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Paul A. Heidenreich, MD, MS

Arch Intern Med. 2009;169(14):1262-1264.

	Since this article does not have an abstract, we have provided the first 150 words of the full text and any section headings.

Why has diagnostic testing, and in particular diagnostic imaging, increased to such a high level in the United States?¹ I would argue that it is a combination of our medical culture (and our human nature) to eliminate uncertainty, scientific and technical advances leading to new and improved noninvasive tests, substantial barriers to evaluating the value of each test, and patient preference. Combined, these factors have likely contributed to an exponential growth in testing (particularly imaging) in recent years and are the areas that must be addressed if we wish to provide more efficient care.

Traditional medical education instructs the student to create a differential diagnosis, perform those tests that will address each of the items on the differential, and then repeat this process until he or she arrives at a diagnosis. For symptoms with multiple etiologies such as syncope, a list of possible causes and . . . [Full Text of this Article]

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