Widening Disease Definitions: What Can Physicians Do?

Citation metadata

Date: Feb. 1, 2021
From: American Family Physician(Vol. 103, Issue 3)
Publisher: American Academy of Family Physicians
Document Type: Article
Length: 1,349 words
Lexile Measure: 1730L

Document controls

Main content

Article Preview :

Disease definitions are often broadened over time to include milder and earlier cases. (1) A strong driver for such definitional changes is the belief that they will benefit patients by preventing more severe disease or future complications. Family physicians must ensure that these claims are rigorously evaluated to show clinically meaningful reductions in morbidity and mortality and that the potential harms of widening disease definitions are not ignored. Table 1 includes examples of widened disease definitions. (2-6)

Why Are Widening Disease Definitions a Problem?

Widening disease definitions cause harm by exposing more patients to the adverse effects of treatments, triggering investigation and prescribing cascades, increasing anxiety, and placing a financial burden on patients and the wider society.

Advocates for widening definitions, including authors of guidelines, often argue that the diagnosis and treatment of earlier and milder disease will result in better health outcomes for patients. They assume that evidence of benefits in more severe cases applies (or is even greater) in patients with milder or earlier disease, when in fact benefits are likely to be smaller or nonexistent. Examples include claims that increased detection of nonalcoholic fatty liver disease will reduce future incidence of cirrhosis or that diagnosing a patient with hypertension will lead to improvements in diet and physical activity that prevent cardiovascular events. At the same time, potential physical and psychological harms of diagnosis and treatment are often underestimated or not evaluated. (1)

Much of the burden of managing these millions of new cases of disease falls to primary care clinicians. There is a substantial opportunity cost, diverting attention and resources away from patients who would benefit most. What appear to be small changes to disease definitions cause large changes in disease prevalence and create a demand for unproven, ineffective preemptive services. This contributes to the increasing number of tasks a family physician is expected to perform, such that a physician would need to work more than 13 hours a day to provide care for 1,500 patients. (7) As Margaret McCartney states in The Patient...

Source Citation

Source Citation   

Gale Document Number: GALE|A648962578