More is Not Always Better: Study Shows “Cascades of Care” are Harming Patients, Providers.

In Uncategorized by Seth Peterson, Physical Therapist Oro Valley

Have you ever had an x-ray or MRI that led to more tests and appointments?  If so, then you may have experienced a “cascade of care,” which was a term used in a new study in JAMA you can find here.  The study classified “cascades of care” as decisions, further testing, emergency room visits, etc that occurred following an incidental finding from testing. 

The Study

In the study, physicians were surveyed to determine whether they had experienced cascades of care and how it impacted them and their patients.


99.4% of physicians experienced cascades of care

68.4% reported their patients experienced psychological harm

15.6% reported their patients experienced physical harm

57.5% reported their patients experienced financial burden

The majority of physicians themselves reported feeling anxiety and frustration as a result of a cascade. Another finding was that most of the tests causing this were diagnostic imaging tests like x-rays and MRIs.  We know, and have written about in previous posts, the frequency of incidental findings during these tests.  For example, the finding of “degenerative disc disease,” which can cause significant psychological stress on some patients, is present in most people over the age of 50.  However, these “wrinkles on the inside” can lead to nervous patients and providers performing additional tests and procedures.

What it Means for You

The authors of this study suggested avoiding the initial test whenever possible.  1 of 3 physicians reported the initial test was not appropriate.  Since the majority of testing in this study were diagnostic imaging tests, it might be worthwhile to avoid getting these tests whenever possible.  In most cases, the findings on diagnostic imaging tests do not lead to a change in treatment.  Since you are most likely interested in getting better from your condition, not changing what your x-ray looks like, it makes sense to see someone that can detect clinical findings that are amenable to treatment.  Aside from deciding treatment, remember than most of the physicians said this testing caused their patients “financial burden.” This is is line with other posts we have done showing that you can save around $1,500 by starting care with a physical therapist. Most of that money is likely saved by avoiding other risky tests and procedures.

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Cascades of Care After Incidental Findings in a US National Survey of Physicians | Anxiety Disorders | JAMA Network Open | JAMA Network. Accessed October 27, 2019.