More is less: an investigation of unnecessary testing

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  • Format Audio
  • Language/s English
  • Target Audience Self-directed learning
  • EBM Stage 0 - Why EBM?
  • Duration 5-15 mins
  • Difficulty Introductory

Key Concepts addressed


.. or Every CAT Scan Has Nine Lives.

This radio programme was first broadcast in 2009.  It is a co-production of This is American Life and National Public Radio in the US.  It deals with issues around unnecessary spending on tests that don’t work, and some of the sociocultural barriers to implementing what we know from research.

A surgeon holds up an x-ray of moneyThe programme lasts 60 minutes in total, but you can shortcut to “Act Two” using the link above.

We have included this as a learning resource because it covers many of the key issues in an engaging form.

Here are some quotations from the programme to give you a further flavour.

According to the Dartmouth Atlas of of medical spending is on treatments and tests that are not actually necessary. And in some cases, may actually harm us.

The show includes a first-hand account from a doctor of his experiences of dealing with a patient’s father, who demanded an unnecessary CAT scan for his daughter.

The really strange thing is that I’ll get paid more if I do the CAT scan. Because the way that bills are made, you get paid more for more complex patients. And the insurance companies of the world think that it proves that the patient was more complex and more difficult if you had to do a CAT scan. So everything about this was pushing me to do the CAT scan.

A man examines the contents of his underpants
Avoidable harm from unnecessary testing can mean lifelong impotence and incontinence as a result of unnecessary treatment of prostate disease.

It also deals with use of the PSA test as a screening instrument for prostate cancer, for which the balance of benefits and harms is unclear.  In spite of guidance that men should be informed of the possible risks of testing, the majority of men in the US get the test without any discussion.

To question whether the test is necessary, a doctor is flying in the face of all sorts of cultural forces. Like the idea that if you can find cancer early, you always should. Not to mention all the billboards and free PSA screening events and celebrities in TV ads telling men to get tested.

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