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Less Is More
March 28, 2011

Better Off Not KnowingImproving Clinical Care by Limiting Physician Access to Unsolicited Diagnostic Information

Author Affiliations

Author Affiliations: Division of Gastroenterology and Hepatology and Center for Behavioral and Decision Sciences in Medicine, University of Michigan Health System, Ann Arbor (Dr Volk); and Fuqua School of Business, Duke University, Durham, North Carolina (Dr Ubel).

Arch Intern Med. 2011;171(6):487-488. doi:10.1001/archinternmed.2011.63

A 70-year-old woman with back pain unresponsive to conservative measures underwent magnetic resonance imaging of the spine, which incidentally revealed a complex cyst in the kidney. Her physician felt obligated to investigate, but the cyst was beyond the reach of the radiologist for biopsy. Several anxious weeks later, the patient lay in a hospital recovering from a total nephrectomy. Final diagnosis: benign renal cyst.

Most clinicians recognize a variant of this story from their clinical practice. A test is ordered for appropriate indications but provides information about an unrelated condition, leaving the physician and patient to contend with information they had not sought but which, nevertheless, they find impossible to ignore. We contend that patients would be better served if the medical profession adopted simple interventions to limit physicians' access to unsolicited diagnostic information. We discuss herein how this information can end up harming patients and suggest steps the health system could take to reduce the availability of such information.

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