“Overkill” – Is overtesting and overdiagnosing patients leading to harm?

This week Dr. Atul Gawande, professor at the department of surgery in Harvard Medical School, wrote an article in The New Yorker, “Overkill”. He discusses potential consequences with ordering too many tests that may be unnecessary and how it contributes to high cost and decreased value of health care. Interestingly, he argues that even the correct diagnosis doesn’t lead to good outcomes all the time. He discusses how “overdiagnosis” can lead to anxiety and stress on the patient’s end and even more tests, procedures, and costs. Dr. Gawande uses examples from his own personal life and colleagues that illustrate how much harm can happen when not appreciating the actual value of the care we provide. He even refers to the Texas town of McAllen and the remarkable change the hospital systems and providers have undergone in a positive way since writing his well publicized article in 2009, “The Cost Conundrum.” Thanks to Dr. Kazi for bringing this to our attention! Check out his article below by clicking on the link.


(Image is illustration by Anna Parini featured in May 11, 2015 issue of The New Yorker)

Common confirmatory tests in Brain Death

Cerebral angiography

  • Contrast medium under high pressure in both anterior and posterior circulation injections
  • No intracerebral filling at the level of the carotid or vertebral artery entry to the skull
  • Patent external carotid circulation
  • Possible delayed filling of the superior longitudinal sinus


  • Minimum of eight scalp electrodes
  • Interelectrode dependencies should be between 100 and 10,000
  • Integrity of the entire recording system should be tested
  • There should be no electroencephalographic reactivity to intense somatosensory or audiovisual stimuli

Transcranial Doppler ultrasonography

  • Bilateral insonation
  • The probe is placed at the temporal bone above the zygomatic arch or the vertebrobasilar arteries through the suboccipital transcranial window
  • The abnormalities should include a lack of diastolic or reverberating flow, small systolic peaks in early systole, and a lack of flow found by the investigator who previously demonstrated normal velocities

Cerebral scintigraphy (technetium Tc 99m hexametazime)

  • Injection of isotope within 30 minutes of reconstitution
  • Static image of 500,000 counts at several time intervals: immediately, between 30 and 60 minutes, and at 2 hours.