Oral Presentation Australian Podiatry Conference 2019

Overdiagnosis and overtreatment of musculoskeletal conditions in Australia and implications for podiatric practice  (#37)

Rachelle Buchbinder 1
  1. Monash Department of Clinical Epidemiology, Cabrini Institute, Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia

While early detection and treatment of disease brings benefits for many, there is increasing evidence of unnecessary testing and treatment, harming patients and diverting scarce resources from where they’re most needed. Overtesting and overtreatment is driven by many factors including clinician concern about missing diagnoses, increasingly sophisticated diagnostic tests which detect smaller and smaller abnormalities of uncertain prognosis, and screening programs that save lives but can also detect disease that won’t progress to cause harm. This leads to unnecessary treatment which can result in complications and harm to patients.

There are many examples of overtesting, overdiagnosis and overtreatment of musculoskeletal conditions. For example, an MRI of the knee will show some abnormality in 84% of people over the age of 50 years who have knee pain, and in 20% it will show meniscal damage. However these changes are equally as common in people without knee pain. Failing to take account of the prevalence of these abnormalities in the asymptomatic population can result in needless worry for the patient, and unnecessary treatments like arthroscopy.  This cascade of unnecessary tests and treatments harms the patient and places a financial burden both on the individual and the health service.

This talk will provide examples of overdiagnosis and overtreatment relevant to podiatric practice in Australia and present some of the work of Wiser Healthcare, an Australian research collaboration that is investigating the cause and size of the problem and testing new solutions.