Andrew Rudin MD | The Silent Risk in Modern Medicine: How Excessive Testing Is Harming Patients

As medicine becomes increasingly digitized, data-driven, and diagnostic-focused, a profound yet quiet problem is growing beneath the surface: overtesting. While diagnostics are vital in delivering effective healthcare, a surge in unnecessary tests is now linked not only to increased healthcare costs—but to physical harm, psychological distress, and even cancer.

Recent research published in The Journal of General Internal Medicine reports that more than one-third of diagnostic tests performed in outpatient settings are medically unnecessary, often leading to downstream interventions that yield no measurable benefit. The implications for clinical practice are serious: diagnostic overuse may soon rival overtreatment as a leading contributor to iatrogenic harm.

Among those sounding the alarm is Andrew Rudin, MD, a highly respected cardiologist practicing in Tennessee. Known for his rigorous commitment to evidence-based medicine, Dr. Rudin has emerged as a leading voice on the dangers of diagnostic excess and the urgent need for clinical restraint.

“The issue isn’t just waste,” says Andrew Rudin, MD. “It’s that we’re exposing patients to unnecessary risk—radiation, biopsies, surgeries, anxiety—and we’re calling it thorough care.”

The Diagnostic Cascade: A Modern Clinical Dilemma

The primary concern with overtesting lies in what researchers term the diagnostic cascade—a chain of events triggered by a test that may not have been needed in the first place. Often, a single imaging scan or lab result sets off additional procedures, each with its own set of risks and psychological implications.

For example, a CT scan ordered for non-specific abdominal pain may detect a benign lesion. That “incidentaloma” might then prompt a biopsy, which could lead to complications, all in a patient who had no life-threatening condition to begin with.

A review of Medicare claims revealed that 40% of patients who underwent imaging for non-urgent symptoms were subject to at least one follow-up test or specialist referral—even when no clinical intervention was ultimately required.

Dr. Rudin explains, “In Tennessee, I’ve seen patients cycle through months of tests, appointments, and procedures after one ambiguous finding. We end up treating the imaging, not the person.”

Radiation and Risk: The Long-Term Impact of Imaging

One of the most concerning findings in recent literature relates to the cumulative radiation exposure from overused imaging tests, particularly CT scans and nuclear medicine procedures. The American College of Radiology notes that a single abdominal-pelvic CT delivers the equivalent of nearly 400 chest X-rays worth of radiation. Repeat scans compound this exposure, particularly in younger patients and those with chronic conditions.

A 2024 study published in JAMA Internal Medicine found a statistically significant association between frequent diagnostic imaging and an elevated risk of secondary malignancies, particularly thyroid and hematologic cancers.

Dr. Rudin has responded by establishing stricter protocols within his clinic: “We don’t avoid imaging when it’s indicated. But we ask: Will this test change our management? If not, we pause.”

Psychological Toll and the Burden of Uncertainty

Overtesting also carries a profound psychological burden. Incidental findings and ambiguous results lead many patients to believe they are seriously ill, even when follow-up tests prove otherwise. The resulting anxiety, emotional exhaustion, and erosion of trust in the healthcare system are often overlooked.

A survey conducted by the University of Michigan found that 61% of patients who received an incidental finding described the experience as more stressful than their initial symptoms. This is particularly problematic in an era where mental health and patient well-being are increasingly recognized as integral to health outcomes.

Andrew Rudin, MD, emphasizes this dynamic in his patient interactions. “When you give someone a label or a shadow of a diagnosis, it changes how they view their body. That has consequences—emotionally and physically.”

Defensive Medicine and Economic Incentives

While most physicians agree that unnecessary testing should be reduced, many continue to order them out of fear of litigation, lack of time, or misaligned incentives in fee-for-service models. In some institutions, diagnostic volume still equates to higher revenue, regardless of clinical necessity.

In this environment, Dr. Rudin advocates for diagnostic minimalism—a discipline of choosing fewer, more meaningful tests grounded in patient history, clinical probability, and shared decision-making.

“A careful physical exam, good listening, and thoughtful reasoning are sometimes more valuable than any lab result,” says Andrew Rudin, MD. “But we’ve built systems that reward reaction instead of reflection.”

Toward Diagnostic Stewardship

To counteract this trend, a growing number of institutions are adopting diagnostic stewardship programs—clinical frameworks designed to optimize testing by reducing unnecessary orders, improving test selection, and educating clinicians and patients alike.

Dr. Rudin’s clinic in Tennessee was one of the first in the region to implement a formal diagnostic stewardship initiative. It includes:

• Use of clinical decision support tools integrated into the electronic health record
• Mandatory second-opinion protocols for high-cost imaging
• Patient-facing educational materials explaining risks of overtesting
• A “choose wisely” checklist embedded into new clinician training

The results have been striking: reduced imaging utilization, improved diagnostic accuracy, and higher patient satisfaction scores.

Patient Engagement and Shared Decision-Making

One of the most effective tools in preventing overtesting is patient engagement. Many patients simply do not realize that tests have risks—physical, financial, and psychological. Engaging them in shared decision-making empowers them to participate meaningfully in their care and ask the right questions.

Dr. Rudin trains his staff to explain the potential harms of overtesting as part of routine informed consent. “It’s not about saying no to patients—it’s about inviting them into the conversation. When they understand the trade-offs, they often choose the simpler path.”

Conclusion: A Better Kind of Care

The movement against overtesting is not about cutting corners—it is about restoring trust, reducing harm, and practicing medicine with integrity. As new technologies emerge and data becomes more abundant, clinicians will need to balance their use with thoughtful restraint.

Physicians like Andrew Rudin, MD, are leading this shift. By grounding their practice in clinical reasoning, evidence-based thresholds, and transparent communication, they are showing that less can indeed be more—not just for budgets, but for patient safety and peace of mind.

“Good medicine is not about how much we do,” Dr. Rudin reflects. “It’s about how wisely we do it.”

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