DEDIAGNOSING: Fighting Medicalization and Polypharmacy

It was when I read James Maskell’s The Evolution of Medicine that I became interested in Functional Medicine. Since then, I have loosely followed what is going on in the Functional Forum. Today, checking email while resting with the dogs midday, I saw a word I had never heard, read or used, but it resonates with things I have written, like Aren't We All on the Spectrum of Disease and Medicalization and Demedicalization in US Healthcare.

The new word I learned was DEDIAGNOSING. It appears in an article first published online 2021 in the European Journal of Internal Medicine. (In spite of this being an Elsevier publication, this article is free!)

Here is the Abstract:

Diagnosing constitutes a substantial part of healthcare work and triggers a wide range of actions including the prescription of medicines. Dediagnosing is proposed as a novel framework for removing diagnoses that do not contribute to the reduction of persons’ suffering and should be introduced to make people less ill. Dediagnosing comes together with other efforts to reduce overuse, such as deimplementation, deprescribing, decommissioning, and disinvestment. Because diagnoses may influence identity construction and social rights, dediagnosing must be conducted in close collaboration with the patient.

The authors are Norwegian, and we Scandinavians tend to be a bit more pragmatic than Americans and we tend to consider the greater good of society a bit more when we think about and discuss healthcare. Here is their list of negative consequences of overdiagnosing:

Maybe their list of 10 reasons to dediagnose doesn’t sit well with everyone, but I think we always need to consider that making a diagnosis can cause psychological harm in some cases and medical harm in cases when we decide to prescribe. Their first reason to dediagnose is The condition is an ordinary life phenomenon that does not benefit persons in making it a diagnosis and their last one is The condition is due to ordinary aging processes.

I highly recommend reading the original article:

Dediagnosing – a novel framework for making people less ill - ScienceDirect

https://www.sciencedirect.com/science/article/pii/S0953620521002612