Dec 28th 2016

When Does Medical Testing Become Unnecessary or Even Harmful?

Recently, well-known bioethicist Arthur Caplan and his fellow researcher, radiologist Dr. Stella Kang, raised an important question: Does the growing tendency to offer more and more medical tests inadvertently harm some patients?

“How can radiologists fulfill the ethical obligation to support patient interests when very low-risk incidental findings concern patients for different reasons and lead to excessive resource utilization?" wrote Kang, Caplan and other researchers from NYU Langone Medical Center in the Journal of the American College of Radiology. 

They were referring to the incidence of diagnostic testing that uncovers unrelated or incidental findings that might have otherwise gone undetected—and untreated. In many cases, the result of one test is another test… and another test. And another one. A cascade of diagnostic tests can lead to treatment that might be, at best, unnecessary or, at worst, harmful. These tests and treatments can also be costly for the entire healthcare system. 

“A similar analogy is lots of people take their car to get just an oil change, but they come away with a long list of recommended repairs that may or may not be needed," says Caleb Hemmer, solution lead for radiology and cardiology at eviCore healthcare. 

It's much easier, however, to brush off the suggestion to buy a new set of windshield wipers or replace the air filter than for a person to ignore the results of a test that their physician ordered, rightly or wrongly.

The study by the NYU researchers, Hemmer notes, for example, found that incidental findings can and do lead to both unnecessary treatment and anxiety for patients. 

And doctors know it's a problem. A 2014 study conducted by the ABIM Foundation and funded by the Robert Wood Johnson Foundation found that nearly three out of four physicians were concerned by how often doctors order unnecessary tests or procedures. 

But how do healthcare providers know which direction to take? Do they err on the side of caution—and if so, which side is that? It's critical to strike the right balance. Healthcare providers must rely on evidence-based medicine to guide them down the right path.

eviCore's evidence-based clinical guidelines are designed to help healthcare providers weigh the risks and benefits of medical testing. They're free and easily accessible, and they were created with information from respected national medical organizations such as the American College of Physicians and the American College of Cardiology.

The categories include:

  • Cardiology
  • Radiology
  • Medical Oncology
  • Musculoskeletal
  • Post-Acute Care
  • Lab Management
  • Sleep
  • Radiation Therapy
  • Specialty Drug Management.

When used appropriately, eviCore's clinical guidelines minimize the negative impact of patients getting unnecessary tests or treatments that may themselves cause harm, or lead to additional tests or treatments that do not improve the patients' care. Hemmer says: “We help providers know what is appropriate, and give peace of mind to patients that they are getting the right clinical test of procedure."