8 Policy and practice in the european countries regarding overdiagnosis and quaternary prevention

Objectices To get an overview on the policy and practice regarding overdiagnosis and related medical excess in our European countries. Secondly to analyse facilitating factors, barriers and possible actions taken on this matter such as avoidance of mitigation of harm from excessive or unnecessary health interventions. Background It is generally agreed that problems related to ‘too much medicine’, overdiagnosis and overtreatment are on the rise. Unwarranted medical activity leads to unnecessary waste of resources, more inequalities in healthcare and, at worst, direct harm to patients and healthy citizens. Examples include bacteria resistance from antibiotic overuse, over irradiation from excessive X-rays (over-investigation), complications from unnecessary procedures (overtreatment), mortality rise caused by polypharmacy and overtreatment at the intensive care units among terminal care patients. Therefore, health care stakeholders and others have taken initiatives to revert this evolution. Recently, the Nordic Countries and WONCA Europe, The World Organization of National Colleges and Academic bodies of family doctors in the European Region have agreed upon general position papers on this threat. Methods and learning issues Presentations on an evaluation of overdiagnosis and overtreatment in different European countries, followed by critical case reports from selected countries. Questions to be discussed: Is ‘too much medicine’ an important part of doctors’ salaries? Does governmental initiatives to minimize overdiagnosis and overtreatment threaten the quality of health care? Participants are invited to reflect on their own situation and challenged to indicate which actions can or cannot be taken.