Refraining from testing and evidence-based testing is nice, but difficult in today’s practice environment:

In one study in which Dr. Kroenke said he examined 500 patients with physical symptoms, 70% of all subjects improved two weeks after seeing a primary care physician. While symptoms persisted in about 25% of patents, follow-up studies showed that serious diseases not suspected during initial evaluations rarely emerged after one year.

The lesson, said Dr. Kroenke, is that a full battery of testing is often not the solution to common complaints. “Additional testing is quite often negative, so we want to avoid repeating workups and referrals,” he explained.

In court, it’s much more difficult to defend not doing a test, than to defend doing a (likely unnecessary) test with a negative result. So far, physicians are not being sued for doing too much testing, and until that changes, there will continue to be a disconnect between real-world medicine and evidence-based medicine.