MRI overuse and misuse really makes me angry. Did you know that a growing number of doctors don’t even read the tests themselves? Another shocking aspect of this industry is that some doctors will order an MRI because it’s quicker than doing an in-depth history or a good physical exam. That would take too much time, just order an MRI. Rushing to an MRI can oftentimes erase clinical correlation, that is, connecting the dots between pain and what the MRI shows.
MRI is unnecessarily overused. In a recent study of 221 patients who had MRIs, the results showed that only 5.9% actually needed to have an MRI done. The remaining 94.1% of the patients sacrificed their time and money. (Christopher W. DiGiovanni, M.D.) What’s worse is that the use of MRI for screening isn’t as effective as other methods.
MRI needs to be judicious and scrutinized by the physician who ordered it. It can be as dangerous as it is useful. Many patients view the MRI as a security blanket, and will go as far as requesting it. I have numerous cases of diagnostic problems that result from misuse of the MRI. The real problem is one of clinical correlation (making sure that what’s seen on MRI is in agreement with the patients problem) and the fact that any test including an MRI must be ordered to confirm a preliminary diagnosis that is already known or vey highly suspected from the history, exam, and more simple, inexpensive tests such as an x-ray. Here are a few examples…
Never Have Knee Surgery Based on an MRI Diagnosis
The Boom in M.R.I.’s: Concerns Grow on Costs and Overuse
New Thoughts on the Diagnostic Value of MRI in Foot and Ankle Surgery
If you suspect your doctor is just being quick or using MRI to reach that “aha” moment, then you’re in a bad scenario. When I order an MRI, I am 90% certain about what the results are going to show. Doctors need to have a clear-cut idea on what they can expect to see from the results. Next time you’re told to get an MRI, and your doctor has little clue to your diagnosis, you may want to get a second opinion. Also, be sure to ask the physician if they read the MRI themselves.
Nothing makes me quite as angry as the doctors who can’t or won’t read the MRI themselves.
Have you ever had an MRI? Did you question the necessity of it? Do you have a horror story?
Love the site and the logo is dead on. Lol. I couldnt agree more. One of my favorite sayings I admit I have told a patient, “I’ve never seen an MRI make someone better unless you have too much time and too much money. If that’s the case it just might work.”
I really appreciate free, succnict, reliable data like this.
I agree with Natedawg. The logo is sweet. Thanks for the links and the invite to see this site.
Personally, I feel the biggest issue with MRI utilization is cost. While sometimes MRI muddies the water regarding diagnosis, I generally think that more information is often better. Especially when dealing with an uncertain diagnosis. On the other hand, when the diagnosis obvious (e.g. classic case of PTT dysfunction), a test such is generally a waste (with some caveats).
We recently went through some issues with our son and he needed a brain MRI. I felt the MRI was of minimal value, but trusted the neurologists opinion. We got socked with an $800 bill after insurance. (granted, this includes anesthesia, he’s 5). As an orthopod, I can easily absorb that kind of cost, but many patients cannot. My biggest frustration is trying to help the working poor patients and people struggling financially in the recession. When I actually do need an MRI, after having done a thorough history, physical and XRAY exam, sometimes they just can’t afford it.
I agree 100% about visualizing the MRI, not just looking at the report. The other day, our computers all went down and I was unable to access imaging of two patients for MRI follow-up. I had to just read the report. I felt like I was walking into the room naked…I ended up telling them that I would call them on the phone after I looked at the MRI with my own eyeballs…
Finally, my other concern is conflict of interest. Our practice owns an MRI. I’m an employed doc. Two issues come up:
1. I know that I can get a great MRI, with high resolution, specific imaging sequences, and an MRI that is tailored to the pathology for which I’m looking from “our MRI tech”. For example, if I suspect a peroneal tendon split tear he will get sagittal cuts in the plane to maximalize visualization of the peroneal tendons. I don’t really have time to call the guy accross town and tell him to do this. MRIs that I see from the other places generally stink.
2. How can I know that I’m not ordering more MRIs because my practice is profiting from the test? Bottom line: I can’t. On the other hand, if I was just out to profit, I would be fixing a lot of nondisplaced weber B ankle fractures and getting “great results”. It’s my job to be as ethical as I can. I don’t need some bureaucrat telling me whether or not my practice can own an MRI when it clearly has benefits for my patients. I just wish all the other guys (those over-ordering MRIs, not examining their patients, running assembly line practices with 100 – 120 patients per clinic day, and/or not looking at the imaging) would just stop. Perhaps when the ABOS performs the licensure exam, they should be looking at issues like this…
Just my two cents.
