ARIA Spotlight: Denis Chmoulevitch

Denis Chmoulevitch's ARIA project: Drivers and solutions for “too much medicine” in mental healthcare: a cross-sectional study

The past summer, the work I have been doing at the Lady Davis Institute has been supported by a generous donation from Mr. Harry Samuel. I have looked into the issue of “too much medicine” in mental health. The concept of too much medicine has been used to describe excessive and unnecessary health care that brings little or no benefit to patients. We have identified 4 mechanisms by which too much medicine arises in mental health: (1) Overdiagnosis occurs when a patient receives a properly applied diagnosis but cannot benefit from it because it medicalizes ordinary life experiences not amenable to improvement through medical intervention. (2) Misdiagnosis refers to the application of a diagnosis when standard diagnostic criteria are not met which can result in an individual receiving treatment for a disorder they do not have. (3) Overtreatment refers to treatment that is offered after a correct diagnosis even though the best evidence available suggests that it is not effective for the diagnosed condition. (4) Overutilization, in the context of mental health, refers to the exclusive reliance on pharmaceutical treatments when alternative treatments exist and may be similarly effective with less adverse effects but are not considered. Importantly, overdiagnosis and too much medicine, more broadly, coexist in health care settings with underdiagnosis and where many patients have difficulty accessing the health care they need. Too much medicine, however, can lead to anxiety and unnecessary harms from testing and treatment, inefficient use of scarce health care resources, and reduced trust in health care practitioners. To address these issues, we performed a systematic review of the literature and identified possible drivers and solutions.

I first approached the ARIA office out of curiosity. I wanted to obtain some experience during the summer doing research and I had an opportunity to join Dr. Brett Thombs at the Lady Davis Institute to work on a fascinating project. To have the opportunity to dedicate most of my summer time to learning without having to worry about paying amenities was a great privilege not available to all. My objectives were to familiarize myself with the in-depth approach necessary for a qualitative meta-analysis. Working effectively as a group on a long-term project would let me acquire experience directly applicable in most collaborative endeavors. Seeing our project come to fruition as a full picture began to emerge was incredibly satisfying and rewarding. Many minute-details came to form a whole greater than its parts as we built the framework for all the possible reasons that can lead to too much medicine. It felt like creating order out of chaos. The most difficult challenge, given that this was a qualitative analysis, was in the subjective interpretation of the data we extracted. We addressed this by parsing what could be considered a cause from what would be a consequence of too much medicine. This was still surprisingly difficult as the first cause might have causes itself, like Russian nesting dolls. A dialectal approach was necessary to resolve disagreements between raters.

Having had this opportunity to be tutored over the summer by a great team has certainly given me the tools and the confidence to work on difficult projects. I feel like I can build on this experience to develop myself as a researcher, but more importantly as an individual contributing to a better understanding of healthcare and its shortcomings, while still appreciating everything it has achieved. Time and time again, I have been reminded to take a more nuanced approach to criticism and research. To be given this kind of break as a researcher speaks about the values that the ARIA project promotes. This would not be possible without the generosity of donors that trust that their contribution will provide learning opportunities and lead to a better, more informed society. I would like to convey my deepest appreciation to Mr. Harry Samuel for his trust and hope to one day be able to do the same for a budding young researcher.

Back to top