Kevin Pho M.D. has written that a screening test incidentaloma can make healthy people ill. This is a theme that appears too frequently in the medical literature. When I previously addressed this issue in a prior article it did not then occur to me that the argument might be used to impair patients receiving recommended screening.
Medicine constantly searches for safer more specific screening tests to permit early diagnosis of treatable, but otherwise deadly diseases. Before a new strategy is introduced generally or prescribed in the care of a particular patient, considerable thought has been given to the sensitivity and specificity and cost of the method. Complications associated with a particular method are considered. Complications associated with such follow-up as may be employed in the pursuit of false positives is very much a part of the process. A nodule appearing on an imaging study doesn’t automatically require a biopsy or invasive form of follow-up. The distinction between findings that require follow-up and the particular kind of follow-up required is a matter of ongoing study, and it should be.
Earlier I addressed the idiocy of ignoring unexpected findings made on a diagnostic study. Example: A chest x-ray is performed because pneumonia is suspected. The film when interpreted by the radiologist reveals a mass. Should one ignore the mass since that is not what was expected? The same logic could be employed to ignore a mass seen on a CT scan of the brain performed because of a recent head trauma. What is common to this point of view is the assumption that a physician’s initial assessment represents the universe of possibilities.
We once believed the earth was flat. Knowledge is acquired when we put aside assumptions that stand in the way of recognizing what is real.