With the bases ldoaed you struck us out with that answer!
I recently injured my shoulder at work lifting too much heavy items on November 13, 2011. I went to a doctor in town, he referred me to one of his good buddies which is a Doctor, MD. The doctor twists my arm so bad that I could had cried. He orders and X-Ray on my shoulder, nothing shows up. He then wants a MRI done on my shoulder, finally after my insurance saying, “NO” he gets them to say, “YES”. I get it done, he schedules me to come in a week later so, I can get the results.
I go into the office and sit down, he looks at the MRI for 2 seconds and says, there isn’t anything wrong. Now, the pain I’m feeling 2 months later from when I injured my shoulder is still in the same kind of pain. It has not healed and it limits me to what I’m able to do as far as working goes. I’m a single mom struggling to make it by and I cannot afford to quit my job so, I have to continue hurting my shoulder more and more and I know there is something wrong with my shoulder. This doctor wouldn’t even listen to me and when I asked, if the MRI shows I’m fine then, why am I still in alot of pain. His reply, “oh, it’s probably just your rotater cuff.” Really???
Now I”m searching for a new Doctor with excellent feedback that doesn’t treat his patients like he did me.
Hi there, love the site. I was wondering if 2you different radiologists can write different reports for the same mri? I’ve had 2 on my lumbar and the first one showed a lot of damage and cord compression. For the second the Dr who ordered it only looked at the report and said I was fine. A friend actually looked at a copy of the mri and said he saw 2 herniated discs as well as a lot of other stuff I won’t bore you with. Could the Dr reading the 2nd one be wrong?
You are correct in your suspicions and both could be wrong. The only person who can really read the MRI correctly is your treating doctor who knows your story, as well has examined you. It is called clinical correlation and it is a critical part of medicine rapidly being forgotten, largely due to our (docs, etc.) increasing reliance on test like the MRI. The radiologist read is really only good for one thing. They have the ability, because they look at everything, to see the odd things I am not looking for because my focus is on the area of interest based on my exam and history. This is info the blind radiologist does not have. Get a new doc!
I can see you have been through a very hard time and I am sorry to see anyone go through that. However, It is important that you to understand I am not here to solve individual medical problems. But I can give some general advice already addressed on the AngryOrthopod blog. Please read my blog The Rescue Patient, Part One and Part Two – http://angryorthopod.com/?p=353 and http://angryorthopod.com/?p=362.
I’ve been in pain for years but the last 2 have been horrible! My lower back…so went to the doc & right away he orders an MRI but I had to wait a bit to be able to save money to pay for it I’m uninsured. Had the MRI & it showed nothing. Well my pain has progressed down my hips. Anywhere from my lower back to above my knee hurts & is debilitating at times. Now he says the first MRI they did didn’t go low enough. He sends me to an imagining center so I didn’t think he got any kick backs from them I don’t know but my point is I can’t afford to do this again plus pay his fees, his X-rays & blood tests he does but I continue to go because I’m stuck with no ins. He is cash only. All he’s done for me is throw pain pills & muse relaxers at me & Celebrex which I refuse because why take it when he doesn’t even know what’s wrong? If I refuse the MRI I’m afraid he will refuse to treat me at all! I’m so scared & lost & don’t know if I should do this next MRI…I guess I’m ranting I’m sorry & I know this post is older but I found it on a google search. Thank you
I think this article is sort of ridiculous. With an MRI you have a very safe, very effective imaging tool that lets you see deep into the body in ways you couldn’t see before. It has to be one of the most important inventions for diagnosis of soft tissue, tendon and ligaments damage.
The only real problem with “overuse” is cost… sort of… but I’ll get to that in a minute.
I don’t know if you can necessarily say that XX% of MRI’s were unnecessary. As a diagnostic tool, ruling things out can be just as important as verifying the suspected cause of an issue. Now you know what it is NOT, and can proceed confidently with treatment. On that note, missing a correct diagnosis because you don’t order an MRI is far far worse than ordering an MRI that finds next to nothing. Its really no different than an X-ray, which are prescribed for patients very frequently. Much of the time you will find nothing, but they are relatively cheap compared to MRIs, so no one really cares.
