Do not prescribe periodic examinations without a specific diagnostic hypothesis.
Prescribing unnecessary tests is detrimental to both patients and the ecosystem, representing a lamentable waste of resources. With the exception of the three oncological screening programs endorsed by the Italian Ministry of Health (breast cancer, cervical cancer, and colorectal cancer), it is not correct to recommend periodic examinations without clinical correlation or a rationale grounded in case finding principles. The latter approach entails the physician postulating the presence of specific pathologies based on the patient’s medical history, physical examination, and the identification of risk factors (age, gender, occupation, environment, etc.). This practice is founded upon at least three reasons:
• Statistical Grounds: the positive and negative predictive value of a test is related to the pre-test probability, whereby the disease prevalence. Administering tests indiscriminately serves to exacerbate false positive outcomes.
• Ethical Considerations: each examination carries the risk of overdiagnosis and adverse events. Hence, only tests that confer tangible benefits to the patient should be prescribed. Furthermore, superfluous tests could delay necessaries ones.
• Environmental Impact: every diagnostic test contributes to greenhouse gas emissions, further exacerbating global warming trends and environmental degradation.
1. Higher Institute of Health. Epicentro. Cancer screening https://www.epicentro.iss.it/screening/
2. Furlan L. et al. Choosing Wisely in clinical practice: Embracing critical thinking, striving for safer care. J Intern Med. 2022;291:397-407.
3. Hernandez LD et al. Expectations about check-up examinations among Swiss residents: A nationwide population-based cross-sectional survey. PLoS One. 2021;16: e0254700 .
4. Akobeng AK. Understanding diagnostic tests 1: sensitivity, specificity and predictive values. Acta Pediatrica. 2007; 96:338-341.
5. Berrington de González A et al. Risk of cancer from diagnostic X-rays: estimates for the UK and 14 other countries. Lancet. 2004;363:345-51.
6. Barratt A, et al. Overdiagnosis is increasing the carbon footprint of healthcare BMJ 2021;375:n2407.
Attention. Please note that these items are provided only for information and are not intended as a substitute for consultation with a clinician. Patients with any specific questions about the items on this list or their individual situation should consult their clinician.