Experts estimate that $200 billion is wasted annually on excessive testing and treatment. The typical dynamic is a chain reaction: Something “comes up” on diagnostic tests or screenings and triggers “cascades” of further testing and treatment. Thus, for example, 52% of radiology and laboratory tests produce incidental findings that result in further screenings and tests. In some cases, further evaluation of these findings may reveal a clinically important and intervenable discovery, such as an early-stage cancer. More often, however, subsequent evaluations find nothing significant. A new national survey finds that 99% of physicians have experienced cascades of care firsthand and that when they happen their patients experience psychological harm, physical harm and financial burden—in addition to the frustration and anxiety physicians feel themselves. The findings were published in JAMA Network Open (the Study.) Policy makers and health care leaders should address cascades after incidental findings as part of efforts to improve health care value and reduce physician burnout, the Study recommends. The Cascade Effect The term “cascade” was coined to describe a sequence of events set irrevocably into motion after an incidental finding. Cascades are widely prevalent and often inevitable once an incidental finding is discovered. One study found that primary care physicians reported […]