That brings us back to cost. Why exactly do they cost so much to administer? Well the machines are expensive, and the cost of the services have to be recouped. If an MRI is only given 2-3 times a day, as opposed to 20-30 a day, you’d have to charge those 2-3 patients 10x more. Sure there are maintenance costs, and labor costs that need to be factored in as well, but volume always helps to reduce overall costs. If the machines were more utilized, its conceivable that MRIs would drastically reduce in price.
So, saying we need fewer MRI’s is really backwards thinking IMO. Any time we take such a valuable and precise tool like this and start saying “we need to use it less”, shows that we need to take a step back. If our priorities favor *not* using a safe & powerful diagnostic tool, then the problem is with the system and not the tool.
Thank you for this blog. It’s very useful (I hope I have made you less angry, now that I read it 😉 )
You answered a question of mine (lower back pain and MRI) elsewhere on this page, but I wasn’t able to answer there. Therefore I write here – to thank you enormously for your time and helpfulness.
PS: I am doing the calf stretching religiously to cure my PF. For 6 months I have done this and only been able to stretch for 60 seconds each day. Now suddenly 100 seconds. And yes, it has helped the pf so much THANK YOU
I have found that not one DPM or even this latest “GOOD” neurologist wants to see the disc when offered. They only read reports! Now I’m getting angry! Is it that they just don’t know how because they are not a radiologist??
Now I am angry! Once again the hornet’s nest has been kicked. There is a mix of factors why they will not look at the actual MRI. This is my opinion, based on many years of practice and experience talking to patients and other docs. Keep in mind the MRI was pretty much introduced at the start of my career, and I have seen it and the doctors ultra reliance on it evolve.
* The non-radiologists, your docs, may be unable or feel less able to read the MRI. This is fair in a way and safe for patients in most cases especially non-orthopaedic surgeons.
* The doc may rely only on the “read” for liability reasons. Chicken sh$ts.
* Laziness and greed. Seriously! We don’t get paid to read them, and it takes time to do it. I say do the right thing. If you have the skills and a bit of experience with reading MRIs, like a podiatrist or orthopedic surgeon should possess, read the damn thing. You are there and you are my patient; I’m going to read it.
* And my favorite, “I did not order it and I will not read someone else’s MRI”. These are the grown up kids who took their toys and went home.
* Or my singular, but ofter used rationale seen below. BTW, I would tell you exactly why I would not read it and you would understand. It is only fair.
Here is why in selected cases I would not read nor look at an MRI or the report, really. As you sit there in front of me and I know the diagnosis determined by old fashion deduction based on knowledge and experience with a tincture of the boldness to trust myself. For instance, consider a case of second MTP synovitis. The story and exam fit, which is usually clear and unmistakable. In this case, I would not have done an MRI (because I don’t need it) and the MRI was done by someone who did not know what the problem was (that is why you are in my office). The MRI and the read are not germane even though you have shelled out the money…sorry.
Note this well, the MRI is not all that. Don’t get me wrong, it has its place, but it is definitely a trust, but verify situation in every case. Wouldn’t it be nice if we could pull into CVS, or Google, or Walmart, get our MRI and voilà you have your diagnosis. Sorry, but it doesn’t work that way.
I think it is time to write a new blog on MRIs.
Stay healthy my friends,
I had a foot injury and had surgery to put plates and screws, but never got MRI, just Xray and CT scan to get a clearer photo.
Would you say I should get an MRI because I tend to think about what ifs – like what if I had a torn ligament or other findings and was never discovered?
You almost certainly do not need an MRI. I do not know your injury, but to make you feel a bit better broken bones (requiring plates and screws) usually imply there are not significant or fixable ligament/soft tissue injuries. There are certainly exceptions to this concept, but not many. Based on the mechanism of injury and the current imaging studies the surgeon is tuned into any possible additional ligament injuries and they will undertake the appropriate imaging, possibly an MRI, if needed.
Your are, my dear, entering the “beware of what you ask for” twilight zone if you get an MRI. Believe me that they will find a lot on an MRI and that is the problem, and danger with MRI’s, interpretation of the findings. This is a definite case of leaving the judgement to the surgeon and not the almighty MRI. When it comes to trauma the MRI is (should be) very low on the list of imaging options. Radiographs and CT scan are the gold standard. Finally, newest is not always best and does not supplant previous technology.
In my 32 years of doing this I have determined that doing less is almost always better. I hope this helps.
Stay healthy, my friends,