[Sometimes less is more. Preventing overdiagnosis by sharing decisions]. / Moins, c'est parfois mieux . Prévenir le surdiagnostic en partageant les décisions.

In this article, we will define «quaternary prevention¼, which consists in minimizing the iatrogenic effects of medical interventions, and more specifically the notion of «overdiagnosis¼. We will then discuss how a poor appreciation of the risks, on the part of both patients and clinicians, seems to fuel the phenomenon. We will discuss the interest of placing quaternary prevention within the broader framework of Shared Decision Making. We will focus on one of the stages of Shared Decision Making process, that of risk communication. Finally, we'll conclude that, fundamentally, clinicians should not only share information with patients, but also the power to decide.

Dans cet article, nous définirons la «prévention quaternaire¼, qui consiste à minimiser les effets iatrogènes de nos interventions et plus particulièrement de la notion de «surdiagnostic¼. Ensuite, nous discuterons en quoi une mauvaise appréciation des risques, chez les patients comme chez les thérapeutes, semble nourrir le phénomène. Nous discuterons de l'intérêt de replacer la prévention quaternaire dans le cadre plus large de la prise de décision médicale partagée (DMP) («Shared Decision Making¼). Nous nous attarderons sur une des étapes du processus de prise de DMP, celle de la communication des risques. Enfin nous conclurons que, fondamentalement, il s'agit pour les thérapeutes de non seulement partager l'information avec les patients, mais aussi le pouvoir de décider.

Is Myocardial Infarction Overdiagnosed?

This Viewpoint examines whether overdiagnosis rather than underdiagnosis may now be the dominant form of myocardial infarction misdiagnosis.

Posttreatment Lyme Disease Syndrome-What It Might Be and What It Is Not.

Lyme disease is a multisystem disease caused by Borrelia burgdorferi infection and accounts for well-defined manifestations, appearing either at an early or late stage. Appropriate antibiotic therapy generally leads to a favorable outcome. Still, unspecific persisting symptoms such as fatigue, myalgia, arthralgia or cognitive dysfunction are reported by several patients months to years after adequate treatment. Their underlying pathophysiologic mechanism is unclear. However, there is no evidence for microbiological persistence in these cases and attempts to resolve the symptoms by repeated or prolonged antibiotic treatment have not been convincingly successful, but they may rather be harmful. To narrow down the controversially handled entity of posttreatment Lyme disease syndrome (PTLDS) and to avoid overdiagnosis and overtreatment, case definitions have been proposed, acknowledging PTLDS as a complex of nonspecific, subjective symptoms, which are neither caused by ongoing infection nor by any other identifiable disease. PTLDS is mainly a diagnosis of exclusion and requires careful evaluation of differential diagnosis followed by counseling about optimal management in light of missing specific therapeutic options.