjgp.org/content/67/663/442.abstract N2 - It is time to challenge the narrative that concern about overdiagnosis/treatment and underdiagnosis/treatment are opposing world views. Passionate advocates on both sides of the debate battle for the hearts and minds of clinicians, policymakers, and the public. But this is a false dichotomy that inhibits us from finding solutions to important clinical dilemmas. Undertreatment and overtreatment are both examples of suboptimal care. They can coexist at population level and individual level, and they create real tensions for the clinician to balance. They both cause harm, both are difficult to get right, and both are aspects of primary care that would benefit from systematic quality improvement. Too often clinicians feel driven to support one polarised view or other. In reality, they need support to minimise under-and overtreatment, and to manage the tension between them.How does this tension and suboptimal care manifest in day-to-day practice? There are many examples. Implementation of multiple single-condition guidelines in the individual patient can lead to pursuit of tight glycaemic or blood pressure control that does not take account of multimorbidity and individual risks and benefits.1 Treatment that is not tailored to the individual can lead to polypharmacy, reduced quality of life, and serious adverse effects. In people with known atrial fibrillation (AF) who suffer a stroke, 47% have not been anticoagulated before their stroke despite the overwhelming evidence of benefit.2 There is wide variation among clinical commissioning groups (CCGs) (22% to 91%), suggesting that many of these strokes were preventable. In England, the average practice achieves blood pressure control to 150/90 in 79.6% of people with hypertension. But there is substantial variation: excluding outlying practices and including excepted patients in the denominator, achievement varies from 43% to 100%.3 In … ER -