The problem of abnormal or incidental findings leading to an uncontrollable series of unforeseen events, is described as The Cascade Effect. Such findings, found on routine exams, more often on screenings (see last post on incidentalomas) most frequently result from ill-advised diagnostic testing, and are almost always without medical significance. Yet they can result in a series of extensive and risky diagnostic procedures culminating in clinical catastrophes.
Cascade fiascos are frequently catalyzed by anxiety on the part of the patient or his physician, and are becoming increasingly more common in clinical practice because of the introduction of new and ever more pervasive technologies along with uninhibited and unjustified medical testing.
Here’s one example:
A 35 year old nurse underwent abdominal ultrasound for vague GI symptoms. The study was negative except for the incidental discovery of a small liver “lesion.” She was told, “It might be serious,” and a biopsy was suggested. Over the next several weeks she developed a serious depression, and consulted a psychiatrist. A CT was nondiagnostic, so she ended up having hepatic angiography, a invasive procedure, not without risk, in which dye is injected into a major artery leading to the liver. A diagnosis of “benign hemangioma” was finally made. This is a tiny localized collection of blood vessels seen in over 2% of the population. Later review of the ultrasound study showed a typical pattern. Medical Cost: $8,500, including psychiatrist. Emotional Cost: Impossible to estimate.
More examples will follow in upcoming posts.