Author Affiliations: VA Outcomes Group, Department of Veterans Affairs Medical Center, White River Junction, Vermont (Drs Sirovich and Schwartz); and The Dartmouth Institute for Health Policy and Clinical Practice, Lebanon, New Hampshire (Dr Woloshin).
We strongly agree with Dr Volpintesta's call for training primary care physicians in how to live with clinical uncertainty and suspect he is correct that intolerance of uncertainty often contributes to excessive reliance on diagnostic testing.
One fundamental principle that new physicians need to understand is that, ironically, more testing often increases—rather than decreases—clinical uncertainty. First, it is a rare diagnostic test that yields a yes or no answer regarding a suspected clinical condition; test results may reduce—or increase—uncertainty.1 Second, diagnostic testing (particularly imaging) frequently reveals unexpected abnormalities unrelated to the reason for the examination.2,3 There is typically great uncertainty about whether following and treating these abnormalities does more good than harm.
Sirovich BE, Woloshin S, Schwartz LM. Training in Uncertainty Has Value for Primary Care Physicians: Overreliance on Technology Can Be Remedied—Reply. Arch Intern Med. 2012;172(3):296-297. doi:10.1001/archinternmed.2011.1567