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Editor's Note
Less Is More
January 13, 2020

First Physical, Reprised

Author Affiliations
  • 1University of California, San Francisco
  • 2Editor, JAMA Internal Medicine
  • 3New York City Health and Hospitals, New York
  • 4Deputy Editor, JAMA Internal Medicine
JAMA Intern Med. Published online January 13, 2020. doi:10.1001/jamainternmed.2019.6612

Ten years ago, President Obama received an unnecessary coronary artery calcium scan.1 Some might argue that a president’s health is more vital than that of the average person but that misses the point. Medical diagnostic tests have consequences. Beyond the anxiety caused by false positive results, incidental findings can result in a cascade of further tests, some of which, if invasive, carry substantial risks.2,3 Whether you are the president or not, medical tests should be performed when there is reasonable evidence that the benefits outweigh the harms, not just because they are available. As Korenstein et al4 reported in JAMA recently, services, such as coronary artery calcium scans with a grade I designation from the US Preventive Services Task Force meaning insufficient evidence, are included in executive physicals.

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    1 Comment for this article
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    Unnecessary test?
    Michele Nanna, Associate Professor | A. Einstein Coll of Med
    I am not sure it is proven that ( in this group of affluent, educated, individuals, who will get - and can afford- more than one second opinion.... )
    over testing results in worse outcome. What happened to this cohort of people? How many underwent unnecessary subsequent risky tests or procedures? How many suffered untoward events as a consequence of over testing? How many occult diseases were discovered as consequence of over testing?
    A deadly left main coronary artery obstruction could be clinically silent and its first clinical manifestation could be ...sudden death... an option that these wealthy, assets
    rich individuals are not willing to take.
    Guidelines are good for MOC exams but not always valid in real world decisions ...for example guidelines recommend no further follow up for a serendipitously discovered X-ray lung mass less than 8 mm in a low risk individual. Most of us, however, will obtain a follow up CT to avoid explaining to a crying widow and a sympathetic jury that we missed to follow up on an aggressive deadly lung cancer because...we were following guidelines.
    CONFLICT OF INTEREST: None Reported
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