Too much of a good thing: Overtreatment in epilepsy

Abstract

Disagreements between clinicians and patients when considering treatment often arise because patient and practitioner differ as to what they believe constitutes overtreatment. In this paper, I focus on tensions that can arise between practitioner and patients with a particular illness: temporal lobe epilepsy. I argue that some ill patients with temporal lobe epilepsy may believe that maintaining their current condition is preferable to suppressing it. Consequently, they view what practitioners tend to see as the right amount of treatment (that which eliminates seizures) as excessive. I argue that in some cases, these patients' beliefs are justified, but that failure to acknowledge this on the part of practitioners may lead to overtreatment in a number of ways.

Treating real people: Science and humanity

“…With their focus on person‐centred approaches, both Mäkelä's paper and the contribution that follows it, by Saloni de Souza, very much resonate with the contributions to the following section of the edition, on “rethinking disease”. While (on some definitions, at least) it is tautological that illness is bad for us, de Souza notes that, in the context of the lives of specific persons, conditions typically classed as illnesses may indeed be preferable to health.…”

“…We are delighted to report that, in the year following these comments, we have received a vast amount of correspondence and submissions from some of the most insightful and influential commentators in health research and practice, taking this “great debate” forward in just the way we had hoped. This thematic edition of the Journal of Evaluation in Clinical Practice (the largest single edition of the JECP in its 24‐year history) includes over 50 papers, reviews, and reports of conferences that reflect the attention being given across the board—by practitioners, guideline developers, systematic reviewers, and philosophers—to the relationship between evidence, science, context, bias, truth, value, and methodology, with the quintessentially pragmatic goal to develop accounts of these concepts to assist decision‐making in practice. It includes specific sections consisting of papers delivered to major conferences on diagnostic categories (focussing on both their limitations and their overuse), clinical guidelines, and mechanisms in medicine .…”