Franca Dicuonzo1,2, Stefano Purciariello3, Stefano Andresciani3, Aurora De Marco3, Antonio Colamaria4, Antonio Calace4. 1. Department of Neuroradiology, School of Medicine, Department of Basic Med Sci Neurosci & Sense Organs, School of Medicine, University of Bari "Aldo Moro", Bari, Italy. franca.dicuonzo@uniba.it. 2. Department of Neuroradiology, School of Medicine, Department of Basic Med Sci Neurosci & Sense Organs, School of Medicine, University of Bari "Aldo Moro", School of Medicine, Piazza Giulio Cesare, 11, 70124, Bari, BA, Italy. franca.dicuonzo@uniba.it. 3. Department of Neuroradiology, School of Medicine, Department of Basic Med Sci Neurosci & Sense Organs, School of Medicine, University of Bari "Aldo Moro", Bari, Italy. 4. Department of Neurosurgery, School of Medicine, Department of Basic Med Sci Neurosci & Sense Organs, School of Medicine, University of Bari "Aldo Moro", Bari, Italy.
Abstract
OBJECTIVE: The aim of the study is to try to explain what an overtreatment is and which ones are the possible risks related to an excess of simplification in the medical practice, through the description of an emblematic clinical case. METHODS: In the present article, we report the case of a female patient aged 57 who complained about lower back pain and crural neuralgia and had a lumbar and sacral magnetic resonance imaging performed in the Department of Neuroradiology in Bari showing suspicious repetitive bone lesions; therefore, the patient underwent several medical procedures and laboratory exams which ended with a surgical removal of a left L3-L4 foraminal disc herniation and a bone biopsy. RESULTS: When it was finally possible to exclude any other diseases including thyroid neoplasms, a "reassuring" osteoporosis diagnosis has been made since the lesions were likely to be degenerative and the patient underwent menopause 7 years ago. However, the multiplicity of the lesions of the vertebrae and of the pelvic bones as well as their signal could not be ignored, so that a close magnetic resonance imaging follow-up has been recommended. CONCLUSIONS: The present case is therefore a good example of overtreatment which may lead to delicate questions, investigating any possible mistakes in the diagnosis procedure as well as the role that defensive medicine is playing nowadays on medical procedures and the economic impact that all this can have on our healthcare system. In the end, we may ask ourselves: is "less" better or is "more" always "more?"
OBJECTIVE: The aim of the study is to try to explain what an overtreatment is and which ones are the possible risks related to an excess of simplification in the medical practice, through the description of an emblematic clinical case. METHODS: In the present article, we report the case of a female patient aged 57 who complained about lower back pain and crural neuralgia and had a lumbar and sacral magnetic resonance imaging performed in the Department of Neuroradiology in Bari showing suspicious repetitive bone lesions; therefore, the patient underwent several medical procedures and laboratory exams which ended with a surgical removal of a left L3-L4 foraminal disc herniation and a bone biopsy. RESULTS: When it was finally possible to exclude any other diseases including thyroid neoplasms, a "reassuring" osteoporosis diagnosis has been made since the lesions were likely to be degenerative and the patient underwent menopause 7 years ago. However, the multiplicity of the lesions of the vertebrae and of the pelvic bones as well as their signal could not be ignored, so that a close magnetic resonance imaging follow-up has been recommended. CONCLUSIONS: The present case is therefore a good example of overtreatment which may lead to delicate questions, investigating any possible mistakes in the diagnosis procedure as well as the role that defensive medicine is playing nowadays on medical procedures and the economic impact that all this can have on our healthcare system. In the end, we may ask ourselves: is "less" better or is "more" always "more?"
Entities:
Keywords:
Defensive medicine; Healthcare system; Magnetic resonance imaging; Medical practice; Oversimplifying; Overtreatment
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