When is it better not to know everything?
نویسنده
چکیده
table solutions.Myguess is that the real limitation is concern about the medical-legal implications of not following up on incidental findings,3 although therehavebeen fewstudies of such concerns.4 But physicians—not lawyers—create the beast that they most fear, the standardof care.What if all radiology societies declared that, as of a certain date, the new standard of care was erasing or not acquiring unwanted images outside the body area of interest? Could this approach solve this vexing problem? This proposed solution would not address incidental findings seen in thebodyareaof interest, suchas thepulmonarynodules that mypatienthad. It alsowouldnotaddress incidentalpulmonarynodules foundonCT scansobtained for coronary calciumscoring.5 Follow-up of such incidental findings is probably an inevitable consequenceof theuseof advanced imaging, and it hasbeenargued that patients have the right to know about them.3 A more contentious proposalwould be tomore precisely focus imaging evenwithin the body area of interest (eg, the brachial plexus and lung apices onmy patient’s chest CT scan). Taking that additional step would lead to subjective judgments regardinghownarrowly focused the imaging examination should be and potential complex decisions regarding howmore limitedexaminationswouldbebilled.Nonetheless,mitigatingtheproblemof incidental findingsby limitingscanstothebody area of interest would be amajor step forward. Chasing my patient’s incidental findings was low-value health care. I certainly deserve a share of theblame for letting the cascade goon for as longas it did.Approximately 50%ofpeopleharbor thyroid nodules6 and 5%have adrenal nodules,7 although few people die of thyroid or adrenocortical carcinoma. I am especially thankful that the2 contrast reactions thatmypatient experiencedalong the way were relatively mild. To increase the value of health care and reduce its harms, novel solutions are needed that get to the root causes of problems, such as the solution that I propose here.
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ورودعنوان ژورنال:
- JAMA internal medicine
دوره 174 6 شماره
صفحات -
تاریخ انتشار 2014