I was weaned on New York-style pizza- reheated slices, folded length-wise, scarfed down for lunch on school days and dinner on Saturdays, usually at Mama Lucy’s or Angelo’s, around the corner on Main Street. Don’t google those places. They’re gone.
When I was older, I began pedaling my red Raleigh down Queens Boulevard, over the 59th Street Bridge into “the city,” up 3rd Avenue to one of the Original Ray’s, where the slices were heavy with tomato sauce, mushrooms, onions, and extra cheese. In college, we filled up on Koronet, which to this day is more famous for its value than anything else. After enduring four years of pizza purgatory in Philadelphia, I finally gained admission to the “apizza” heaven that is New Haven.
We can’t go wrong around here. Have you tried Pepe’s, where it all began? How about Sally’s, especially the sliced tomato in late August when the tomatoes are fresh off the vine? If the lines are too long, walk to Abate, and ponder why it’s not as famous as the legends down the block. If you’re closer to State Street, do Modern. Feeling upscale? Try Da Legna. When I’m home, I get take out from Olde World Brick Oven, usually the tomato basil. If I’m ambitious, I’ll drive to West Haven for the shucked-to-order fresh clam at Zuppardi’s, or my daughter’s new find in Milford- GG’s. What’s the best, you ask? No doubt it’s Bufalina in Guilford. Read the menu.
My pizza obsession hasn’t been lost on residency applicants. This year, more than half my “welcome to New Haven” letter to them is dedicated to pizza, including a link to this extraordinary video:
The rest of the letter is devoted to trainee testimonials, Distinctions, The Beeson Beat, the fellowship match, and other lesser topics.
Needless to say, my threshold for eating pizza is low. The clank of a pan on a Formica table, or the ripping open of a cardboard box. The sweet aroma. The burnt crust, the floral onion arrangements, the red sauce on white mozzarella. All stimulate a Pavlovian reflex. How can I control myself?
But I digress. This PD Note isn’t about pizza. I want to discuss medical testing.
Why do we get so many tests? Can’t we stop ourselves? False positives. Redundancy. Waste. Sleep deprivation. Iatrogenic anemia. How can we prevent test regret?
What drives our testing? Are we obsessed with rare diagnoses? Do we prove our worth by expansive and expensive workups? Does watchful waiting make us feel cavalier, or anxious? Are we reluctant to challenge cultural norms? Are we blind to the cost? Is it impossible wait six long weeks for a follow up x-ray? Are we afraid to trust our instinct that a faint murmur is benign and forgo the formal echo? Can we control our testing drive?
I think we can restrain ourselves. Maybe the next time we’re about to order tests, we can stop to reflect, and ask the following:
-Do I really need this test to make the diagnosis?
-Will the results change my management?
-Is it worth the cost and inconvenience?
-Is the test time-sensitive? Do I need it now, or can I watch and wait?
I understand the temptation to test, just as I understand the temptation of pizza. Both have merit in the right quantity. I love tests that clinch the diagnosis, like positive blood cultures. I also love biting into that luscious first slice. But too much of either can precipitate regret. I’m not the first and certainly won’t be the last to preach moderation. Like Aristotle, sort of.
So let’s be mindful of our choices. Temptation never leaves us. But maybe today we can give the patient a lab holiday. Maybe today we can eat a salad.
Enjoy your Sunday, everyone,
PS For further reading, a study published last week showing extraordinary variability in test ordering within a medical residency: