The Hidden Dangers of Too Much Testing: A Call for Diagnostic Restraint in Modern Medicine

Examining the Clinical, Ethical, and Long-Term Consequences of Overdiagnosis

In an age of medical abundance, where diagnostic technology is more sophisticated and accessible than ever before, a quiet crisis is unfolding: the epidemic of overtesting. While early detection and prevention remain cornerstones of modern medicine, a growing body of peer-reviewed research now reveals that too much testing can harm patients, both physically and psychologically. From false positives to radiation-induced cancers, overdiagnosis has become a clinical and ethical concern that demands urgent attention.

A new cohort study published in Annals of Internal Medicine found that more than 25% of imaging studies and laboratory tests performed in outpatient settings are unnecessary, yielding minimal clinical value and, in many cases, introducing new risks. The authors concluded that excessive diagnostics lead to a cascade of follow-up procedures, complications, and prolonged anxiety—what experts now refer to as “the diagnostic spiral.”

One of the strongest voices on this issue is Andrew Rudin, MD, a Tennessee-based cardiologist who has long championed a more measured, evidence-driven approach to testing. With more than two decades of experience treating diverse populations, Dr. Rudin is a respected thought leader in diagnostic stewardship and harm reduction.

“We've trained ourselves—and our patients—to believe that more testing means better care,” says Andrew Rudin, MD. “But the evidence is clear: indiscriminate testing introduces new layers of risk that we're only beginning to understand.”

From Overuse to Overharm

The core issue lies in the unintended consequences of overtesting. While diagnostic tests are essential in many contexts, their overuse has become widespread—particularly in asymptomatic individuals or in response to low-probability complaints. Researchers have identified several downstream harms:

Radiation exposure from imaging: CT scans and nuclear medicine tests expose patients to ionizing radiation, which, in high or repeated doses, increases lifetime cancer risk. The Lancet Oncology journal reports that medical imaging now accounts for over 40% of all radiation exposure in developed countries.
Psychological burden of incidental findings: Unrelated abnormalities (incidentalomas) often prompt additional tests and specialist visits, even when these findings are benign. This phenomenon creates anxiety, mistrust, and medical fatigue.
Surgical and procedural complications: False positives or ambiguous results often lead to invasive diagnostics such as biopsies or exploratory surgeries, which can cause bleeding, infection, and, in rare cases, permanent damage.

Andrew Rudin, MD, recalls one case where a patient underwent a chest CT for minor shortness of breath. An incidental nodule led to two follow-up scans, a needle biopsy, and weeks of stress—only to discover the nodule was entirely benign. “We gave her a diagnosis she didn't need and a burden she didn't deserve,” Rudin says.

Why It Happens: Systemic and Cultural Factors

The overtesting problem is not merely clinical—it is deeply embedded in the culture and economics of medicine. Studies cite multiple drivers:

Defensive medicine: In an environment of malpractice litigation, physicians often order tests to avoid perceived liability.
Reimbursement incentives: Fee-for-service models reward volume, not value. This leads to financial motivations for higher test utilization.
Clinical uncertainty: Lack of time or diagnostic clarity prompts physicians to “rule out” rather than reason through a diagnosis.
Patient demand: Many patients equate testing with thoroughness and reassurance, often pressuring clinicians for more data.

“Clinicians face enormous pressure to ‘do something,'” explains Andrew Rudin, MD. “But we must distinguish between doing something helpful and doing something harmful. A test without a clear purpose is not neutral—it's a liability.”

A Return to Clinical Judgment: The Case for Diagnostic Stewardship

In response, many healthcare leaders are promoting diagnostic stewardship, a structured approach to ensuring tests are ordered only when truly beneficial. This model emphasizes:

Careful assessment of pre-test probability
Utilization of evidence-based guidelines (e.g., Choosing Wisely)
Patient-centered shared decision-making
Ongoing audits of diagnostic test use within practices

Dr. Rudin has implemented diagnostic stewardship protocols at his Tennessee clinic, including internal audits of test ordering patterns, physician education, and patient-facing materials that explain the risks of overtesting. His team has seen both cost savings and improved patient satisfaction, with fewer unnecessary referrals and follow-ups.

“The goal is not to test less—it's to test smarter,” says Andrew Rudin, MD. “We want to order the right test, for the right reason, at the right time.”

Educating Patients to Break the Cycle

One of the greatest challenges in addressing overtesting is patient perception. Many believe that more tests equal better care. But without informed consent—true understanding of the risks, benefits, and implications of diagnostic tests—patients cannot make empowered choices.

Dr. Rudin uses what he calls “diagnostic literacy” conversations in his practice. These are short, structured dialogues where he outlines what a test can and cannot tell the patient, along with potential risks. This method has significantly reduced demand for unnecessary imaging and labs.

In one instance, a patient requested a full-body MRI “just to be sure” after a friend's sudden cancer diagnosis. After a 10-minute conversation about false positives, anxiety, and the cascade of testing that can follow, the patient agreed to a more targeted and appropriate evaluation instead.

“Educated patients are our best allies in fighting overtesting,” Dr. Rudin says. “When they understand the stakes, they often make the most conservative choice themselves.”

Moving Toward Value-Based Care

As medicine transitions toward value-based models, diagnostic appropriateness is becoming a key performance indicator. Health systems that prioritize outcomes over volume are incentivizing clinicians to adopt evidence-based diagnostic strategies.

Insurers, too, are taking notice. Several now require prior authorization for high-cost imaging and monitor utilization data to detect outliers. While this approach has faced criticism, it also reflects a growing recognition that diagnostic overuse is a cost and safety issue.

Physicians like Andrew Rudin, MD, are helping to lead this transformation—not by cutting corners, but by elevating the diagnostic process through careful reasoning, clear communication, and humility.

Conclusion: Restraint Is the New Responsibility

As new technologies continue to flood clinical settings, the temptation to test will only grow stronger. But clinicians must remember that every test is a clinical intervention, one that carries risks as well as rewards. The best care is not defined by how many tests are ordered, but by how well they are chosen.

With voices like Andrew Rudin, MD, urging the medical community to prioritize thoughtful, ethical decision-making, there is hope for a future where diagnostics serve the patient—not the system.