Too much medicine; too little care

“Too much testing of well people and not enough care for the sick worsens health inequalities and drains professionalism, harming both those who need treatment and those who don’t.” Margaret McCartney.1

A growing frustration in clinical medicine is that we are now so busy managing the proliferation of risk factors, “incidentalomas,” and the worried well that we lack the time to care properly for those who are seriously ill. As the definitions of common conditions such as diabetes and kidney disease have expanded and the categories and boundaries of mental disorders have grown, our time and attention for the most worryingly ill, disturbed, and vulnerable patients has shrunk. Too much medicine is harming both the sick and well.

Much of the growth in apparent illness has escaped public attention. One striking example is the tripling of the incidence of thyroid cancer in the United States, Australia, and elsewhere between 1975 and 2012,2 3 during which time the death rate did not change. This dramatic rise is best explained by increased testing and improved diagnostic tools, rather than a real change in cancer incidence. It has been described as an epidemic of diagnosis rather than a true epidemic. Similar “epidemics” have occurred in conditions where there has been active screening, such as breast cancer …