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Less Is More
October 2015

An Injudicious Request—Performing a Test That Is Not Indicated

Author Affiliations
  • 1Department of Internal Medicine, University of California, San Francisco
JAMA Intern Med. 2015;175(10):1606-1607. doi:10.1001/jamainternmed.2015.4387

One predawn morning during my medical school surgery rotation, I noticed threatening shadows in my groin—lymph nodes decorating my normally smooth inguinal creases. I had lost a little weight too, despite deliberate attempts to bulk up, symptoms that stuck in the refining sieve of my developing medical intuition. I thought of my family’s cancer history and recent travel, so I scheduled a student health appointment.

There, I detailed my year of living and fearlessly eating in developing countries. While my physician put in orders for blood work, I also shared a bit of information a lecturer had divulged the previous week. The Brazilian açaí plant is frequently contaminated with reduviid bug feces. If the plant is not pasteurized before being eaten—and I ate a lot of it—açaí can be a route of transmission for Chagas disease. Never mind that none of my symptoms fit with Chagas, which is frequently asymptomatic in its early stages. I worried creatively. “Can you test me for Trypanosoma cruzi too?” I asked.

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