Pain, fear, and waste: the costs of unnecessary care
By Ryan Levi and Dan Gorenstein of Tradeoffs · Mar 23, 2023
Dr. Meredith Niess saw her patient was scared. He’d come to the Veterans Affairs clinic in Denver with a painful hernia near his stomach. Niess, a primary care resident, knew he needed surgery right away. But another doctor had already ordered a chest X-ray instead.
The test results revealed a mass in the man’s lung.
“This guy is sweating in his seat, (and) he’s not thinking about his hernia,” Niess said. “He’s thinking he’s got cancer.”
It was 2012, and Niess was upset. Though ordering a chest X-ray in a case like this was considered routine medical practice, Niess understood something her patient didn’t. Decades of evidence showed the chest X-ray was unnecessary and the “mass” was probably a shadow or a cluster of blood vessels. These non-finding findings are so common that doctors have dubbed them “incidentalomas.”
Niess also knew the initial X-ray would trigger more tests and delay the man’s surgery further.
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