Clinical Implications of Overutilization in Diagnostic Medicine

 

 

A growing body of clinical literature is now challenging one of the most entrenched assumptions in modern healthcare—that routine testing is inherently harmless and always beneficial. A major multi-institutional study, recently published in The Lancet, confirms that overuse of diagnostic testing is not only wasteful, but potentially harmful to patient health. The findings demonstrate that excessive imaging, screening, and laboratory tests are contributing to a rising incidence of overdiagnosis, overtreatment, and even iatrogenic harm, including radiation-induced malignancies.

This evolving evidence has sparked an important shift in medical philosophy. For physicians like Andrew Rudin, MD, a Tennessee-based doctor known for his thought leadership in conservative care models, the study only affirms what many in primary care have observed anecdotally for years: diagnostic overreach is not benign.

“We are discovering that the consequences of unnecessary testing are more than theoretical,” says Andrew Rudin, MD. “From anxiety to physical harm, the downstream effects are tangible—and often irreversible.”

The Data Behind the Warnings

The recent analysis examined over 250,000 diagnostic encounters across hospital networks and outpatient clinics. Researchers found that up to 35% of imaging studies—including CT scans, MRIs, and PET scans—were categorized as either low-value or inappropriate per evidence-based guidelines.

Particularly concerning was the cumulative radiation exposure among patients receiving multiple scans within a short time frame. The study concluded that recurrent diagnostic imaging, especially in asymptomatic individuals, significantly increased the relative risk of developing cancers over a decade-long period.

Laboratory tests were also scrutinized. Unnecessary bloodwork often triggers false positives, prompting further diagnostic procedures or invasive biopsies with little clinical justification. The authors of the study stressed that the concept of "do no harm" must extend beyond treatment to encompass diagnostics as well.

Andrew Rudin, MD, whose clinical practice spans both urban and rural populations in Tennessee, highlights the hidden toll. “We see patients undergoing cascading interventions based on questionable results. It's not just an ethical issue—it's a public health problem.”

Drivers of Diagnostic Overuse

Several factors contribute to the culture of overtesting:

  1. Defensive Medicine – Physicians, wary of malpractice litigation, often over-order tests to protect themselves legally, even when the clinical rationale is weak.

  2. Patient Expectations – Many patients equate testing with quality care, pressuring clinicians to order diagnostics to satisfy perceived thoroughness.

  3. Financial Incentives – In some systems, reimbursement models still reward volume over value, encouraging high test utilization.

  4. Technological Dependence – With rapid advances in diagnostic capabilities, clinicians are increasingly reliant on technology rather than clinical judgment.

Andrew Rudin, MD, notes that newer physicians are particularly susceptible to these pressures. “There's a growing gap between the physical exam and the test order screen,” he says. “What's missing is the critical pause—the moment where we ask, ‘What do I expect this test to change?'”

The Psychological and Physical Consequences of Overdiagnosis

One of the most overlooked outcomes of overtesting is the psychological burden it places on patients. Incidental findings—those anomalies detected by chance—often have no clinical significance but create significant anxiety. These so-called "incidentalomas" can lead to months of worry, frequent follow-ups, and unnecessary procedures.

Beyond mental distress, the physical risks are equally grave. Invasive testing can result in bleeding, infection, and in rare cases, permanent organ damage. Radiation exposure from diagnostic imaging adds cumulative lifetime risk, particularly in children, young adults, and individuals with chronic conditions who require ongoing monitoring.

Andrew Rudin, MD, recalls several patients in his Tennessee clinic who experienced these effects firsthand. “One patient underwent five separate tests to investigate a benign lung nodule that never changed in size or shape. By the end, he'd received two rounds of contrast, a biopsy, and months of lost sleep—all for something that never needed intervention.”

Toward a More Disciplined Approach: Diagnostic Stewardship

In light of these revelations, experts are urging clinicians to adopt diagnostic stewardship, a framework that promotes the rational, evidence-informed use of diagnostic testing. It involves:

  • Evaluating pretest probability before ordering

  • Considering net benefit vs. net harm

  • Engaging in shared decision-making

  • Following validated clinical guidelines

Andrew Rudin, MD, has implemented these practices in his Tennessee clinic by utilizing clinical decision tools, personalized risk assessments, and in-depth consultations that inform patients about both the pros and cons of testing.

“Testing is not always caring,” Dr. Rudin says. “Sometimes, restraint is the highest form of care we can offer. Patients deserve to know that more tests do not automatically mean better outcomes.”

He also recommends increased education in medical training programs to better prepare new physicians to evaluate the clinical necessity of tests, rather than rely on habitual protocols or fear of liability.

Re-Educating the Public

Addressing the problem of overtesting also requires shifting public perception. Patients often request tests under the assumption that they are harmless or universally beneficial. Without education about the risks of overtesting, it's difficult for physicians to push back against inappropriate expectations.

Some healthcare systems are now developing patient-facing decision aids that explain the risks of radiation, false positives, and overdiagnosis in accessible language. Rudin has piloted several such tools in his practice, with promising results in both patient satisfaction and reduction in low-value test ordering.

Conclusion: From “More” to “Wise”

As the data mounts, the medical community faces an ethical imperative to recalibrate its approach to diagnostics. Testing must be viewed as a medical intervention—not a harmless default. With clinicians like Andrew Rudin, MD, at the forefront of this shift, there is growing momentum toward more thoughtful, evidence-guided decision-making.

Ultimately, the goal is not to eliminate testing but to refine its use—ensuring that every test has a clear purpose, informed consent, and a reasonable expectation of improving clinical care.

In the words of Andrew Rudin, MD:

“The future of medicine isn't more—it's wiser. Every test we don't order unnecessarily is a step toward safer, more responsible, more human care.”