When Less Is More – Two Boneheads Video Series

,Jeffrey Berg, MDWe are an over-tested and over-diagnosed society.  Part of this is our doctor’s fault, part is the fault of advertisers promoting various diseases, medications, hospitals and procedures and, I’m sorry to say, a large part is our fault, all of us patients.

Unfortunately, this overtesting and overdiagnosing can lead to over-treatment and unnecessary complications. Which can lead to further testing and treatment (…and more complications).

Our doctors’ and our own desire to identify what ails us is understandable.  When we are ill or bothered by any symptoms, we are anxious… worried that something bad…really bad is going on.  When we have pain, we worry that we will always be like this…that we will be unable to work or enjoy our leisure activities…and that things will get worse.

Our doctors sense this.  We’ve come to them, asking for their assistance and they want to help…that’s what they do. But in our rush to get an immediate answer to our problem, we bypass the greatest clues our doctors have to help identify the correct diagnosis…that is the progress of the disorder and how it responds to treatments.  And we often substitute that process with testing. But most medical tests or imaging studies are not designed or good enough to make a diagnosis by themselves.  They are best used to confirm or disprove a suspicion or narrow a list of possible diagnoses.

Furthermore because we push to be diagnosed and treated now, we force our doctors to get the diagnostic steps backwards – Test first – Develop potential diagnoses second.  Garbage in…Garbage out.

Because this bypasses the normal diagnosing process, it often can lead to the wrong diagnoses. And the wrong diagnosis almost always leads to the wrong treatment.  And, unfortunately, wrong treatments frequently lead to persistent problems, avoidable complications, unnecessary costs and further diagnosing, testing and treatments…that may be all wrong as well.

This is unfortunately magnified by the advertising campaigns of the cholesterol-lowering-info.com, hospital and other healthcare companies.  There now is a name (read: diagnosis) for every symptom…We’ve medicalized the human condition and in doing so, we’ve become trained into thinking that our bodies shouldn’t breakdown, that we should always be young…and live forever.  That we should feel no pain or have any medical inconvenience.  These companies have trained us to demand a cure immediately as McDonalds and microwaves have trained us to demand our food immediately.  Unfortunately the quality of immediate healthcare is not much different than the quality of immediate food…but with a lot more potential problems.

Unnecessary Testing = Unnecessary Treatment

Most are unaware of the limits of our testing and imaging studies.  These tests can help identify what exists, but rarely are they able to tell us if what is there is the source of our symptoms and NEVER are they able to tell us what the proper treatment (if any) should be.

Take for example the frequently used (and I might add, often demanded) MRI.  In people with NO symptoms (that is absolutely ZERO symptoms)MRI’s will identify a meniscal tear in up to  63% of people.  In asymptomatic people, MRIs will note abnormalities that can be read as a rotator cuff tear up to 80% of the time.  Similar findings are seen for shoulder and hip labral tears. So if you get an MRI for your knee, shoulder or hip problem, not only might the abnormal findings seen on the study have existed before your symptoms began but if you got another MRI on your other side, the findings might be exactly the same.  Not very helpful, huh? And these confusing findings are also found in most other imaging studies and all sorts of other testing.

So that is why, Dr. Howard Luks and I both think that often LESS IS MORE.  Watch the video below as we discuss this important issue. As always, please reach out to us if you have any questions or comments.  This is an important topic…and we’d love to get the conversation going.

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