Dediagnosing- making people less ill with Prof. Bjørn Hofmann and Dr Marianne Lea

The Words Matter Podcast with Oliver Thomson

Welcome to another episode of The Words Matter Podcast.

Once again, a huge thank you to those you that support the show via Patreon – every pledge helps, so a big warm thank you.

The response to the recent episodes and the qualitative research series has been immense – it seems like the podcast is rippling through the lives of more and more people.

I think we’re approaching 60,000 downloads since the podcast started 18 months ago or so. Coming up on the podcast I have series on clinical reasoning and critical physiotherapy, plus more AMAs (see previous AMAs here, here and here).

So on this episode I’m speaking with Dr Marianne Lea and Prof Bjørn Hofmann about their recent paper Dediagnosing – a novel framework for making people less ill (see paper here).

Marianne holds a Postdoc position in clinical pharmacy at the University of Oslo. She obtain her PhD in clinical pharmacy in 2019 and her research focuses mainly on multimorbid patients and how we can optimize the health care provided to them.

She also works as at the Hospital Pharmacies Enterprise, South-Eastern Norway and has over ten years of experience as a clinical pharmacist in the hospital setting, conducting tasks like medicine reconciliation, medicine reviews and deprescribing.

Bjørn is a scholar in philosophy of medicine and bioethics with a special interest in the relationship between epistemology and ethics. He is affiliated with the Department of Health Science at the Norwegian University of Science and Technology (NTNU) and the Centre for Medical Ethics at the University of Oslo. Bjørn originally trained in the natural sciences (electrical engineering and biomedical technology) and is now interested history of ideas, and philosophy.

His main fields of interests are basic concepts for health care including disease, causality, (over)diagnosis, medicalization and severity. He’s also interested in the norms of knowledge including knowledge generation, evidence production, norms of science and forms of rationality. See more about Bjørn on Wikipedia here.

So in this episode we speak about:

• What a diagnosis is, both from a social constructionist view but also the biological components which seek to categorise such diagnostic labels.
• The primary role that diagnoses and the process of diagnosis plays in healthcare and how they structure healthcare systems, economics and clinical specialisms.
• Bjørn and Marianne outline the problem of too much medicine and too much diagnosing.
• The process of de-diagnosis- That is, the removal of diagnoses that do not contribute to reducing the person’s suffering.
• Diagnostic creep and expansion and about the increase in diagnosis and disease screening.
• The powerful implications of a diagnosis including stigmatization, discrimination and guilt.
• The psycho-behavioural effects of embodying or living with a diagnosis plus the socialisation of it which can remain imprinted on the person.
• The positive and negative consequences of a diagnosis.
• And finally we talk about the relationship between de-prescribing and de-diagnosing.

So this was such a fun conversation – it drew together so many great topics which I’ve covered on the podcast. Many of us have a Spidey sense of the problem of overdiagnosis but we may unable to structure a solution to it – well fortunately Marianne and Bjørn have offered a compelling way to start to undo the harms of overdiagnosis.

As you’ll hear Bjørn offered to come back on the show and dive even deeper into the topics of medicalisation and overdiagnosis, to which I bit his hand off – so stay tuned.

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