5 The difficult art of un-doing

Abstract

The evidence for overdiagnosis and overtreatment within medicine is growing: across disciplines and across the globe. Clinicians and their patients must now face the challenge of integrating this new knowledge into the realities of their everyday practice and the numerous decisions about investigation, labelling and treatment that have to be taken. While patients seek more involvement and more balanced information, professionals too often struggle with lack of confidence and lack of political and legal support in proceeding slowly and carefully. While winding back the harms of too much medicine is a noble cause, the very real fear of making mistakes continues to push doctors, and perhaps especially younger colleagues, towards acting precipitately and unthinkingly. This symposium will offer a theoretical framework for the ‘de-implementation’ of both screening and treatments that cause harm or do not improve outcomes for patients. We will present new thinking and a new vocabulary for a new practice. We will then describe clinical examples from everyday general practice to demonstrate how new knowledge on overdiagnosis/overtreatment can be integrated within shared decision-making in the consultation. Finally there will be an interactive role play on overdiagnosis/overtreatment, based on experiences from teaching and training medical students at the University of Trondheim, Norway. Objectives The symposium will offer a theoretical framework and demonstrate practical clinical examples for the ‘de-implementation’ of diagnostic processes and treatments that cause harm or do not improve outcomes for patients. Method In the symposium the presenters will share new thinking and a new vocabulary for a new practice. We will then describe clinical examples from everyday general practice to demonstrate how new knowledge on overdiagnosis/overtreatment can be integrated within shared decision-making in the consultation. Finally there will be an interactive role play on overdiagnosis/overtreatment, based on experiences from teaching and training medical students. Results Interactive session aimed at sharing theoretical reflections and clinical GP experience from. Conclusions Interactive session aimed at sharing theoretical reflections and clinical GP experience.