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Over-medicalising

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It’s hardly an original thought, I know, but I do seriously worry that we’re over-medicalising patients these days. Blood pressure targets are screwed to the floor. Shy people are pathologised into having social phobia. And if patients aren’t technically diabetic, then we label them as impaired glucose tolerance, impaired fasting glycaemia, pre-diabetes or metabolic syndrome, and manage them as if they are.

I’m not sure this makes anyone healthier, but it sure makes me busier.

Now I’ve found what I think is the ultimate in slack, pro-medicalising diagnostic criteria. ‘So have I actually got polycystic ovary syndrome?’ asked my patient, having had some humming, hawing, testing and scanning from my colleagues. Good question, I thought. Let’s get all PUNny and DENny, shall we? So I checked out the current definition of PCOS. Ladies and gents, I present to you, only slightly paraphrased, the Rotterdam criteria. Perm any two of the following three for the diagnosis:

1 Oligomenorrhoea

2 Clinical or biochemical evidence of hyperandrogenism

3 Polycystic ovaries on ultrasound

Notice anything odd? Correct. You don’t need ultrasonic proof of polycystic ovaries to have PCOS. What’s not completely clear is whether you’ve got PCOS if one and two apply but a coincidental ultrasound is normal. Because we all know you can have polycystic ovaries without having PCOS. But this seems to suggest you can have PCOS without having polycystic ovaries, which is a bit of a diagnostic paradigm shift.  Indeed, you can probably have PCOS without having ovaries. After all, I get the occasional zit and I’ve never had a period, so I fulfil the criteria – which possibly explains why I’m putting on weight.

‘Ahem,’ said my patient, ‘So have I got PCOS?’

‘Hum,’ I said. ‘And haw.’ Which I think answered her question.

 

Readers' comments (3)

  • That's why it's called a syndrome and not a disease. Many women are on the spectrum, not all will be significantly symptomatic.

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  • One of the great unacknowledged truths in medicine is that these days we are so healthy, by comparison with historical times, that every minor twinge seems significant.

    As you get older, stuff no longer works as well as it did. Who knew?

    Here's one I don't see much discussed, though. As we get better at fixing chronic diseases and other countersurvival mutations, are we perhaps increasing their prevalence? People with asthma (which I have), Crohn's (which I don't but my youngest might), coeliac (which I have) and other chronic diseases may well have died young or failed to have a family back in the day. Am I spreading bad genes? Or is my disgustingly healthy older son proof that it's all the luck of the draw?

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  • We spend so much time, money and investigation minor and routine stuff - just in case - we are so scared of litigation. If I had guidelines in leaving things alone, such as endoscopy - there are thousands of these done not necessary - I could save the NHS 50 % . Litigation is driving up costs.

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From: Copperfield

Dr Tony Copperfield is a jobbing GP in Essex with more than a few chips on his shoulder