Anna Stavdal - on the agenda!

When Anna Stavdal stood for election as WONCA President-elect, in Seoul, she focused on the importance of adapting the core values of family medicine to current trends. Here she reflects on this issue, overmedicalisation and a recent BMJ article.
I believe the issue of adapting core values is relevant globally, as family doctors are close observers of the effects of fragmented medical care following speedy increase of specialisation, fueled by technology and accessible diagnostics.

One of the consequences seems to be that the range of normality gets narrower at the same pace, and hence an increasing risk of over-medicalisation. Medical risk intervention is part of that picture, and has been a matter dear to my heart all throughout my career.

Language, in terms of definitions of disease and risk, plays a crucial role in how we perceive health and well-being and the messages we convey to our patients. During the International Preventing Overdiagnosis Conference 2018, in Denmark, a group of colleagues decided to take a closer look at disease definitions, and in April this year, they published a paper on this matter in the BMJ, and I am one of the authors.

In short, our message is that the human person can no longer be treated as an ever-expanding marketplace of diseases, benefitting professional and commercial interests, while bringing great harm to those unnecessarily diagnosed.

Our proposal calls for a new process to be led by family doctors or GPs, with strong engagement from civil society, and entirely free of ties to drug companies or other vested interests.

The 13 authors come from Europe, Latin America and Australia. The proposal arises from the Preventing Overdiagnosis conference, which is supported by the BMJ, and will this year take place in Sydney, December 5-7, co-sponsored by the World Health Organisation.

Our article is open access by following this link

The paper attracted attention among WONCA member organisations, - and one example, the reaction by RCGP, can be read here:. It also managed to stir up interest from the general media, such as in “Der Spiegel”, one of two the biggest weekly journals in Germany.

My hope is that the discussion on disease definition and the relation to the increasing overdiagnosis and overtreatment can spread in our organisation globally. As family doctors we have a specific responsibility to protect people against being treated as patients unnecessary. It is also a public health matter, as overdiagnosis steal resources from the sick, - which puts us at risk of contributing to increased inequality in health instead of the opposite.

Moynihan R, Brodersen J, Heath I, et al. Reforming disease definitions: a new primary care led, people-centred approach. BMJ Evidence-Based Medicine Published Online First: 08 April 2019. doi: 10.1136/bmjebm-2018-111148