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July 25, 1977

Tempering or Tampering

JAMA. 1977;238(4):305-306. doi:10.1001/jama.1977.03280040025009

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To the Editor.—  The letter by Drs Teigs and Mishkin (237:644, 1977) suggesting that the use of bone scans as a screening procedure for metastasis "should be tempered by the clinical examination" merits rebuttal.There is no disagreement that nuclear medicine procedures and laboratory tests in general may be overused to the point of abuse. It would be well if all physicians requesting these studies would be guided by some specific criteria. We could suggest two: (1) the test is requested in order that its results be applied directly to the management of the particular patient; (2) the test is necessary to study the natural course of a disease to guide the clinical care of other patients with a similar disease. Too often consultations and laboratory studies are requested "just for the record."However, the main thrust of their letter is that "a bone scan... in patients with proved carcinomas...