One of the most common disabling conditions I see is back pain. I probably see more bad back cases in Tucson than any other type. People with bad spines tend to get the same medical care. Doctors go from as conservative as possible to the most invasive. Typically, this means your doctor will begin by getting X-rays and sending you to physical therapy, followed by steroid injections. Only if nothing else works, will you doctor schedule you for surgery. It makes sense to go slow and look at all the options. But new research calls into question one of the main tools doctors have for evaluating back pain, the MRI.
Too Much Information?
The MRI is considered the gold standard for looking at the spine to see what is wrong. Doctors put a lot of weight behind them. Administrative Law Judges (ALJ’s) also find MRI results persuasive. So what’s the problem? It seems as if as many as one-third of all these MRI tests are unnecessary. That would be bad enough on its own. But, there is a real risk of undergoing MRI’s. While MRI’s don’t use radiation the way X-Rays do, that does not mean they are harmless.
Oddly, the issue is that an MRI of the back might provide too much information. An MRI can show, for example, minor spinal defects that are likely causing no symptoms at all. In addition, an MRI can reveal benign changes in the internal organs. An MRI could show a cyst in the kidneys or adrenal glands. Once the doctor knows about these, she is obligated to look further. This could mean surgeries or other procedures you simply do not need.
Why So Many MRI’s?
So, if doctors know that they are overusing MRI’s, why does the practice persist? It turns out that one primary reason is financial. Many doctors own MRI machines. Every scan they do adds to their bottom lines. At the same time, many patients demand that their doctors provide every test available, regardless of medical necessity. When you are in severe pain, do you want a test to possibly find the cause? Or, would you prefer a discussion about conserving medical resources and saving money? Pretty obvious answer to that one.
As Always, Talk To Your Doctor
If your doctor has ordered an MRI of your back, ask her pointed questions about why she thinks the test is a good idea. Ask what she intends to do about incidental findings. There is much for you to consider before sliding into that MRI tube to start the test.
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