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Failure to Diagnose is Dangerous — but so is Overtreatment

Doctors must balance many factors when working in our complex healthcare system. But patient care must still be primary. This means, in part, that doctors order diagnostic tests when necessary, but refrain from doing so when it serves no real medical purpose.
To be sure, failure to diagnose cancer is a real risk. This is as true in New York or Brooklyn as it is anywhere in the country.
The need to detect cancer and other conditions early, however, does not justify excessive tests and unnecessary procedures that do not benefit or may actually harm a patient.
The former head of the Centers for Medicare and Medicaid Services, Don Berwick, says that nearly 30 percent of the spending on medical care is essentially a waste.
A new book by a prominent doctor, Otis W. Brawley, tackles the issue head-on. Brawley is the chief medical officer of the American Cancer Society. His book is called “How We Do Harm: A Doctor Breaks Ranks About Being Sick in America.”
One of the problems Dr. Brawley sees with the healthcare system is the frequent use of medical tests, procedures and medications that aren’t really helpful. In fact, sometimes they make things worse.
Dr. Brawley gives the example of Ralph DeAngelo, a 72-year-old man who had a free prostate cancer screening at his wife’s insistence. His PSA test showed a level of antigen that was only slightly elevated. This could easily have been the result of an enlarged prostate, which after all is common in older man. It did not necessarily indicate prostate cancer.
Nevertheless, the heavy medical guns swung into action. DeAngelo endured 12 biopsies, the removal of his prostate gland, and radiation therapy that opened a hole between rectum and bladder that led to a colostomy. Five years after the original PSA test, DeAngelo died of a urinary tract infection.

Author

Jay W. Dankner

JAY W. DANKNER was born, raised and educated in Brooklyn, New York. After graduation from law school in 1973, he joined the firm of the legendary, Harry H, Lipsig, under whose tutelage he learned the intricacies of civil litigation and trials. He tried and won his first case against General Motors in a case involving a design defect within weeks after his admission. Thereafter, he focused his attention on the emerging and developing field of law known as products liability litigation.

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