RESUMO
The improvement of our investigative and diagnostic capability allows us to recognize early stage or mostly stable diseases in asymptomatic individuals and to treat those patients based on research conducted on more severe and acute conditions. Our main concern is avoiding not to treat a patient because of a missed diagnosis, so that we can avoid regrets and legal troubles. Usually, we do not take into account the opposite risk: overtreatment induced by overdiagnosis. For example, the increased number of diagnoses of pulmonary embolism did not reduce the incidence of death, but increased the number of bleeding from subsequent anticoagulation therapy. Similarly, the widespread detection of troponin increased the number of diagnoses of myocardial infarction solely on the basis of Lab values. In both cases we apply therapeutic strategies that have been proven effective in patients with more advanced and unstable clinical presentations with the risk of doing more harm than benefit. To be reassured by doing more, we risk to do worse.
