Trapped in the Medical Labyrinth
I am astonished at the diagnostic accuracy of today’s radiologic technology. CAT scanners today, for example, can detect lesions that were invisible 5 or 10 years ago. As a gastroenterologist, I am routinely referred patients with subtle abnormalities seen in their livers, pancreases and digestive tract. Indeed, every medical specialty has been similarly affected. Pulmonary specialists see patients with tiny lung nodules that would not have been seen with older technology. Oncologists see patients with borderline abnormalities that can only be detected with the latest generation of scanners.
Shouldn’t we celebrate this futuristic diagnostic accuracy? I’m not so sure. I believe that these phenomenal technologies harm many more patients than they save. Follow my reasoning.
Most of the abnormalities that scans detect today are innocent lesions that will never make a patient sick. Our internal organs are not smooth and perfect. New scanners reveal ‘abnormalities’ inside our bodies with their incredible resolution. Healthy people are told every day about internal irregularities, which doctors will then pursue. CAT scan abnormalities create an undertow that drags patients into medical deep waters. Consider a hypothetical example that happens every day in every city in America.
A concerned patient comes to the emergency room with chest pain. The ER physician properly considers a diagnosis of a pulmonary embolus, or a blood clot in the lungs, and orders a CAT scan. No clot is found and the patient’s symptom resolves. However, the radiologist reports a tiny nodule in the right lung and states in writing that malignancy cannot be excluded.
This patient has just involuntarily entered the medical labyrinth. This tiny nodule was discovered entirely by accident and would likely never cause illness. This patient will now undergo a CAT scan every 3 months for 2 years just to make sure that the lesion doesn’t change. Doesn’t this sound like fun? This exercise is going on every day in every city of the country. Imagine the financial and anxiety costs of chasing after all of these ‘abnormalities’? Of course, the repeat CAT scans may discover other trivialities which then pushes the poor patient deeper inside the labyrinth. Is this our idea of medical quality? The health care reform effort will have to address the issue of excessive medical care to if it has any chance of succeeding.
CAT scans and other radiographic tests are just too accurate for our own good. For example, look at the skin on your own hand. Now, bring your hand closer and closer to your eyes. With closer inspection, the topography of your skin comes into sharper focus. From a distance, your skin seems smooth and unblemished, but with closer examination, surface irregularities, small scars, pigmented spots, freckles and veins will come into view. Don’t rush off to see a dermatologist STAT! These are the normal imperfections that every physical object has if it is studied at high magnification. CAT scans today are now so precise and accurate, that they are finding ‘freckles’ in our internal organs that will never bother us but lead us to medical care that we don’t need. It’s a great irony that better radiology quality diminishes our health.
Michael Kirsch, MD is a full time practicing physician and freelance author. He writes about the joys and challenges of medical practice including controversies in the doctor-patient relationship, medical ethics and measuring medical quality. When he is not writing, he is performing colonoscopies. For more articles on this subject, visit: http://mdwhistleblower.blogspot.com/