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Less Is More
October 2014

Looking for Trouble—Patient Preference Misdiagnosis and OvertestingA Teachable Moment

Author Affiliations
  • 1Department of Medicine, University of Colorado Denver School of Medicine, Aurora
JAMA Intern Med. 2014;174(10):1548-1549. doi:10.1001/jamainternmed.2014.3429

A 74-year-old woman with systemic sclerosis was referred to a rheumatology clinic to reestablish care after a 5-year hiatus. Diagnosed as having scleroderma 30 years earlier, her disease manifestations of sclerodactyly, Raynaud phenomenon, gastroesophageal reflux, and calcinosis were consistent with the limited cutaneous subtype of systemic sclerosis, and she had never required anything more than a proton pump inhibitor to control her symptoms. Over the course of the visit, she made it clear that as long as she felt well enough to spend time with her family and tend to her garden, she wished to avoid invasive medical testing. She mentioned that she discontinued routine cancer screening several years earlier because, “At this stage in my life, I don’t want any more uncomfortable tests if I don’t really need them. No point in looking for trouble if I feel good.”

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