“Millions of Americans get tests, drugs, and operations
that won’t make them better, may cause harm, and cost billions.”
Illustration by Anna Parini for The New Yorker
The article “Overkill” by The New Yorker is a little long but well worth reading with feet up by the fire.
The core issues are what to do with the growing mound of false positives and how much care is too much. The medical world keeps adding new screens which unearth heaps of real pathology, along with many many “incidentalomas.” These are abnormalities that would likely be fine if left alone… or not.
Watchful waiting is just not very easy. Patients hate the sense of carrying around time bombs and doctors are terrified of missing anything. I don’t even like when my dentist sees a shadow on my dental X-rays. Imagine someone saying “that spot on your chest X-ray is probably fine, but could be cancer. Let’s just follow it.” … “Heck no! Irradiate me with your latest, greatest, most expensive CT today!”
Incidental findings cause massive anxiety amongst patients and doctors alike. So very often these are rescanned, biopsied or removed just so everyone can rest… never mind the added radiation, pain, danger, expense.
I don’t have the answer. But my mantra before any test is this: “If the test turns up positive, will we do anything different? If not, no test.” Easier said than done.