Skip to main content

Main menu

  • HOME
  • ONLINE FIRST
  • CURRENT ISSUE
  • ALL ISSUES
  • AUTHORS & REVIEWERS
  • SUBSCRIBE
  • BJGP LIFE
  • MORE
    • About BJGP
    • Conference
    • Advertising
    • eLetters
    • Alerts
    • Video
    • Audio
    • Librarian information
    • Resilience
    • COVID-19 Clinical Solutions
  • RCGP
    • BJGP for RCGP members
    • BJGP Open
    • RCGP eLearning
    • InnovAIT Journal
    • Jobs and careers

User menu

  • Subscriptions
  • Alerts
  • Log in

Search

  • Advanced search
British Journal of General Practice
Intended for Healthcare Professionals
  • RCGP
    • BJGP for RCGP members
    • BJGP Open
    • RCGP eLearning
    • InnovAIT Journal
    • Jobs and careers
  • Subscriptions
  • Alerts
  • Log in
  • Follow bjgp on Twitter
  • Visit bjgp on Facebook
  • Blog
  • Listen to BJGP podcast
  • Subscribe BJGP on YouTube
British Journal of General Practice
Intended for Healthcare Professionals

Advanced Search

  • HOME
  • ONLINE FIRST
  • CURRENT ISSUE
  • ALL ISSUES
  • AUTHORS & REVIEWERS
  • SUBSCRIBE
  • BJGP LIFE
  • MORE
    • About BJGP
    • Conference
    • Advertising
    • eLetters
    • Alerts
    • Video
    • Audio
    • Librarian information
    • Resilience
    • COVID-19 Clinical Solutions
Editorials

Overdiagnosis and overtreatment: generalists — it’s time for a grassroots revolution

Julian Treadwell and Margaret McCartney
British Journal of General Practice 2016; 66 (644): 116-117. DOI: https://doi.org/10.3399/bjgp16X683881
Julian Treadwell
Hindon Surgery, Wiltshire; Vice-Chair, RCGP Standing Group on Overdiagnosis; Editorial Board Member, ; GP Appraiser, NHSE South Central.
Roles: GP
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
Margaret McCartney
Fulton Street Medical Centre, Glasgow; Chair, RCGP Standing Group on Overdiagnosis.
Roles: GP
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
  • Article
  • Info
  • eLetters
  • PDF
Loading

Published eLetters

eLetter submission guidelines

Submit a Response to This Article
Compose eLetter

More information about text formats

Plain text

  • No HTML tags allowed.
  • Web page addresses and e-mail addresses turn into links automatically.
  • Lines and paragraphs break automatically.
Author Information
First or given name, e.g. 'Peter'.
Your last, or family, name, e.g. 'MacMoody'.
Your email address, e.g. higgs-boson@gmail.com. PLEASE NOTE: your email address will be published.
Your role and/or occupation, e.g. 'Orthopedic Surgeon'.
Your organization or institution (if applicable), e.g. 'Royal Free Hospital'.
Statement of Competing Interests
CAPTCHA
This question is for testing whether or not you are a human visitor and to prevent automated spam submissions.

Vertical Tabs

Jump to comment:

  • Guidance – improving patient outcomes or ticking boxes?
    Farzina Tanya Alam
    Published on: 03 April 2016
  • Published on: (3 April 2016)
    Page navigation anchor for Guidance – improving patient outcomes or ticking boxes?
    Guidance – improving patient outcomes or ticking boxes?
    • Farzina Tanya Alam, Medical Student,, The University of Manchester

    Overdiagnosis and overtreatment carry a number of widespread consequences both at the patient level and at a national level.  Treadwell and McCartney do well to highlight some of the culprits of this unhealthy practice, with the dilemmas associated with following national guidelines being a main offender. To this day, we remain driven to sculpt patient care according to outcomes of clinical trials; the principle concern with this approach is that those formulating the trials and those who are required to deliver patient care have differing goals. This runs the risk of providing ineffective patient care.

    Carrying out an audit recently against the NICE hypertension guidelines for investigating target organ damage highlighted the magnitude of the effects of impractical guidance.1  A few patients in the sample were found to have an eGFR between 60-90ml/min/1.73m2. Therefore, do we label these patients as having chronic kidney disease stage 2?  If so, how would these patients feel being told that they had signs of kidney failure?  Furthermore, how much more differently would we be managing these patients if they had an eGFR above 90ml/min/1/.73m2?  The psycho-social implications of carrying out investigations are often neglected but it is important to consider what the outcome of investigations would mean to patients. Sometimes, I feel we need to take a step back and ask “why am I carrying out this investigation?” an...

    Show More

    Overdiagnosis and overtreatment carry a number of widespread consequences both at the patient level and at a national level.  Treadwell and McCartney do well to highlight some of the culprits of this unhealthy practice, with the dilemmas associated with following national guidelines being a main offender. To this day, we remain driven to sculpt patient care according to outcomes of clinical trials; the principle concern with this approach is that those formulating the trials and those who are required to deliver patient care have differing goals. This runs the risk of providing ineffective patient care.

