[The physician and the collector of diagnoses]

In the course of the medical curriculum, medical students are trained to recognise diagnoses. They classify these in their minds, together with detailed information on laboratory and imaging tests, as collections of diagnoses. The downside of this could be overdiagnosis. This paper describes some of the faces of overdiagnosis. American writer and physician Abraham Verghese eloquently describes one of these: the e-doctor looking at a computer screen to see what is wrong with the patient, rather than starting with a thorough clinical bedside evaluation. Other examples include the finding of small sub-segmental pulmonary emboli by increasingly sensitive spiral CT scanning. Finally, this paper describes a possible answer to overdiagnosis: prognostic research, notably answering questions such as 'what additional diagnostic testing will truly improve my patient's prognosis, given their current presentation of signs and symptoms?'