Purpose: Reducing the prevalence of overdiagnosis and overtreatment has become a priority in light of rising healthcare costs. As one clinical example, otherwise healthy infants with excessive regurgitation and crying are often treated for Gastroesophageal Reflex Disease (GERD), even though symptoms usually resolve spontaneously and medications are no more effective than placebo. In light of these facts, it is unclear why the treatment of GERD persists. In the present research, we examined whether overtreatment persists in part because the physician’s assessment of the symptoms—in particular, use of the diagnostic label “GERD”— increases parents’ perceived need for medical interventions.
Method: 275 parents in the waiting room of a general pediatrics clinic were asked to read a scenario that described an infant who cried and spit up excessively. In the scenario, the infant either received a diagnosis of GERD, or the doctor referred to the symptoms as “this problem” with no mention of a formal diagnosis. Additionally, half of parents were told that existing medications are ineffective at treating symptoms, and the rest were given no effectiveness information. This resulted in a 2 (GERD diagnosis: present vs. absent) X 2 (Medicine ineffectiveness: present vs. absent) design. Outcome measures included parent interest in using medication, and beliefs about whether the infant would get better without medication.
Result: When parents received no GERD diagnosis, they were interested in using medications when they assumed that the medications were effective (M=2.45; scale=0-4), but were less interested when told that medications were not effective (M=1.42; F(1,86)=12.61, p=.001). By contrast, parents who received a GERD diagnosis were interested in using medications regardless of whether they were explicitly told that those medications were ineffective (M=2.55), or not (M=2.46; p=.70). Moreover, all parents were told that their infant would get better without medications, but parents were less likely to believe this when they were given a diagnosis (M=3.02) compared to when there was no diagnosis (M=3.48; F(1,171)=3.95, p<.05).
Conclusion: Labeling an otherwise normal infant as having a “disease” increased parents’ interest in medicating their infant, and led parents to believe that medication was necessary regardless of stated treatment effectiveness. These findings suggest that doctors may inadvertently perpetuate the use of needless medical interventions by using diagnostic labels that increase demand for treatment.