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Monthly Archives: May 2015

The downside to getting what you want

Many of you know from my blog or knowing me personally that I’m very much opposed to unnecessary medical testing and treatments. While at times unavoidable, I do my best to practice clinical medicine and use testing only when necessary. I try not order tests “just to be safe” or to “lets see what it may show”. I usually recommend against back and knee x-rays, especially when there is no blunt trauma, as they tend to reveal no valuable information for the diagnosis. Even when testing is necessary, there are ways to eliminate unnecessary tests such as ordering only a Lipase for suspected pancreatitis, avoiding unnecessary CT scans for abdominal pains clearly due to viral etiologies. Granted there are times when it is unavoidable such as when a patient’s exam is still concerning for an acute event like an appendicitis but their labs are normal. Despite those times, developing good clinical skills, one can still decrease the use unnecessary testing.

Why is that important. Again, while I have written to this notion prior, I think the author of this New Yorker article does a much better job of the reasons and sometimes dangers of inappropriate testing and treatments. He rightly notes that inappropriate testing can be both dangerous and delay/ignore the correct evaluation and treatment of a condition. My one critique of the article is that he mentions the concept of patient satisfaction but does not go into how it relates to unnecessary testing or it’s lack of correlation to patient outcomes. Overall though, this is a good read.

http://www.newyorker.com/magazine/2015/05/11/overkill-atul-gawande

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