This is an important article to read.
Many of the incentives today encourage doctors to order more advanced imaging scans, like CTs and MRIs. This expensive practice is invariably caused by this common scenario, as “patients who are in pain often demand scans hoping to find out what is wrong, doctors are tempted to offer scans to those patients, and then, once a scan is done, it is common for doctors and patients to assume that any abnormalities found are the reason for the pain.”
The problem is that these scans are so sensitive, incidental findings are often found. In many cases, they may not be the true cause of the symptoms, and worse, can necessitate more invasive testing that can have serious side effects.
CT scans expose patients to radiation, and scans that lead to biopsies can have the risk of bleeding and infection as complications.
The article focuses specifically on back and knee pain. It’s noted that mensicus tears are a function of aging, and if found, may not be the root cause of a patient’s pain. Similarly, those who undergo MRIs for back pain may find disk herniations. These however, may not require treatment as almost two-thirds of cases resolve within 6 months.
And here’s an important caveat. Patients who underwent back MRIs and knew about these findings fared no better than those who didn’t. In fact, “there was one effect of being told “” patients felt worse about themselves when they knew they had a bulging disk.”
As scans spread to applications ranging from cardiology (coronary CT scans) and gastroenterology (CT or “virtual” colonoscopies), patients need to be reminded again, that more advanced tests doesn’t necessarily equate to better care.
{ 6 comments… read them below or add one }
Chronically ill are often desperate for answers and have often been told the pain is all in their heads… I don’t think you can address this until that need is met somehow.
I recently had a bad fall down some stairs badly injuring my ankle. I treated myself for 4-5 weeks and finally decided to go see an MD. My doc explained that he could order an MRI, but seeing as how I wasn’t interested in any surgery anyway there was no need. As an RN I certainly understood that, but I was so curious as to what was wrong. I never had the MRI; may ankle still bothers me; I won’t have surgery; I am still curious!
With such curiosity in patients, I’m curious who is going to pay for all of these scans. There probably is a need for third party imaging management services after all!
CT and MRI scans are not only dangerous to the patients but also to the health professions who are working nearby.
According to Dr. Michael Ozner, a popular cardiologist, a CAT scan is equivalent to 750 x-rays or about 3 years of free radicals. In the article, he points out that a CAT scan admits more radiation that the atomic bomb blast of Hiroshima and Nagasaki.
http://www.joyfullivingservices.com/handouts/cardiacCATscans.pdf
If this statement is even true, how can doctors be sure that everyone inside the hospital at the time of a CT scan is going to safe?
Hmm, I would guess that you are primary care. I work in an ER, and we order tons of ct and sometime mri, mainly as a defensive measure. It is much more reliable to get a ct and get the anser, or rule out ‘the bad thing’. I dont worry about radiation. I assume everybody is sick and dying. otherwise, they would not be in the er
Unfortunately the public in the UK are demanding scans on the scale done in the US. There is a failure to grasp that this is not necessarily good medicine.