Preventing what?

My father was a master diagnostician who had an uncanny knack – honed over many years of personally examining and interviewing patients – of making the correct diagnosis of a patient's medical problem without the assistance of expensive and often time-consuming tests. However, my father's way is not the preferred method of modern preventative care, which often tethers patients to their doctors with a dizzying array of tests. Dr. H. Gilbert Welch and his colleagues at the Dartmouth School of Medicine aren't convinced that the modern way is better than my father's approach. This Abigal Zuger, MD/NY Times review of Dr. Welch's new book – Over-diagnosed: Making People Sick in the Pursuit of Health (Beacon Press January 18, 2011) — sums up the core issue well: As the world is currently configured, the authors point out, doctors are never punished for over-diagnosis, no matter how much havoc may be wrought by untrammeled over-testing. It is perceived under-diagnosis that arouses legal and moral wrath. Is that the way it should be? An intriguing question, indeed!

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