Protecting Patients from Unnecessary Testing in Modern Cardiology
Modern cardiology is a field defined by precision and innovation. From wearable monitors to catheter-based interventions, the tools available to today’s cardiologists would have seemed like science fiction a generation ago. But amid the celebration of technology, a quieter crisis is unfolding—one that threatens to erode both patient safety and trust. According to Dr. Andrew Rudin, MD, a nationally recognized cardiologist and medical educator, the overuse of low-value care has become one of the most pressing issues in contemporary cardiovascular medicine.
Low-value care refers to tests, procedures, or treatments that offer little to no clinical benefit for a patient, and may even cause harm. In cardiology, it often arrives subtly—through an unnecessary stress test, a duplicate imaging scan, or a stent placed in a patient whose symptoms could have been managed medically.
“It’s not just about waste,” says Dr. Rudin. “It’s about the damage we do when we stop questioning our assumptions.”
Defining the Problem: What Counts as Low-Value?
To the average patient, every medical test may feel helpful. After all, more data seems safer than less. But in clinical practice, more is not always better—especially when that information does not change the course of care.
In cardiology, this plays out in several ways. For example, a patient with mild, stable chest pain may undergo a stress test, followed by an echocardiogram, then a coronary CT angiogram. Each test builds on the next, not because they are all necessary, but because of a culture that rewards thoroughness over judgment.
Dr. Rudin explains that defensive medicine, institutional protocols, and outdated habits often push physicians toward testing that isn’t clinically justified. “There’s a difference,” he says, “between being careful and being compulsive. The latter can cause real harm.”
The Impact on Patients
While low-value care may seem benign—or even helpful—its consequences can be serious. False positives from unnecessary testing can lead to anxiety, repeat evaluations, radiation exposure, and even invasive procedures that carry real risk.
One of the most common examples is the use of stents in patients with stable coronary artery disease. Studies like COURAGE and ISCHEMIA have shown that in many of these cases, medical therapy provides the same benefit as stenting, without the need for a procedure. Yet many patients still undergo interventions that may not improve their outcomes.
“When a patient believes they were saved by a procedure they didn’t need,” Rudin reflects, “we’ve failed them. Not because we hurt them physically—but because we’ve altered their understanding of their health in a way that’s misleading.”
Why It Persists
The persistence of low-value care isn’t about greed or ignorance. It’s about systems, incentives, and training. Hospitals are reimbursed for procedures. Physicians are measured by throughput. And medical education often emphasizes diagnosis and action over reflection and restraint.
There is also a psychological component. Many physicians feel a moral duty to do everything possible—even when evidence suggests that less would be more. Fear of missing a rare diagnosis, of being blamed for inaction, or of disappointing a patient who expects a test, can push clinicians to over-order.
Dr. Rudin sees these pressures clearly but believes they must be resisted. “You can’t build a relationship on overtesting,” he says. “You build it on trust, transparency, and clinical reasoning.”
Changing the Conversation
One of the most important steps in reversing low-value care is changing the conversation with patients. Instead of focusing on abnormalities and interventions, physicians need to discuss risk, probability, and options.
For example, rather than saying, “Let’s test for blockages,” Dr. Rudin might say, “Let’s talk about what’s causing your symptoms—and whether a test will help us treat you more effectively.” These subtle shifts frame medicine as a collaborative process, not a series of automatic decisions.
He also teaches patients that watchful waiting is not neglect. On the contrary, it often reflects a deeper understanding of the disease and a stronger confidence in the body’s capacity to heal or stabilize without aggressive intervention.
Teaching the Next Generation
As part of his academic work, Dr. Rudin is deeply involved in training cardiology fellows and residents. For him, teaching restraint is not about discouraging curiosity—it’s about sharpening it.
He encourages young doctors to ask themselves hard questions:
- What will I do with this result?
- Will this test change the management plan?
- Am I testing out of habit—or out of need?
By embedding this kind of critical thinking early, Dr. Rudin believes the culture of medicine can shift over time. He envisions a generation of cardiologists who are just as proud of the decisions they didn’t make as the ones they did.
“It’s not heroic to intervene. It’s heroic to stop, think, and listen. That’s harder—and more humane.”
A Systemic Issue, A Cultural Opportunity
To reduce low-value care, it’s not enough to educate individual physicians. Institutions must also evolve. That includes developing metrics that reward outcomes, not just procedures; creating time for meaningful patient conversations; and building systems where clinicians can practice thoughtfully without penalty.
Dr. Rudin also supports national efforts like Choosing Wisely, which provide specific recommendations on what not to do in various specialties. These campaigns empower both patients and providers to question unnecessary care.
Still, he acknowledges that systemic change is slow. “This is a long game,” he says. “But we owe it to our patients—and to ourselves—to play it.”
The Heart of the Matter
At its core, Dr. Andrew Rudin’s message is simple: Cardiology is about people, not just arteries. The heart is not a plumbing system to be flushed and patched on reflex. It is part of a human life, shaped by emotion, story, and context.
When physicians embrace this view, medicine becomes more than a set of tasks. It becomes a relationship—one grounded in humility, curiosity, and care.
“Low-value care looks like something on paper,” Rudin says. “But what it really represents is a missed opportunity to care more wisely.”