A brilliant piece that eloquently states many of the ideas espoused on this blog, focusing on pulmonary embolism as the poster child for over-testing, over-diagnosis, and lack of sound evidence underlying treatment.
These authors, in the Archives of Internal Medicine, accurately describe the chimeric nature of pulmonary embolism – historically described as a dreaded disease, diagnosed clinically from the manifestations of pulmonary infarction, to the modern manifestation of filling defects noted on CTA during an episode of pleuritic chest pain. They discuss the handful of patients who benefited from the first heparinization for treatment, and argue the disease for which anticoagulation is the treatment is not the disease we are diagnosing today.
This article covers so many excellent points, and ties the clinical problems so tightly into the underlying principles, that it’s almost the sort of must-read article to which medical students should be exposed – in order to bring about that frightening moment of maturity in medicine in which you realize the emperor is distinctly lacking in clothes.
Lovely work!
“The Diagnosis and Treatment – of Pulmonary Embolism: A Metaphor for Medicine in the Evidence-Based Medicine Era”
www.ncbi.nlm.nih.gov/pubmed/22473672
I love this paper. Thank you for highlighting this.
A similar review of overtreatment of spontaneous pneumothorax in the absence of evidence is –
Spontaneous pneumothorax: time for some fresh air.
Simpson G.
Intern Med J. 2010 Mar;40(3):231-4. Review.
PMID: 20446970 [PubMed – indexed for MEDLINE]
http://www.ncbi.nlm.nih.gov/pubmed/20446970
.