ARE MRI'S OVERPRESCRIBED? Questions you should ask, and tips to know when you need one.
Physicians have long prescribed the use of MRI’s, or magnetic resonance imaging, to assist them in accurately diagnosing and treating patients. MRI’s provide valuable information—without the use of radiation—that physical examinations may not always reveal. However, negative publicity has recently surfaced alleging that MRI’s are overprescribed and potentially causing more harm to patients than good.
Consider: approximately fifty percent of all middle-aged people show evidence of a partially torn rotator cuff on imaging, but never knew they had it. Why? Because the tear doesn’t cause them pain or affect their activities of daily living. A similar study shows that ten percent of participants, who claimed to have no pain or disability, had disc degeneration or a condition known as a “spondylo” appear in images of their spine (What’s even more ironic is that people with “normal” images typically have a higher likelihood of injury than people whose images appear “abnormal.”). Doctors see these “abnormal” findings in the image report and are ready to pounce on them, whether they’re the source of the patient’s problem or not. Are imperfect MRI findings causing physicians to treat patients for injuries that aren’t the cause of their disability or pain?
There are over 28 million MRI’s performed every year in the U.S., and they are expensive. A simple MRI of the knee can cost up to $2,000. It makes sense that an MRI scan costs so much when you figure that the price of owning an MRI machine is anywhere from $300,000 to $1 million. That’s a lot of overhead. Are physicians, who own MRI machines, unnecessarily prescribing MRI’s to recoup their costs? Are physicians, who do not own MRI machines, unnecessarily prescribing MRI’s because they receive kickbacks from the owners? Who knows? I sure don’t know, but this is something else to consider.
There is no denying that MRI’s and other imaging are critical to the health of a patient and the efficiency of the physician. I have personally prescribed multiple MRI’s during my clinical days and don’t regret a single prescription. However, every MRI I’ve prescribed fell within two categories: the patient suffered recent trauma or injury, or the patient didn’t show improvement after two-three weeks of conservative care. I recommend that you receive an MRI or other imaging if you fall within these two categories, as well.
MRI’s are critical to the health care industry. They provide valuable information that is often hidden to the naked eye and ambiguous upon physical examination. However, make sure your doctor is justified in prescribing one. I recommend the following tips to help you decide when you need an MRI:
-Get a second opinion. Whenever your doctor tells you anything you are not 100% comfortable with, get a second opinion. This rule applies to imaging, too. If you don’t think you need an MRI, get a second opinion. If your second opinion tells you to get an MRI, get it.
-If you haven’t had recent trauma or injury, try conservative care first before you schedule an MRI or other imaging. Try the conservative care for 2-3 weeks. If you don’t have improvement after 2-3 weeks, get imaging.
Dr. Zumstein is the author of Secrets to Preventing Back and Neck Pain: 60 Ways to Protect Your Spine and founder of The Back Safety & Wellness Consultants. You can find his book, information about his company, or sign up for his free newsletter at www.backsafetyandwellness.com.