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“Less is better”—always true?

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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?”

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Authors and Affiliations

  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, Stefano Purciariello, Stefano Andresciani & Aurora De Marco

  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

  3. Department of Neurosurgery, School of Medicine, Department of Basic Med Sci Neurosci & Sense Organs, School of Medicine, University of Bari “Aldo Moro”, Bari, Italy

    Antonio Colamaria & Antonio Calace

Authors
  1. Franca Dicuonzo
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  2. Stefano Purciariello
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  3. Stefano Andresciani
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  4. Aurora De Marco
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  5. Antonio Colamaria
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  6. Antonio Calace
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Correspondence to Franca Dicuonzo.

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Dicuonzo, F., Purciariello, S., Andresciani, S. et al. “Less is better”—always true?. Neurol Sci 41, 41–47 (2020). https://doi.org/10.1007/s10072-019-04016-w

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  • DOI: https://doi.org/10.1007/s10072-019-04016-w

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