The inverted U curve and emergency medicine: Overdiagnosis and the law of unintended consequences

Abstract

We all think and assume that more is better, but unintended consequences can arise in a complex system. However, in our complex world, everything of consequence follows an inverted U curve. The inverted U curve helps us challenge our natural assumption that more is better. This leads us to the issue of overdiagnosis and the harms that result. Journals are now publishing lists of studies where more medical care caused harm. Changing diagnostic thresholds together with the fear of uncertainty by both patients and doctors has a synergistic and costly effect on the health system. The over-reliance on technology tends to supplant clinical judgement. This intervention bias promotes the overutilisation of diagnostic testing. What patients actually value is thinking doctors who talk to them. Promoting clinical judgement reinforces the mantra that less is more, resulting in positively intended consequences. This essay aims to be a thought-provoking commentary of our practice.