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February 1989

DICE: Nonclinical Causes of Overtreatment

Author Affiliations

Department of Pediatrics The Mary Imogene Bassett Hospital Cooperstown, NY 13326-1394

Am J Dis Child. 1989;143(2):142. doi:10.1001/archpedi.1989.02150140024012

Sir.—A vague clinical concept led to the medical odyssey described by Dr Stickler in the September 1988 issue of AJDC.1 However, when there is overtreatment, professional competition and overspecialization are frequent synergists. The acronym "DICE," which is described below, helps explain the pathogenesis of overtreatment.

Diffused responsibility.—Each physician's sense of responsibility for therapeutic catastrophe declines in proportion to the number of consultants on a case. This is true all along the pecking order, from the primary physician who first asks for help to the surgeon who promises to cure.

Inexperience.—Clinicians tolerate wider deviations from normal as their experience increases. Clinicians with the least experience are most likely to be anxious about the need for treatment. An important element of inexperience is lack of familiarity with the child and the family.

Cookbook thinking.—Children whose growth is more than 2 SDs below the mean are abnormal.

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