Cascades of Care After Incidental Findings in a US National Survey of Physicians

Abstract

This survey study estimates the national frequency and consequences of cascades of care after incidental findings using results from a national survey of US physicians.

Evaluation of Low-Value Diagnostic Testing for 4 Common Conditions in the Veterans Health Administration

“…1 , 2 Examples include cancer screening for patients with a limited life span or performing preoperative electrocardiography for patients undergoing low-risk cataract surgery. 3 , 4 Up to 43% of Medicare beneficiaries have received low-value care, which may be associated with physical and psychological harm and an erosion of their trust in the health care system. 5 , 6 …”

Capsule Commentary on Nevedal et al. “Factors Influencing Primary Care Providers’ Unneeded Lumbar Spine MRI Orders for Acute, Uncomplicated Low-Back Pain: a Qualitative Study Use of Patient Decision”

“…4 This is also important because incidental findings on diagnostic tests are common and often trigger unnecessary testing and treatment. 5 Another potential solution could be to implement pre-authorization from on-call radiologists or, in the VA, utilizing available teleradiology services to curb this problem. Finally, more efforts should be focused on disseminating the best practices to providers.…”

The Important but Rarely Studied Cascade of Care

“…1 Nearly 90% of physicians reported that a cascade had caused patient harm, including psychological harms, treatment burden, financial burden, and physical harm. 1 Cascades also negatively affected physicians in terms of wasted time and effort, frustration, and anxiety. 1 Notably, approximately half of physicians experienced a cascade when they or family members were patients.…”

“…1 Cascades also negatively affected physicians in terms of wasted time and effort, frustration, and anxiety. 1 Notably, approximately half of physicians experienced a cascade when they or family members were patients. 1 Consider first that cascades are core to the practice of medicine.…”

“…1 Notably, approximately half of physicians experienced a cascade when they or family members were patients. 1 Consider first that cascades are core to the practice of medicine. The whole point of mammography and prostate-specific antigen testing, for instance, is to trigger more imaging, a biopsy, and potentially beneficial therapy.…”