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Less Is More
July 2015

Uncertainty and the Diagnostic Leviathan

Author Affiliations
  • 1Department of Radiology, Hospital of the University of Pennsylvania, Philadelphia
JAMA Intern Med. 2015;175(7):1085-1086. doi:10.1001/jamainternmed.2015.1103

“She had a normal CT yesterday. Why another?” I asked the physician.

“That scan was enhanced. Contrast obscures small kidney stones. We need an unenhanced CT to rule out a stone,” he reasoned.

“A small kidney stone is unlikely to explain her pain. There was no hydronephrosis or perinephric stranding. You will advise ‘avoid dehydration.’ This is good advice regardless of the presence of a 2-mm nonobstructing calculus,” I explained.

“We need to know why she has pain. You don’t know that a small stone is not the cause of her pain. You can’t rule that out,” he concluded.

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