Overdiagnosis and Overtreatment: A Sociological Perspective on a Contemporary Healthcare Systems Issue

Overdiagnosis and overtreatment are increasingly being recognised as a significant problem in contemporary healthcare but are yet to receive any significant sociological attention, over and above that which is arguably transferable from the medicalisation literature. Overdiagnosis and overtreatment occur when a diagnosis is ‘correct’ according to current standards but the diagnosis or associated treatment has a low probability of benefitting the patient, and may instead be harmful.

Overdiagnosis and overtreatment might be constructed as problems best addressed by educating patients and clinicians, and improving the relationships between them. The emergence of tools seeking to support decision making and to facilitate patients’ asking questions about whether interventions are really necessary certainly supports this conceptualisation.

However, notwithstanding the efforts of interventions of this type, it is unlikely that significant traction on overdiagnosis and overtreatment is possible through these means alone. Even when professionals and patients may wish to do less rather than more, the system within which care is delivered and received can make this challenging to achieve. Overdiagnosis and overtreatment are compounded by the way in which many attempts to improve care quality tend to encourage both doing more rather than less and the standardization of care. Guidelines intended to reduce variation and improve care have arguably encouraged the neglect of respect for patients’ preferences.

This paper will argue that a sociological perspective on overdiagnosis and overtreatment recasts them as issues that must be understood as a consequence of the organisational, financial and cultural attributes of the system, not just individual interactions. Social theory exploring accountability, governance and regulation can enhance our thinking about how features of the health system may make it challenging for clinicians and patients to do less rather than more, not least because of concerns that doing so might be considered deviant.