“And one more thing, what do you want to do about this?”

The trainee looks so apologetic that I suspect a medical error relating to our octogenarian patient admitted overnight with confusion. Scrolling through the images on the computer, I see the problem, even without the arrows pointing to an “ill-defined abnormality” around the colon.

I am mildly irritated.

“Who ordered a CT of his abdomen to investigate confusion?” I ask. The trainee winces.

“He had a pan-scan, but we didn’t order it.”

A “pan-scan” is a head-to-toe scan, also known in the vernacular as a fishing expedition. It is the poor cousin of a targeted scan, performed to confirm or exclude a clinical diagnosis.

A chat with the patient’s son quickly reveals the cause of confusion to be underlying dementia and a medication mishap (sedatives mistaken for antihypertensives) and the patient makes a good recovery, but alas the “fishing expedition” hauls a net of incidental findings.

Besides the possible bowel abnormality, his prostate looks craggy and the pancreas odd – and this is just the abdominal scan. The chest CT discovers a “lesion”, its benign description paired with the admonition to do a follow-up scan thus destroying any chance of it being left alone.

“Please tell me the brain CT is pristine,” I plead.

“It shows an old stroke the patient can’t recall.”

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At the bedside, my happy observation that his confusion has resolved is drowned out by questions from concerned relatives about “all those cancers”.

Wary of easily harming an elderly patient, I counsel:

“In the absence of any........

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