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Treat your patient, and not his MRI!
  1. C Niek Van Dijk
  1. Academic Medical Centre, 1105 AZ Amsterdam, The Netherlands
  1. Correspondence to Professor C Niek Van Dijk, Academic Medical Centre, 1105 AZ Amsterdam, The Netherlands; C.NiekvanDijk{at}

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Some years ago, I was asked for a medical report about a left-handed truck-driver, 60 years old, who’d had a neck lipoma removed, and then lost the use of his left-arm. All of which had cost him his job and his marriage.

It happened like this. The truck-driver was attracted by one of those professional-looking adverts, and undertook a total body-scan, which revealed a benign-tumour beside his adrenal gland. So he decided to have it removed. The day before surgery, however, he mentioned that he also had a fat-lump in his left-neck, and could that also be removed? The surgeon investigated, and said he would do both at the same time. A week later, however, and strength began to disappear from the truck-driver’s shoulder. Gradually he lost all control of his upper arm.

A subsequent EMG revealed a complete lesion of the accessory nerve, and disappearance of the trapezius muscle.

As we are all aware, these periodical medical-check-ups have a limited value, if only because they lull the patient into a false sense of security. But it gets worse with false-positive outcomes. Benign incidentalomas (incidental imaging-findings) are found in up to 7% of total body scans, and their prevalence increases with age.1

For instance, If you were considering a Prostate Cancer Test (PSA) as a …

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