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Table 2 Five domains of change in the current practice of medicine, and their potential adverse consequences**. Second domain: escalating tests, drugs, and interventions

From: The Spectrum of Harm Associated with Modern Medicine

↑ Dependence on tests; ↓ Clinical skills: declining attention to the patient’s narrative and examination; ↓ Self-confidence; ↑ Distancing; ↓ Satisfaction; ↑ Unnecessary tests and redundant procedures; ↑ Incidental (“false-positive”) findings (begetting more tests: a vicious cycle); ↑ Cascades of care and potential of iatrogenic harm; ↑ Costs to the health-care system and patients; ↑ Disparities in health care; ↑ Prescriptions/polypharmacy, often favoring new and expensive medications; ↑ Congestion and delays compromising access; ↑ Interventions not significantly prolonging life or allowing quality of life (“futility”); ↑ Options beget harder decisions
  1. **Reported for every discipline (primarily, family medicine and general internal medicine) and setting, including hospital admissions. Domains’ effects are interwoven with each other. All contribute together to the “crisis,” “collapse,” or “chaos” (quotes) in current health-care systems