Re: Appropriate use of diagnostic tests in medical practice

It has been some time since I practised medicine actively, but I think there is some nuance required in the statement “It is not a sufficient justification to order a test solely to satisfy one’s curiosity or to alleviate anxiety if the evidence does not support its use” [BCMJ 2026;68:141-144].

Stewardship of limited resources is the responsibility of everyone in the health care system. There can be and are different perspectives on what responsible decisions are. Evidence-based decisions are ideal but often lack precision and can be poorly informed. Curiosity is the foundation of clinical care—without it, differential diagnoses are not possible, and an evolving worldview is stymied. Algorithmic care, perhaps in the future mediated by artificial intelligence, may have value, but it will not replace the human side of medicine or substitute the need of physicians to advance their perspectives. Trust and human relationships remain the foundation of clinical care. Managing complexity and uncertainty remain the most challenging aspects of providing care. Therefore, I disagree. Curiosity is the only reason to order a diagnostic test; everything else is superfluous, even if alternative considerations are important.

As an example, my father-in-law recently died of metastatic cancer. His ordeal started when he complained of pain and disability in his right hip sufficient to stop working and to interfere with his responsibilities as a caregiver at home. His family doctor attributed his symptoms to trochanteric bursitis. However, despite time and treatment for bursitis, his symptoms worsened. Eventually, a diagnosis of metastatic cancer was made after an emergency admission and a CT scan. He died shortly after.

From my perspective, failed treatment is an indication for timely advanced investigations—curiosity and urgency—especially in a person who is disabled enough to stop working and is the primary caregiver of a wife with dementia. The lack of appropriate investigation in a timely manner is, from my perspective, linked to a dysfunctional health care system and also to promoted behavioral changes that may be inferred from the statement referred to above. I assume it was not the intent to discourage physicians from ordering tests or to inadvertently justify administrative decisions within a dysfunctional health care system, but I also think awareness of the potential unintended consequences of using platforms and words should be carefully considered.

Why would it be reasonable to assume that a physician ordered an investigation solely to satisfy their curiosity, and why would anyone presume that the evidence did not support its use? I think that a better recommendation might be “For the sake of responsible stewardship and in alignment with evidence-based care, medical decisions should include consideration of the entire clinical context and all competing interests.”
—Scott A. Lang, MD, FRCPC, FANZCA (retired)
Calgary, Alberta

This letter was submitted in response to “Appropriate use of diagnostic tests in medical practice.”