Side effects of evidence-based medicine.

In the framework of an objective assessment of medical practices, it has become the rule to limit preoperative examinations, including thoracic imaging, in asymptomatic patients with a low surgical risk (that is, in "good health"). The insistence on the avoidance of "unnecessary" technical examinations in patients in seemingly good health may disregard common symptoms and lead to untoward consequences for the patients as we recently experienced in our respiratory department: two patients were admitted, one for a cavitary tuberculosis and the other one for a small cell carcinoma. These patients had uneventfully undergone in the recent weeks ear, nose and throat procedures and gynaecologic surgical procedures, respectively, without preoperative chest radiography as they were considered "asymptomatic" at the time of surgery. Retrospectively, ordinary symptoms (cough in the patient with cavitary tuberculosis and shortness of breath in the patient with lung carcinoma) were present but did not "ring a bell" during the preoperative assessment.