Overdiagnosis harms patients — professor calls for Danish medical education overhaul

The University Post reported recently that medical students with the new University of Copenhagen (UCPH) curriculum as of autumn 2024 have sustainability on the syllabus.

However, according to Professor in General Practice John Brandt Brodersen, the new curriculum only scratches the surface of what he sees as the core problem: the massive waste of resources in the healthcare system.

He has for many years done research on the Too Much Medicine problem, which includes the concept of overdiagnosis — a trend where the healthcare system unnecessarily turns people into patients.

READ ALSO: Future doctors need to know about climate change

According to the professor, up to 40 per cent of all activities in the healthcare system are either wasteful or directly harmful to patients.

»The research is well-founded scientifically. But the field is underreported, underprioritised, and neglected. So now I am reaching out to the University Post to emphasize that this is critically important and something we should be teaching medical students,« says John Brandt Brodersen.

Tests that harm patients

In addition to being one of approximately 500 researchers worldwide working on the Too Much Medicine field and overdiagnosis, John Brandt Brodersen teaches general practice in the final semester of the Medicine master’s programme at UCPH.

He currently dedicates three lectures to teaching evidence-based diagnostics, screening, and overdiagnosis.

However, according to the professor, this is far from sufficient. Many medical students leave these lectures confused and frustrated because they are asked to completely rethink their understanding of what goes on in the healthcare system.

It is a difficult story to sell politically, and in society — as who would vote for someone proposing fewer tests and examinations in the healthcare system?

John Brandt Brodersen, professor, UCPH

»Teaching students about this would require far more hours. And when I introduce the topic, most find it strange that they have never encountered it in the five to six years they have studied medicine,« he says.

Overdiagnosis, according to the professor, also encompasses the concept of medicalization — the tendency in the Global North to view everyday problems through the optics of medicine.

He believes that 30 per cent of activities in the healthcare system are wasteful, while 10 per cent directly harm patients by subjecting them to tests and treatments they do not actually need.

John Brandt Brodersen describes this waste of resources as unnecessary tests, scans, blood samples, examinations, and treatments, some of which lead to diagnoses and overtreatment that may harm the patient.

This waste, he argues, can be curtailed if doctors work in an evidence-based manner, focusing on the patient rather than on potential diseases that they may or may not have.

Would you want to know if you had cancer?

But surely, the healthcare system tests people to ensure that serious diseases are not overlooked. Isn’t it risky to eliminate all ‘unnecessary’ testing?

»The risk is minimal, whereas the risk of harm increases with unnecessary testing. It is about adopting a completely different patient-centred approach. And this requires a fundamental shift in how we approach medicine. It is a difficult story to sell politically, and in society — as who would vote for someone proposing fewer tests and examinations in the healthcare system?« he asks, and offers a specific example of how overdiagnosis turns up in practice:

»In a recent cancer plan presented by Sophie Løhde of the Liberal Party, the narrative is that the survival rate for cancer patients has increased significantly over the past 20 years. But they overlook that a key reason for this increase in survival rate is that the number of cancer diagnoses has also increased,« he says, adding:

»There is a significant degree of overdiagnosis. And the survival rate for an overdiagnosed patient is, by definition, 100 per cent.«

So some people are diagnosed with cancer even though they don’t actually have it?

»No, but you can have cancer at a cellular level without ever developing symptoms or dying from it. Research suggests, for example, that nearly 50 per cent of men in our society are overdiagnosed with prostate cancer, while approximately 25 per cent of women are overdiagnosed with breast cancer.«

It is problematic that no Danish universities have incorporated this into their curriculum, despite research on the topic dating back to the 1990s.

John Brandt Brodersen, professor, UCPH

So you’re saying that for some people, it would have been better if their cancer had never been detected?

»Yes. If they had not been examined in the healthcare system, they would never have discovered or been told that they had cancer. If we test people extensively enough with various scans and analyses, we would overdiagnose them with many conditions.«

Most people would probably want to know if they have cancer—regardless of the cancer type’s risk of becoming fatal?

»Yes, this is a typical layperson perspective. And it is important to teach medical students that this is exactly what they will encounter from patients.«

Revolutionizing medical education

According to John Brandt Brodersen, medical programmes across Denmark should incorporate an evidence-based paradigm into both teaching methods and curriculum.

In other words, he is calling for a revolution in medical education.

»I find it problematic that no Danish universities have incorporated this into their curriculum, despite research on the topic dating back to the 1990s,« says the professor.

»There have been minor course adjustments here and there. But what I am advocating is a complete transformation of how we approach medical education. When we talk about resource waste and sustainability, we must also address the root causes of this waste. And there is no political will to do this.«

Despite attempts to push this agenda within various academic working groups at the Faculty of Health and Medical Sciences, Brodersen says his efforts have only led to »patchwork solutions.«

The current approach to medicine harms people, society, and the climate. Why are we not doing something about it?

John Brandt Brodersen, professor, UCPH

»The way we teach today is outdated. We scratch the surface but never get to the core problems. I don’t think we are fulfilling our primary mission as a university when we allow students to complete an entire medical degree without informing them about this,« he says.

And when the conversation turns to sustainability, the healthcare system and future doctors should take a critical look at their own field, John Brandt Brodersen argues.

»Of course, it’s important for future doctors to understand what new diseases will emerge due to climate change. But if we are to talk about sustainability, I believe we should also be teaching about the 40 per cent waste in the healthcare system,« he says.

What you are proposing sounds controversial?

»Perhaps in a Danish context, but other places in the world are ahead of us—for example, at University of Sydney in Australia or McMaster University in Canada. The current approach to medicine harms people, society, and the climate. Why are we not doing something about it?«

»We educate generalists«

Torben Lykke Sørensen, clinical professor and head of the Medical Studies programme, acknowledges that John Brandt Brodersen »raises some valid points« but does not see them as directly opposing the current medical curriculum.

»Right now, we have two courses in clinical decision-making — one at the bachelor’s level and one at the master’s level — which have been expanded as part of the new curriculum and specifically address some of the issues John (Brandt Brodersen, ed.) highlights,« says the programme director.

Is John Brandt Brodersen right in saying that the new curriculum only scratches the surface when it comes to sustainability?

»I believe we are doing more than just scratching the surface. But we must also remember that medical and health education is, in many ways, an introduction — we train generalists who specialise only after their studies,« he says.

»We all agree that we should treat patients as effectively as possible and allocate resources wisely. And, of course, we must do so while being mindful that excessive testing and examination can also harm patients.«