Unnecessary medical testing or overtesting is medical testing which is performed without a legitimate reason to do the test, such as a medical indication.
Some patients feel safer when their doctors perform more tests on them, because they assume that if they have health problems then the doctors will detect them. However, all medical tests have associated risks. Unnecessary medical testing brings the risk of a test showing a false positive result in a healthy person who would then go on to receive more tests and treatment under the mistaken assumption that the person needs it. Also unnecessary testing leads to health care providers charging patients for procedures which they do not need.
Causes
editInherent limitations in the good practice of medicine
editBad science
editSometimes it has happened that autopsies have revealed that doctors were very wrong about their patients' health, perhaps because the doctors began their practice assuming that the science on which it was based was correct when in fact it was not.[1]
It can happen that there are problems in differential diagnosis. A study may give guidelines for a large group of people, when despite the science the guidelines may only some members of that large group. This might be typical of new science - first it gives a broad guideline then over time the recommendation is refined.
Unwarranted variation
editRegional variations of standards of care
Good intentions with harmful results
editSometimes physicians have no reason to regret recommending a medical test even when it is not indicated.[2] [3]
Diagnostic errors
editFor various reasons in any health care system there will be a certain number of diagnostic errors.[4]
Financial pressures
editEconomic models for delivering health care
editDefensive medicine
editConflict of interest
editMedical malpractice
editSometimes health care providers recommend medical testing for no reason and have no excuses and perhaps the cause is medical malpractice.
Effects on patients
editEffects on economies
editActivism
editstuff
editResearchers have expressed difficulty in identifying reasons why physicians order medical testing which is not indicated.[5]
The intuition of individual doctors is an inherent part of medical practice.[6]
Causes of uncertainty about when to conduct a test include inherent limitations of medical guidelines, uncertainty in data obtained even using the scientific method, the probabilistic nature of health care, the limitations of any health provider to give consistently perfect treatment, and perpetuation of traditional practices even when better new practices are developed.[7]
Some physicians do testing beyond what it is indicated in an attempt to achieve greater diagnostic certainty.[8]
References
edit- ^ Anderson, R. E.; Fox, R. E. C.; Hill, R. B. (1990). "Medical uncertainty and the autopsy: Occult benefits for students". Human Pathology. 21 (2): 128–135. doi:10.1016/0046-8177(90)90120-T. PMID 2307439.
- ^ Hozo, I.; Djulbegovic, B. (2008). "When is Diagnostic Testing Inappropriate or Irrational? Acceptable Regret Approach". Medical Decision Making. 28 (4): 540–553. doi:10.1177/0272989X08315249. PMID 18480041.
- ^ Woolf, S. H.; Kamerow, D. B. (1990). "Testing for Uncommon Conditions<subtitle>The Heroic Search for Positive Test Results</subtitle>". Archives of Internal Medicine. 150 (12): 2451–2458. doi:10.1001/archinte.1990.00390230011003. PMID 2244763.
- ^ Newman-Toker, D. E.; Pronovost, P. J. (2009). "Diagnostic Errors—The Next Frontier for Patient Safety". JAMA. 301 (10): 1060–1062. doi:10.1001/jama.2009.249. PMID 19278949.
- ^ Williams, Sankey V.; Eisenberg, John M.; Pascale, Linda A.; Kitz, Deborah S. (1982). "Physicians' Perceptions About Unnecessary Diagnostic Testing". Inquiry. 19 (4): 363–370. JSTOR 29771522.
{{cite journal}}: Unknown parameter|month=ignored (help)CS1 maint: date and year (link) - ^ Hall, K. H. (2002). "Reviewing intuitive decision-making and uncertainty: The implications for medical education". Medical Education. 36 (3): 216–224. doi:10.1046/j.1365-2923.2002.01140.x. PMID 11879511.
- ^ Fortess, E. E.; Kapp, M. B. (1985). "Medical Uncertainty, Diagnostic Testing, and Legal Liability". The Journal of Law, Medicine & Ethics. 13 (5): 213–8, 212. doi:10.1111/j.1748-720X.1985.tb00925.x. PMID 3854683.
- ^ Kassirer, J. P. (1989). "Our Stubborn Quest for Diagnostic Certainty". New England Journal of Medicine. 320 (22): 1489–1491. doi:10.1056/NEJM198906013202211. PMID 2497349.