The Hidden Cost of "Just to Be Safe" Testing

​​The Hidden Cost of “Just to Be Safe” Testing

I’m suddenly on the other side of the conveyor belt I know so well professionally — this time, as the patient.

Recently, a large thyroid nodule was found incidentally, and now I’m staring down the familiar sequence: more imaging, more interpretation, biopsy discussions, the phrase “it may be nothing,” followed quickly by the implication that it also may not be nothing.

Here’s how it started.

I recently switched to a new doctor, who also happens to be my husband’s physician. I made the change because I’ve been genuinely impressed with the care he’s given my husband (and trust me when I tell you my standards are HIGH).

At my first visit, as part of getting established in the practice, he ordered a thyroid ultrasound. I had never had one before and, honestly, hadn’t thought much about my thyroid. I’ve never had symptoms that suggested a problem.

During the scan, I could see the screen as the technician moved the probe across my neck. Years of looking at medical images have trained my eyes in a way that’s hard to turn off. And pretty quickly, something caught my attention.

There it was: a large thyroid cyst, also called a nodule — and it wasn’t subtle. In that moment, I felt the quiet shift that so many patients experience: the realization that a routine check can suddenly open the door to a whole new set of questions.

And there’s a very specific kind of psychological whiplash that comes from going in search of reassurance — and instead being handed uncertainty. This is the part of modern medicine we do not talk about enough.

We love the language of “proactive”; we praise vigilance; we celebrate early detection as if more information is always better information, and more testing is always better care. Sometimes that is true, and sometimes it is lifesaving. But sometimes what starts as a non-standard scan, a “just to check,” or a body-peeking expedition uncovers an incidental finding that is real enough to demand follow-up, but ambiguous enough to disrupt your peace, your sleep, your concentration, and frankly, your identity.

That gray zone is expensive, not only financially, but psychologically.

Let me be very clear: I am not anti-testing or anti-imaging, and I am certainly not anti-medicine. I am deeply pro-evidence, pro-good judgment, and pro-using the right test for the right patient at the right time. My motto is: don’t do a test unless you know what you will do with the RESULTS of that test.

But I am also increasingly aware of the hidden cost of testing that is not truly standard, not clearly indicated, or marketed more as emotional insurance than sound medical strategy.

Because here is what can happen: You feel fine, then you get a ‘procedural’ test, something is seen (which it often is), now you are no longer “fine.” Not because you are necessarily sick, but because you have now entered a new category: person under evaluation.

That is not a small shift.

A thyroid nodule is actually a perfect example of this. Thyroid nodules are common, very common, and most are benign. Although many are found accidentally, once they are discovered, they often trigger a cascade of ultrasounds, recommendations, measurements, surveillance, sometimes biopsies, and an unavoidable question hanging in the air: could this be cancer?

Even when the statistical odds remain reassuring, the emotional experience is anything but.  

In my case, several features are suspicious for malignancy: its size, appearance, and shape. Last week, I had an FNA (fine needle aspiration) with four relatively painless needle aspirations of this nodule, and now I await the results. The endocrinologist did not love the way it looked, and because I understand the correlation between ultrasound characteristics and malignancy risk, I am trying to prepare myself for whatever the pathology report may show.  

But this is where I think the conversation needs to get more sophisticated.

We tend to talk about testing in binary terms: good or bad, responsible or neglectful, early detection or dangerous avoidance. Real life is messier. Some tests save lives, some tests create noise. Some findings matter urgently, some create months of medical theater before ultimately meaning very little. And some findings fall into that maddening middle where follow-up is reasonable, but the psychological toll starts long before the pathology report does.

It’s the late-night Googling, the sudden awareness of your body and your mortality. It is the bizarre emotional speed with which the brain can go from “routine” to “what if this is the beginning of something terrible?” And the part that’s worth sitting with is the loss of innocence that comes from becoming a patient, even temporarily.

Because one of the hidden costs of incidental findings is that they can change the way you relate to your own body. A body that felt familiar and trustworthy on Monday can feel suspect by Wednesday. You start listening, interpreting, and watching differently. And that shift, even before any diagnosis, is real, powerful, and sometimes all-consuming.

Sometimes the most medically intelligent question is not “what else can we scan?” but rather “was this test truly necessary in the first place, and if it reveals something incidental, am I prepared for the emotional and medical cascade that may follow?”

That is not fear-mongering.
That is informed consent.
And frankly, I think we deserve a lot more of it.

So this is where I am landing, at least for now: more testing is not automatically better care, more detection is not automatically better health, and more information is not automatically more wisdom. Sometimes, additional testing can detect something dangerous before it produces symptoms or causes harm, and only time will tell if that will ultimately be my story.

For now, I’m staying anchored in the grounding practices that help steady me. This experience has changed me in ways I am still processing, but it has also sharpened my gratitude for every moment and experience I get to have. I’m not perfect at it, and I still feel the pull toward rabbit holes and overwhelming worst-case-scenario thinking, but I am trying, as intentionally as I can, to focus on joy and strength rather than fear of the uncertain. (With the understanding that doctors tend to swing from overt denial to full-blown emergency mode)!

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