Invited Commentary
Mar 25, 2013

Diagnostic Testing and the Illusory Reassurance of Normal ResultsComment on “Reassurance After Diagnostic Testing With a Low Pretest Probability of Serious Disease”

Author Affiliations

Author Affiliations: Veterans Affairs Center of Excellence for Implementing Evidence-Based Practice, Regenstrief Institute and Indiana University, Indianapolis.

JAMA Intern Med. 2013;173(6):416-417. doi:10.1001/jamainternmed.2013.11

Diagnostic testing is enticing to patients and clinicians. It appears more objective and less pedestrian than a simple clinical interview and physical examination. Medical certainty is seldom solidified until all the tests results are in. Patients anxiously await the telephone call or letter announcing “your tests are all normal.” Indeed, the grander the technology, the more alluring. However, the testing imperative can become addictive. As noted in a 1991 cautionary essay:

Technology pounds upon the shore, but the danger is the undertow. The effacement of sand castles we abide; the relentless tug is another matter, sucking us deeper. Like systole and diastole, there is faint pause, endless indications. Imaging fits the metaphor, wave after wave: radionuclide scanning, computerized tomography, magnetic resonance imaging, duplex sonography. The very names captivate our diagnostic instincts, and yet excess appears inevitable. . . . Endoscopy is equally irrepressible. . . . To witness a cause transcends the more banal concerns of costs and therapeutic outcome. Follow-up is inconvenient. To wait and see whether growing suspicions will justify exploration or whether signs and symptoms prove merely transitory cannot compete with immediate visualization.1

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