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Mrs. B's Story: How Excessive Testing Can Do More Harm Than Good

Posted By Administration, Wednesday, August 31, 2016
Updated: Wednesday, August 31, 2016

When it comes to medical procedures, always do your homework and speak honestly with your doctor about any concerns you have. 

by Michael Kelleher, MD


There are many medical situations where more care and more testing does not translate to better care. The American Board of Internal Medicine (ABIM) and its partners, through the Choosing Wisely campaign, have compiled lists of tests and procedures that should be carefully considered.


Let’s take a look at how excessive testing and procedures can do more harm than good. This is the case of a real patient. We’ll call her “Mrs. B.”


Physicians often perform tests

of marginal value because of
patient demands.

Mrs. B’s Multiple Procedures

Mrs. B had been experiencing upper abdominal pain after meals. Her ultrasound test revealed gallstones were the cause. One of her liver tests, a gamma-glutamyl transpeptidase (GGTP), was also mildly abnormal, so her husband, who had been a critical care nurse, pressed the gastroenterologist to proceed with more testing. Her husband wanted to exclude the possibility of her bile duct being blocked by a gallstone.


The physician performed an endoscopy test called an ERCP as a prelude to surgery. That ERCP test revealed no abnormality, but within an hour after the procedure, Mrs. B begin having severe abdominal pain and very low blood pressure. Her daughter alerted the nursing staff, and Mrs. B was rushed to the operating room for repair of a ruptured loop of bowel, a known complication of ERCP, which extended her recovery by three months and caused several postoperative infections.


What Went Wrong?


First, the ERCP test was not necessary in this case. It caused a serious complication, which was preventable. The mildly elevated GGTP test by itself did not suggest blockage of the bile duct with a stone, and is not recognized by experts as an indication for ERCP testing.


Secondly, physicians often perform tests of marginal value because of patient demands, to reduce their perceived risk of a malpractice lawsuit. Neither patient nor physician are well-served by such misguided testing.


Finally, over-testing can have negative results for patients. Screening tests for healthy patients represent a special challenge for shared decision-making. It is imperative for clinicians to make sure that patients have a thorough understanding of the risks, benefits, and limitations of such testing.


Low-Value Testing

Consumer Reports has worked with the Choosing Wisely campaign to create patient-friendly summaries of more than 50 medical tests and procedures that are of low value. Before agreeing to treatment, patients can look through evidence-based information on what may or may not be appropriate. There’s a wealth of information on procedures from colonoscopies to Lyme disease tests.


The campaign is meant to empower patients to start a conversation with medical staff regarding which treatments are appropriate or necessary. When it comes to medical procedures, always do your homework and speak honestly with your doctor about any concerns you have. 


This post was adapted with permission from Avoidable Medical Mishaps: A Patient Guide.


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Michael Kelleher, MD, past member of the Massachusetts Medical Society's Quality of Medical Practice Committee, has 34 years of experience as a physician and medical executive responsible for patient safety and quality of care in large group practices.




Tags:  overtreatment 

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