    Carrying out an audit recently against the NICE hypertension guidelines for investigating target organ damage highlighted the magnitude of the effects of impractical guidance.1  A few patients in the sample were found to have an eGFR between 60-90ml/min/1.73m2. Therefore, do we label these patients as having chronic kidney disease stage 2?  If so, how would these patients feel being told that they had signs of kidney failure?  Furthermore, how much more differently would we be managing these patients if they had an eGFR above 90ml/min/1/.73m2?  The psycho-social implications of carrying out investigations are often neglected but it is important to consider what the outcome of investigations would mean to patients. Sometimes, I feel we need to take a step back and ask “why am I carrying out this investigation?” and “what is the likelihood that the outcome of this investigation will improve this patient’s wellbeing?”  These are just some of the questions that distinguish a doctor from a guideline-centred robot.

    Reference

    1.  National Institute for Health and Care Excellence. Hypertension in adults: diagnosis and management.  Published date: August 2011. www.nice.org.uk/guidance/cg127/chapter/1-Guidance#assessing-cardiovascular-risk-and-target-organ-damage (accessed 4 Apr 2016)

     

    Show Less
    Competing Interests: None declared.
Back to top
Previous ArticleNext Article

In this issue

British Journal of General Practice: 66 (644)
British Journal of General Practice
Vol. 66, Issue 644
March 2016
  • Table of Contents
  • Index by author
Download PDF
Article Alerts
Or,
sign in or create an account with your email address
Email Article

Thank you for recommending British Journal of General Practice.

NOTE: We only request your email address so that the person to whom you are recommending the page knows that you wanted them to see it, and that it is not junk mail. We do not capture any email address.

Enter multiple addresses on separate lines or separate them with commas.
Overdiagnosis and overtreatment: generalists — it’s time for a grassroots revolution
(Your Name) has forwarded a page to you from British Journal of General Practice
(Your Name) thought you would like to see this page from British Journal of General Practice.
CAPTCHA
This question is for testing whether or not you are a human visitor and to prevent automated spam submissions.
Citation Tools
Overdiagnosis and overtreatment: generalists — it’s time for a grassroots revolution
Julian Treadwell, Margaret McCartney
British Journal of General Practice 2016; 66 (644): 116-117. DOI: 10.3399/bjgp16X683881

Citation Manager Formats

  • BibTeX
  • Bookends
  • EasyBib
  • EndNote (tagged)
  • EndNote 8 (xml)
  • Medlars
  • Mendeley
  • Papers
  • RefWorks Tagged
  • Ref Manager
  • RIS
  • Zotero

Share
Overdiagnosis and overtreatment: generalists — it’s time for a grassroots revolution
Julian Treadwell, Margaret McCartney
British Journal of General Practice 2016; 66 (644): 116-117. DOI: 10.3399/bjgp16X683881
del.icio.us logo Digg logo Reddit logo Twitter logo CiteULike logo Facebook logo Google logo Mendeley logo
  • Tweet Widget
  • Facebook Like
  • Google Plus One
  • Mendeley logo Mendeley

Jump to section

  • Top
  • Article
    • PSEUDO-SOLUTIONS TO DIFFICULT PROBLEMS
    • CHANGING THRESHOLDS AND INDICATION CREEP
    • Notes
    • REFERENCES
  • Info
  • eLetters
  • PDF

More in this TOC Section

  • Socioeconomic deprivation and post-stroke care in the community
  • Advocating for patients through laboratory tests: what do GPs’ use of blood tests for suspected cancer tell us?
  • Diagnosis of prostate cancer in primary care: navigating updated clinical guidance
Show more Editorials

Related Articles

Cited By...

Intended for Healthcare Professionals

BJGP Life

BJGP Open

 

@BJGPjournal's Likes on Twitter

 
 

British Journal of General Practice

NAVIGATE

  • Home
  • Current Issue
  • All Issues
  • Online First
  • Authors & reviewers

RCGP

  • BJGP for RCGP members
  • BJGP Open
  • RCGP eLearning
  • InnovAiT Journal
  • Jobs and careers

MY ACCOUNT

  • RCGP members' login
  • Subscriber login
  • Activate subscription
  • Terms and conditions

NEWS AND UPDATES

  • About BJGP
  • Alerts
  • RSS feeds
  • Facebook
  • Twitter

AUTHORS & REVIEWERS

  • Submit an article
  • Writing for BJGP: research
  • Writing for BJGP: other sections
  • BJGP editorial process & policies
  • BJGP ethical guidelines
  • Peer review for BJGP

CUSTOMER SERVICES

  • Advertising
  • Contact subscription agent
  • Copyright
  • Librarian information

CONTRIBUTE

  • BJGP Life
  • eLetters
  • Feedback

CONTACT US

BJGP Journal Office
RCGP
30 Euston Square
London NW1 2FB
Tel: +44 (0)20 3188 7400
Email: journal@rcgp.org.uk

British Journal of General Practice is an editorially-independent publication of the Royal College of General Practitioners
© 2023 British Journal of General Practice

Print ISSN: 0960-1643
Online ISSN: 1478-5242