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June 1991

Let's Not Overmedicalize-Reply

Author Affiliations

Boston, Mass

Arch Intern Med. 1991;151(6):1238. doi:10.1001/archinte.1991.00400060144038

In Reply. —  The great majority of "minor illness symptoms" are transient and prove to be inconsequential. The problem, of course, for both the patient and the doctor, is knowing where to draw the line. When are dizziness, headache, fatigue, and a sore throat just "minor vicissitudes," and not Meniere's disease, a brain tumor, hypothyroidism, or a prelude to preventable rheumatic heart disease? Should chest pain and abdominal pain ever be treated as "minor vicissitudes," even though they usually are? Each of us has our own styles in trying to seprarate the wheat from the chaff, but do we know how much overdiagnosis and underdiagnosis we are guilty of? Do we even have the data that would allow us to answer that question?Then, too, as highlighted by Kroenke et al,1 some minor illness symptoms, whatever their basis, are not transient. They are chronic, recurring symptoms that impair a patient's function, sometimes

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