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Friday, Jul 11, 2014
Commentary

The unnecessary test that saved my mother’s life


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A few months ago, my 65- year-old mother had “screening” blood tests, which showed inflammation of the liver. She was healthy and had no symptoms of liver disease. The cause of the inflammation was unclear. To investigate, doctors ordered more tests. As a physician, I have seen how excessive testing can lead to worry and more tests. That seemed to be transpiring — but this time, the patient was my mother.

An ultrasound showed her liver was healthy. But the same ultrasound also discovered a small, fluid-filled cavity in one of her kidneys. The radiologist recommended a CT scan to evaluate the remote possibility that the cavity might be cancerous.

The CT scan, unfortunately, did not settle anything. Like the ultrasound, it did not rule out the possibility of cancer in the kidney. So the radiologist recommended an MRI of the kidney. The CT scan detected other small abnormalities, each of which required more testing. A small spot in the lower part of her lung required a PET scan, which involved injecting a radioactive substance that can highlight cancer cells in certain organs.

I thought this was an all-too-common misadventure. Many physicians consider tests such as the initial screening blood test unhelpful because they often waste money and prompt more tests. When those follow-up tests involve radiation or invasive procedures, they can harm patients.

Radiologists were able to work out all but one issue. The PET scan had not clearly determined whether the spot on her lung was cancerous. She needed chest surgery to remove the mass and examine it under a microscope. This was the ultimate feared consequence of unnecessary testing: risky surgery.

The spot was cancerous. By surgically removing the cancer at such an early stage — before any symptoms — the surgeon probably saved my mother’s life.

But my mom’s story reminds me just how difficult that task will be for all of us, physicians and patients. As a doctor, I know that liver-function blood tests in healthy patients are not often indicated. I still wouldn’t recommend such screening to patients or colleagues. But I also realize that an unnecessary test launched a sequence that saved my mother’s life.

Jason Wasfy is a cardiologist at Massachusetts General Hospital and an instructor in cardiology at Harvard Medical School.

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