This is, in my opinion, the most conceptually important article I have read in the few months I’ve been posting to this blog.
This is where Dr. Newman and Dr. Schriger, outstanding clinicians and analysts of data, present a compelling case regarding the diagnosis and treatment of pulmonary embolism. In brief, the authors try to estimate, based on the limited evidence, both the benefits and harm of diagnosis and treatment of pulmonary embolism. In their review, very few patients were found to benefit from treatment of pulmonary embolism – the existing evidence is weakly supportive of anticoagulation. Additionally, they show a great many patients were harmed by excessive testing and treatment of clinically unimportant pulmonary embolisms.
This is, while a complicated opinion piece, a lovely summation in a nutshell of the concept that finding more “disease” does not equal better outcomes. And, depending on the risks of testing and treatment – the barbaric contrast, radiation, and rat poison that diagnosis of PE typically entails – more people would be alive today if we all stopped testing for pulmonary embolism.
This is not unique to pulmonary embolism – this is partly the same issue we encounter with overtesting our low-risk chest pain patients, particularly with CTA. What this means – and, of course, subject to legal challenge in our bizarre society – is that with our current methods of detection and treatment, society would be better off as a whole if we missed a few pulmonary embolisms in order to find and treat the few clinically relevant ones. The only shame in this article is that not nearly enough people will read it and take it to heart.