Goldilocks Medicine—More is Not Always Better When It Comes to Your Health and Wellbeing

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Work closely with your physician to decide if the benefit of any intervention is worth the risk.

You may have noticed that we are surrounded by amazing technology for nearly everything in our lives. Our cars may soon drive themselves, our refrigerator can link to the internet, and our watches can make calls and track our sleep. All this technology is solving the majority of our problems, right?

Of course not. We use technology more and more, but we all understand it has its limitations and can often create new problems.

The same is true in medical care, though very often this is difficult for us to accept. Americans generally put an unhealthy (pun intended) amount of confidence in medical advances and think it can detect and solve almost any condition, even though this is far from the case. We also pay a lot for our insurance and want to feel like we’re getting our money’s worth. Finally, many patients want to make sure “everything is okay” and think a scan or blood test will confirm good health.

Unfortunately, this misplaced trust in medical technology can sometimes lead to more harm than good.

Let me explain. First, medical technology is an amazing achievement—we have taken incredible leaps in the last few years in preventing, diagnosing, and treating a multitude of diseases. The COVID-19 vaccines are a great example. However, the human body is an astoundingly complex machine, and we are nowhere close to figuring out all the possible problems that can occur or how to treat them, despite what you might read in the news. So, whenever you are prescribed a medication, lab, or radiology procedure, be sure to consider it with a skeptical eye.

Whenever we do anything in medicine, including a simple blood test, the standard mantra is that the benefits should outweigh the risks. But be aware that EVERYTHING in medicine has potential risks, even if small. A simple blood test may seem benign, but a false positive can lead to an imaging test that can lead to a biopsy that can result in a complication. And it happens more often than you’d like to think. Some experts estimate that medical overtreatment leading to complications is the third leading cause of death in the U.S.

And I’m not talking about medical errors, where someone makes a mistake. Complications are just the cost of doing business in the medical field, even when following the standard of care. No test or treatment is perfect and never will be, because people are too variable for a one-size-fits-all scenario.

We define a normal lab in most cases as a “95 percent confidence interval,” meaning that 95 percent of all patients will fall within a certain range for a test. This doesn’t mean that 5 percent of people are sick, just that they don’t fall within this range. It can be like having blue eyes—they’re normal but fall outside the average range. If your doctor orders 20 blood tests (which is quite common), and each has a 5 percent chance of being abnormal, you then have a nearly 100 percent chance of having an abnormal test, but a much lower risk of that test actually indicating a real medical problem. The same is true for other tests and procedures.

What is Goldilocks Medicine?

What does all this mean for you? It means you should always ask questions and educate yourself about any test or treatment that is recommended. I always say that medicine is about playing the odds. If a certain medication has a 20 percent chance of a cure, but a 30 percent chance of a side effect, it may not be worth taking. Physicians should be practicing “Goldilocks Medicine”—not too little, not too much. You aim for “just the right amount” of testing and treatment. That’s not always easy, but it should always be part of the equation.

Feel free to ask your physician the following questions:

  •  Is this necessary?
  •  What are the alternatives?
  •  What are the risks versus the benefits?
  •  How much might this cost?

So next time you see a deal for a full-body CT scan on Groupon, realize that it may not be the deal you think it is. There’s a small chance they might find something concerning. However, there’s a greater chance that you’ll have a complication from radiation or contrast dye or find a “concerning” lesion that is actually benign but leads to a risky biopsy. And now you’re down the medical rabbit hole, with repeated tests, anxiety over results, and possible complications from risky procedures.

To be clear, I’m not admonishing medical care as a whole, just too much medical care. Certainly, mammograms, colonoscopies, and Pap smears, at the right intervals, can catch cancer early and should be continued—and studies back this up. Medications, for the right conditions, can result in better outcomes. And diagnostic imaging tests, for the right reasons, can save lives. I’m in medicine because I feel we have the knowledge and means to make a difference in the right situations.

It’s up to you and your physician to decide if the benefit of any intervention is worth the risk. This is where the art of medicine comes into play. There is no absolutely “correct” approach to any condition, so there should always be a conversation between you and your physician. Consider this the next time you have back pain or headaches—you should talk to your doctor, but think twice before asking for aggressive testing or treatment.

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