My pager emits the same urgent beep no matter the occasion. That afternoon, it was the local preoperative clinic to say my 80-something patient, Lily, had been given an electrocardiogram (EKG) "just to be safe" before a minor office procedure.
The EKG was a little off, the page went on. Could I take a look? Lily (I'm identifying her by only her first name at her request) felt fine. No chest pain. No trouble breathing. But now that the irregularity was out there, the procedure would be delayed until we had answers.
Flash forward one borderline blood test result, several phone calls between myself, Lily, and the anesthesiologist, 14 emails, an office visit, and a completely normal stress test. Lily (and her heart) were in no better health, yet she was slightly less well off and more than slightly distressed by all the trouble she went through. I was disappointed that I'd failed her.
And this was a relatively good outcome.
"If You Give a Mouse a Cookie," Laura Numeroff's classic children's book, is a cautionary tale about the downstream consequences of a single, seemingly innocuous decision. You gave the mouse the cookie. Naturally, he wanted a glass of milk to go with it. Before long, the mouse was moving in and sharing your Netflix password.
This pattern is familiar to many of us, whether as doctors or as patients: A medical test spurs a "cascade" of phone calls, office visits, tests and treatments, each a logical, even inevitable, progression from the one before.
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https://www.washingtonpost.com/health/how-one-medical-checkup-can-snowball-into-a-cascade-of-tests-causing-more-harm-than-good/2020/01/03/0c8024fc-20eb-11ea-bed5-880264cc91a9_story.html
