When a Doctor's Good Intentions Kill
Winter didn't kill him, but his doctors did...
It was a cold Thursday in December – complete with snow, hail, and freezing rain. Despite the poor conditions, George spent the time working outside. He didn't come back inside until dinnertime.
The next day, he wasn't feeling so hot – his throat was terribly sore. Still, he worked outside again – while noticing that his voice had become hoarser. By evening, his throat was so irritated that he could hardly speak.
Then George awoke at 2 a.m., having trouble breathing. Hours later, his doctors drained some of his blood several times... had him drink and gargle with liquids to soothe his throat... gave him an enema... and gave him something to make him throw up.
By 4:30 p.m., George was dying – and he knew it.
He went over his will with his wife. And shortly before midnight, his body just gave out.
The year was 1799. The patient was none other than the founding father of our country, George Washington.
And he was essentially treated to death by his own trusted doctors. Just look at the aggressive treatments they subjected him to...
They bled George multiple times – for a grand total of 80 ounces or nearly half of the blood in his body... The "throat soother" he choked on contained vinegar, molasses, and butter... The concoction he gargled had more caustic vinegar plus sage tea... And, of course, there was the enema and the induced purging.
Nowadays, we see all of these crazy treatments as barbaric (especially bloodletting). But as it turns out, our modern health care system has its own version of this exact same problem. And that's what I'll be talking about today: the big problem with overtreatment in our health care system and how to protect yourself from becoming a victim.
Doctors' Cascade of Care
Nearly everyone, doctors included, knows the line:
I will do no harm.
This famous line is often used in the oath that medical students recite during graduation.
But instead of "doing no harm," today's doctors subject their patients to what medical researchers call "cascades of care" – and not the good kind.
A cascade of care is exactly what it sounds like: a never-ending barrage of tests or procedures.
Now, cascades can be beneficial when the care is evidence-based and justified. For instance, a high-risk patient gets a colonoscopy that reveals early-stage cancer. That kickstarts a chain reaction of care – like biopsies and then treatments – that can save the patient's life.
But then there's the other cascade... like your doctor ordering a test "just to check things out" even though you don't fit the risk profile and have zero symptoms.
Then the results show a little extra that the doctors didn't expect to find, unrelated to the original reason for getting the test. It's something not quite on the normal side of things... what we call an incidentaloma (an incidental finding during medical imaging). And then your doctor wants to further investigate.
So you get more tests... You might find yourself with diarrhea from taking antibiotics or constipated from opioids... or getting bits of you cut out for biopsies that lead to infections... You might even find yourself on the operating table where something could seriously go wrong.
Now sometimes during the battery of tests and procedures, your doctor – or perhaps the multiple specialists you've been ping-ponged back and forth among – might find something potentially dangerous after all... a true problem that needs to be addressed.
But more often, you're left drowning in tests and treatments that eat up your time and money, leaving you constantly anxious as you await each result.
Back to the very first test, the little extra something that it revealed is known as an incidental finding.
Some researchers estimate that incidentalomas turn up in as many as 52% of lab and imaging tests.
This sort of nightmarish chain reaction – all triggered simply by, say, a blur from that unnecessary first X-ray – is more common than you'd expect.
A 2019 JAMA study involving a national survey of nearly 400 responses from internists revealed that nearly all (or 99.4%) of these doctors had experienced cascades of care. While 90.9% reported seeing "clinically important or intervenable outcomes" in at least one of those instances, 94.4% also admitted to participating in cascades with zero such outcomes.
But it gets worse...
- 77.2% saw a cascade lead to an invasive test. More than half saw cascades where the patient ended up in the emergency room or being hospitalized.
- 86.7% of respondents believed that their cascades ended up harming the patient in various ways – psychologically, financially, and physically.
- 68.9% saw at least one kind of harm befall their patients within the past year. 86.5% of doctors said these recent cascades found nothing "clinically important or intervenable." And in 81.8% of cascades that did uncover a problem worth treating, the patient still suffered harm along the way.
- Imaging tests started most of the most recent cascades (54.4%), and most took place in outpatient centers (64.9%). A third of doctors admitted that the initial tests were unnecessary.
- Almost 16% saw their patients suffer physical harm. And more than half (57.5%) said cascades had caused financial harm.
You can see just how one initial, unnecessary test can quickly develop into more tests, visits, and treatments – draining your wallet, time, and peace of mind.
But there's a simple way to avoid that ugly snowball effect...
Be Your Own Health Care Advocate
When you're discussing your care, speak up for yourself.
Specifically, you should ask your doctor 10 questions about the test he or she is proposing you get.
The questions I'll share today are adapted from a campaign called Choosing Wisely. It's an initiative from the American Board of Internal Medicine, along with nine medical-specialist societies, to bring transparency to the overtreatment problem.
In 2012, they collaborated to make evidence-based lists of common tests and procedures that were overused, expensive, oftentimes unnecessary, and had the potential to cause harm.
Over the next decade, more than 80 specialist societies joined in. More than 700 recommendations were listed and reached more than 30 other countries. This campaign is no longer active, but its recommendations remain valuable today.
Here are some of the questions I recommend you ask...
- Do I really need this test?
- What are the risks, including side effects, of getting the test?
- Are there simpler, safer options like lifestyle changes I could try first instead?
- What happens with my condition if I don't do anything?
- How accurate is this test (including false positives and false negatives)?
Stay tuned for part two this Thursday, where I'll share the final five questions you'll need to ask, along with the truth about how hospital monitoring can end up making you sicker.
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What We're Reading...
- Something else: Why Gen Z is trading night clubs for Japanese-style listening bars.
Here's to our health, wealth, and a great retirement,
Dr. David Eifrig and the Health & Wealth Bulletin Research Team
February 24, 2026