How, then, can we limit the harm caused by this unsolicited diagnostic information? One approach would be to gather the information without transmitting it to the clinician or patient. Take, for example, bundled tests such as the metabolic panel. If a physician only wanted to know about a patient’s serum creatinine and albumin, a lab could still run the less expensive bundled panel, while programming the computer to report only the requested results. The programming could be more sophisticated if that makes clinical sense: for example reporting any “critical value” higher than some predetermined threshold.
A second approach would be to obscure data before it turns into information. For example, when conducting diagnostic imaging, areas of the body other than the parts under investigation could be blacked out. A screening test for colon cancer could limit itself to the colon, with CT scanners programmed to obscure other parts of the abdomen. The same could be done for an MRI of the spine.
A third approach would be to reclassify information in ways that reduce the strength with which patients and clinicians respond to the information. For instance, for screening tests with high rates of false-positive results, such as neonatal testing for inborn disorders, the initial report could indicate “positive preliminary screen” rather than a specific diagnosis. This would allow the physician to explain why further testing needs to be done, while emphasizing the preliminary nature of the findings. Not providing a specific diagnosis until confirmatory testing is performed may reduce unnecessary anxiety and curb the impulses to perform extensive additional workup.
All of these changes would be relatively simple to implement, and could reduce the harms associated with incidental findings. Of course, these suggestions would do nothing to address the larger and growing issue of overuse of unnecessary testing6
. However, as described above, there are many instances when physicians are saddled with test results they did not intentionally seek. Given the difficulty of ignoring test results, we need to adopt policies and practices that shield us from distracting and unnecessary information. By doing so, the medical community will have found a way to acknowledge that more information is not always a good thing.