#616: More Testing, Better Health? Harms of Overdiagnosis & Overtreatment - Austin Baraki, MD

Medical screening is often framed as an uncomplicated good: if disease is found earlier, treatment can begin earlier and outcomes should improve.

This episode examines why that reasoning is incomplete. Screening can produce benefit, but it can also generate false positives, incidental findings, overdiagnosis, overtreatment and diagnostic cascades.

Dr. Austin Baraki discusses the distinction between screening people without relevant symptoms and investigating a clinical problem, the probabilistic interpretation of test results, biases that can make screening appear more effective than it is, and the importance of shared decision-making before a test is ordered.

Timestamps:

• [03:35] What screening means
• [06:36] Choosing what to screen
• [11:59] Sensitivity and specificity
• [16:54] Predictive value and prevalence
• [22:16] Harms of screening and testing
• [31:02] Overdiagnosis and biases
• [41:40] The $50,000 physical
• [44:49] Overdiagnosis vs false positives
• [53:03] Overtreatment and surveillance
• [57:22] Clinician action bias
• [01:02:30] What to screen for

Links:

• Go to episode page (with resources)
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• Instagram: @austin_barbellmedicine
• Twitter: @AustinBaraki