Epidemic of Diagnoses

Posted on January 3, 2007 by John Hunter

What’s Making Us Sick Is an Epidemic of Diagnoses by Dr. Welch, Dr. Schwartz and Dr. Woloshin:

For most Americans, the biggest health threat is not avian flu, West Nile or mad cow disease. It’s our health-care system.

True, and probably the biggest economic threat too. See: Deming’s Seven Deadly Diseases and Health Insurance Premiums Soar Again.

But it also leads to more diagnoses, a trend that has become an epidemic.
This epidemic is a threat to your health. It has two distinct sources. One is the medicalization of everyday life. Most of us experience physical or emotional sensations we don’t like, and in the past, this was considered a part of life. Increasingly, however, such sensations are considered symptoms of disease.

Lack of understanding systems and understanding variation? To me this is a very similar idea to seeing everything as a special cause and addressing each problem with special cause thinking (find the one special cause). Instead, often (97+% according to Dr. Deming) the most effective improvement strategy is to examine the whole system (use common cause thinking). This view in itself, might be a sign that I have “Demingitis” – the propensity to see the excessive focus on special cause thinking everywhere I look.

It sure seems to me this tendency to “over-diagnois” leads to Tampering. Lets assign a special cause to some instance and then implement a counter-measure (it seems to be “take this drug” is a common one). And just as tampering in the management world the “solutions” then create all sorts of problems.

I might be trying to make too big a claim without taking the time to state it well. If this were an article, I would have to spend a great deal more time putting the ideas together much more effectively (and given my past history mean I never do it). But since it is my blog I can post it, as it is – I hope it is useful, if not, maybe some of the links here are useful. There are good things being done in healthcare but the room for improvement is huge, see: blog posts on healthcare improvement and articles on healthcare improvement.

For me, when I read:

But the real problem with the epidemic of diagnoses is that it leads to an epidemic of treatments. Not all treatments have important benefits, but almost all can have harms.

I just think: tampering!

Related: Going Lean in Health Care – Health Care Crisis – Control Chart – European Blackout (special cause solution v. common cause)

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