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September 2016

Choosing Our Words Wisely

Author Affiliations
  • 1Department of Medicine, University of California–San Francisco
JAMA Intern Med. 2016;176(9):1249-1250. doi:10.1001/jamainternmed.2016.3653

“But I want all the tests.”

She was a young, healthy woman, and this was our first visit. Near the end, I suggested the few indicated screening tests and started to move on to follow-up. She expressed distress, wondering why I had not ordered more.

“What do you mean by all the tests?” I asked.

“Well,” she countered, “I just want you to order some more tests to make sure there isn’t anything wrong.”

I took a deep breath. From the patient’s perspective, this request seemed perfectly reasonable. Of course she wanted to discover and avert any potential health problems. I made my best attempt at addressing her concerns, inelegantly explaining concepts such as pretest probability and positive predictive value. She was not reassured.

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