Treat the Patient, not the MRIheadingContent

Posted on September 25, 2013

MRI of a kneeOver the last several years, more and more patients present to the office with MRI in hand for a pain that began just days before.  Demands for medical technology and instant gratification are high, but at a very high cost. The art of medicine is suffering, as are patients, and they don’t even know it.

Overutilization of imaging such as MRI will lead to more overutilization and overuse because “abnormal” findings will occur in a high percentage of MRI for orthopaedic conditions that may not be related to the present problem. More testing and even unnecessary surgery may result from these tests.

For example, a large percentage of the population is walking around now with meniscus tears (aka cartilage tears) in the knee without knowing it. There are many of you who currently have rotator cuff tendon tears in your shoulder but don’t know it. Many of you have herniated discs in your neck and low back yet don’t have symptoms.

In this day of low reimbursement, doctors are forced to see more patients, spend less time listening and examining, and thus may order more tests to make the diagnosis. However, as we all learned in medical school, the majority of diagnosis can be made with history and examination. Plus, patients come in demanding MRI and won’t take no for an answer when we explain its not indicated.  The constant media reports of professional athletes getting MRI minutes after injury clouds your vision of what the real standard of care is.

MRI and other advanced technologies are great tools for physicians and practitioners. With judicious use of MRI we can avoid making unnecessary “abnormal” diagnosis. We want to avoid telling our patients that their preexisting silent problem is a cause for alarm or worse, unnecessary surgery.