Cascades of care . . . and other stories

Incidental findings

Nearly 50 years ago, Ivan Illich in his book Medical Nemesis accused modern medicine of being a threat to health. At the time most people thought that his claims were exaggerated. Now many doctors admit that he was right. A survey of members of the American College of Physicians finds that all had witnessed “cascades of care”—a phenomenon in which incidental findings trigger an escalating series of investigations that lead to psychological damage, physical injury, time in hospital, and unnecessary financial cost (JAMA Netw Open doi:10.1001/jamanetworkopen.2019.13325). Minerva thought that cascades of care was too …