GPs take the initiative
Norwegian GPs were among the first to point out the increasing attention paid by modern western medicine to the risk of future disease. As far back as the 1980s, Jostein Holmen put fundamental questions regarding the treatment of blood pressure on the agenda in his doctoral thesis (7), and introduced the concept of «the medical-industrial complex» into Norwegian debate (8). The Norwegian College of General Practitioners, NSAM as it was then called, developed a project of which the topic was the identification and treatment of risk factors in healthy patients. It resulted in the book Diagnose: Risiko [Diagnosis: Risk] in 2000 (9). The academic community of general practice in Trondheim in particular has since published a series of research articles on the topic (10). In 2011, the Norwegian College of General Practice (NFA) published a position paper on preventive health work (11), which has attracted international attention.
The involvement of GPs is not coincidental. They work closely with the general population – at the nexus between science and society, and between disease and normality. While they need to identify and treat disease as early as possible, they also observe how increasing medicalisation underlies problematic tendencies in the population, among politicians and in the medical community. Overdiagnosis is one of these tendencies.
As part of a targeted effort to inspire reflection in the medical community on overdiagnosis, in January 2015 the Norwegian College of General Practice established a reference group. One need that was identified was to summarise arguments that our colleagues can use when faced with requests from patients as well as politicians and the media for services whose benefits are questionable.
The issue is a complex one, and GPs themselves are responsible for significant medical overactivity. However, this in itself is the best argument in favour of working further to achieve clear, well-justified and, as far as possible, unified viewpoints. In the current work programme (12), the Norwegian College of General Practice has decided to develop and promote the position paper on overdiagnosis and related overactivity in collaboration with the reference group, to collaborate with other medical communities and to contribute to the Norwegian Medical Association’s work on this topic.
The position paper was adopted at the board meeting of the Norwegian College of General Practice in April 2016 and presented at the College’s general assembly in May 2016. A draft was presented and discussed at the conference Preventing Overdiagnosis in Washington D.C. in autumn 2015 and in June 2016 at the WONCA Europe Conference in Copenhagen. The document has been translated into English, and at the Nordic leaders’ meeting in Helsinki in August of this year, all the Nordic Colleges of General Practice and general practitioner associations adopted it as the relevant strategy in this area.