Diagnostic testing is enticing to patients and clinicians. It appears more objective and less pedestrian than a simple clinical interview and physical examination. Medical certainty is seldom solidified until all the tests results are in. Patients anxiously await the telephone call or letter announcing “your tests are all normal.” Indeed, the grander the technology, the more alluring. However, the testing imperative can become addictive. As noted in a 1991 cautionary essay:
Like many of our treatments, however, diagnostic testing is not without its adverse effects. Increased health care costs are the most obvious: wide geographic variations in the use of expensive tests persist more than 30 years after such inexplicable variation was first exposed.2 Still more insidious consequences lurk. One is the problem of false-positive results. The prevalence of detecting a serious condition may be as low as 0.5% to 3.0% when diagnostic tests are ordered in patients with a low probability of disease,3 meaning that a diagnostic test with a 90% sensitivity and 90% specificity would yield 4 to 19 false-positive results for every true-positive result in patients for whom the test is ordered simply to rule out a disease for which the clinical suspicion is already low. This disproportionately high false-positive rate may then cascade into additional and sometimes invasive procedures, not to mention considerable patient anxiety that may persist months after a negative finding of a workup cancels out the initial test results. One might consider this PTSD (posttest stress disorder) an iatrogenic variant of the traditional PTSD (posttraumatic stress disorder).
Thank you for submitting a comment on this article. It will be reviewed by JAMA Internal Medicine editors. You will be notified when your comment has been published. Comments should not exceed 500 words of text and 10 references.
Do not submit personal medical questions or information that could identify a specific patient, questions about a particular case, or general inquiries to an author. Only content that has not been published, posted, or submitted elsewhere should be submitted. By submitting this Comment, you and any coauthors transfer copyright to the journal if your Comment is posted.
* = Required Field
Disclosure of Any Conflicts of Interest*
Indicate all relevant conflicts of interest of each author below, including all relevant financial interests, activities, and relationships within the past 3 years including, but not limited to, employment, affiliation, grants or funding, consultancies, honoraria or payment, speakers’ bureaus, stock ownership or options, expert testimony, royalties, donation of medical equipment, or patents planned, pending, or issued. If all authors have none, check "No potential conflicts or relevant financial interests" in the box below. Please also indicate any funding received in support of this work. The information will be posted with your response.
Some tools below are only available to our subscribers or users with an online account.
Download citation file:
Web of Science® Times Cited: 2
Customize your page view by dragging & repositioning the boxes below.
More Listings atJAMACareerCenter.com >
Users' Guides to the Medical Literature
Chapter 16. Diagnostic Tests
Users' Guides to the Medical Literature
Chapter 17.1. Spectrum Bias
All results at
Enter your username and email address. We'll send you a link to reset your password.
Enter your username and email address. We'll send instructions on how to reset your password to the email address we have on record.
Athens and Shibboleth are access management services that provide single sign-on to protected resources. They replace the multiple user names and passwords necessary to access subscription-based content with a single user name and password that can be entered once per session. It operates independently of a user's location or IP address. If your institution uses Athens or Shibboleth authentication, please contact your site administrator to receive your user name and password.