Comments on: Are MRI results accurate? http://www.kevinmd.com/blog/2008/10/are-mri-results-accurate.html Tue, 14 Feb 2012 17:18:00 +0000 hourly 1 By: Anonymoushttp://www.kevinmd.com/blog/2008/10/are-mri-results-accurate.html#comment-87618 Anonymous Tue, 14 Oct 2008 14:12:00 +0000 http://clients.emmense.com/kevinmd/2008/10/are-mri-results-accurate.html#comment-87618 This was a really disappointing article. Like most of Ms. Kolata's medical writing, it's anecdote-driven and fairly off-target. Rather than doing the public the service of explaining that way too many MRIs are done, the message of the article seems to be that you need a more thorough MRI with a fancier, more expensive scanner. <br/><br/>One implied point that does make sense is that we should actually look at whether there are radiologists operating beyond their training.<br/><br/>But as a primary care physician the main thrust of this article ("you need an MRI, and even if you've had one read as negative in the past, you need a repeat fancier MRI...") will be a nightmare if my patients read it. The real problem is that the patients in her article (and patients in general) didn't receive a thoughtful and skillful H&P. Come on! Neurological lesions are best diagnosed by history and exam. I'll never forget the neuro prof who taught me that a good neurologist (or well-trained PCP with time to perform an exam) can detect neurological lesions that matter at sizes many times smaller than those seen on MRI.<br/><br/>Too many MRIs serve primarily to document prevalent conditions that have nothing to do with patients' symptoms...lumbar degenerative disc disease is a perfect example. Then the patients become obsessed with these incidental findings and, as the NYT pointed out in the article below, end up on quasi-fraudulent disability for life. Try adding that to the cost of an MRI!<br/><br/>http://www.nytimes.com/2008/10/08/nyregion/08lirr.html?_r=1&scp=1&sq=long%20island%20railroad%20disability&st=cse&oref=slogin This was a really disappointing article. Like most of Ms. Kolata's medical writing, it's anecdote-driven and fairly off-target. Rather than doing the public the service of explaining that way too many MRIs are done, the message of the article seems to be that you need a more thorough MRI with a fancier, more expensive scanner.

One implied point that does make sense is that we should actually look at whether there are radiologists operating beyond their training.

But as a primary care physician the main thrust of this article ("you need an MRI, and even if you've had one read as negative in the past, you need a repeat fancier MRI…") will be a nightmare if my patients read it. The real problem is that the patients in her article (and patients in general) didn't receive a thoughtful and skillful H&P. Come on! Neurological lesions are best diagnosed by history and exam. I'll never forget the neuro prof who taught me that a good neurologist (or well-trained PCP with time to perform an exam) can detect neurological lesions that matter at sizes many times smaller than those seen on MRI.

Too many MRIs serve primarily to document prevalent conditions that have nothing to do with patients' symptoms…lumbar degenerative disc disease is a perfect example. Then the patients become obsessed with these incidental findings and, as the NYT pointed out in the article below, end up on quasi-fraudulent disability for life. Try adding that to the cost of an MRI!

http://www.nytimes.com/2008/10/08/nyregion/08lirr.html?_r=1&scp=1&sq=long%20island%20railroad%20disability&st=cse&oref=slogin

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