Skip to content
  • About
  • Contact
  • Contribute
  • Book
  • Careers
  • Podcast
  • Recommended
  • Speaking
  • All
  • Physician
  • Practice
  • Policy
  • Finance
  • Conditions
  • .edu
  • Patient
  • Meds
  • Tech
  • Social
  • Video
    • All
    • Physician
    • Practice
    • Policy
    • Finance
    • Conditions
    • .edu
    • Patient
    • Meds
    • Tech
    • Social
    • Video
    • About
    • Contact
    • Contribute
    • Book
    • Careers
    • Podcast
    • Recommended
    • Speaking

MRI abuse can be dangerous and expensive for patients

Chris Rangel, MD
Conditions
June 7, 2010
34 Shares
Share
Tweet
Share

What is “MRI Abuse”? This is when the health care provider orders MRIs (Magnetic Resonance Imaging) in excess or for the wrong reasons. There are many causes of MRI abusive behavior but most evolve out of a significant misunderstanding of how to properly utilize this diagnostic tool. MRI imaging has a high sensitivity to detect anatomic abnormalities, does not expose the patient to high doses of radiation like a CAT scan, and is non-invasive and widely available.

It is these advantages that leads to multiple erroneous assumptions on the part of way too many providers.

* MRI will usually yield a correct diagnosis.
* MRI will usually rule out a serious condition.
* MRI is the BEST of all imaging studies.
* MRI will usually help direct further evaluation efforts and lead to the correct treatment.
* MRI is without risks.
* The costs for an MRI don’t matter.

Even if MRIs were cheaper than aspirin (each scan is well over $1,000) and even if they were 100% safe (gadolinium IV contrast can cause nephrogenic systemic sclerosis in rare cases), they would still not be the definitive end-all, be-all, gold-standard imaging and diagnostic modality of all time.

Other than the excessive costs involved, there are significant downsides to a very sensitive test. For one, MRIs can pick up many abnormal findings that can often confuse the clinical picture. Are these findings incidental and harmless and not related to the problem at hand? Or are the findings related but harmless or unrelated but potentially harmful and in need of further evaluation? Sensitive testing undertaken without a clear clinical question in need of being answered is a problematic setup and likely to raise more questions and worries and lead to more testing (often invasive testing with increased associated costs and risks).

One of the worst cases of MRI abuse I have ever witnessed involved a middle aged patient who presented with some rather vague but worrisome pain. The patient’s exam was benign and routine blood tests and an ultrasound were normal. Because the pain appeared to be improving, we decided to see how it progressed over the next several weeks before deciding what to do next.

In the mean time, the patient ended up being seen by a mid-level practitioner for several visits on follow up (don’t ask me how this happened) who, when told about the mild and improving pain, proceeded to order MRIs of the chest, abdomen, pelvis, lumbar spine, the thoracic aorta, and the renal arteries, all of which were negative for any significant findings.

By the time the patient got back to see me after several months, the pain had resolved — as we hoped it would — and she was doing very well. I reviewed her prior extensive “magnetic therapy” in amazement. It was not at all clear from the mid-level practitioner’s progress notes as to why all of these MRIs were ordered but despite this lack of documentation, the patient reported that the health insurance company had paid the complete MRI bill. The total cost for this work up was well in excess of $10,000.

It’s evident that there remain huge gaps in utilization and cost review processes of insurance companies. It’s also evident that health care providers who don’t have the training, experience, or time to bother with the concepts of cost containment, resource utilization management, and standards of care (which usually call for the simplest and cheapest test to start the evaluation process) are the ones most likely to go for the “shotgun” method of diagnostic medical practice.

This is very bad omen since primary care is headed is towards an ever larger percentage of care being provided by mid-levels and both mid-level providers and physicians are being forced by dropping reimbursement rates to see more and more patients. All of this is going to translate into worse medical resource utilization and higher costs and a big part of it will be MRI abuse.

Chris Rangel is an internal medicine physician who blogs at RangelMD.com.

Submit a guest post and be heard.

Prev

Whistleblowers endure stress and personal hardship

June 7, 2010 Kevin 1
…
Next

Why patients file medical malpractice lawsuits

June 7, 2010 Kevin 44
…

Tagged as: Primary Care, Public Health & Policy, Residency

Post navigation

< Previous Post
Whistleblowers endure stress and personal hardship
Next Post >
Why patients file medical malpractice lawsuits

More by Chris Rangel, MD

  • a desk with keyboard and ipad with the kevinmd logo

    Are Cadillac plans responsible for rising health costs?

    Chris Rangel, MD
  • Should drug testing be considered screening tests?

    Chris Rangel, MD
  • a desk with keyboard and ipad with the kevinmd logo

    Are hospitals really soaking the poor with high prices?

    Chris Rangel, MD

More in Conditions

  • The unjust reality of racial disparities in pediatric kidney transplants

    Lien Morcate
  • The surprising medical mystery of a “good” Hitler: How a rescued kitten revealed a rare movement disorder

    Teresella Gondolo, MD
  • The power of coaching for physicians: transforming thoughts, changing lives

    Kim Downey, PT
  • Unlocking the secrets of cancer conferences: an end-of-life counselor’s journey among pharmaceutical giants

    Althea Halchuck, EJD
  • An obstetrician-gynecologist reveals the truth about reproductive planning and how to navigate society’s expectations

    Yuliya Malayev, DO, MPH
  • Nose-brain connection: The surprising link between allergies and mental health revealed

    Kara Wada, MD
  • Most Popular

  • Past Week

    • A patient’s perspective on the diminishing relationship between doctors and patients

      Michele Luckenbaugh | Conditions
    • How chronic illness and disability are portrayed in media and the importance of daily choices for improved quality of life

      Juliet Morgan and Meghan Jobson | Physician
    • The hidden factor in physician burnout: How the climate crisis is contributing to the erosion of well-being

      Elizabeth Cerceo, MD | Physician
    • Why affirmative action is crucial for health equity and social justice in medicine

      Katrina Gipson, MD, MPH | Policy
    • The power of coaching for physicians: transforming thoughts, changing lives

      Kim Downey, PT | Conditions
    • Unlocking the secrets of cancer conferences: an end-of-life counselor’s journey among pharmaceutical giants

      Althea Halchuck, EJD | Conditions
  • Past 6 Months

    • “Is your surgeon really skilled? The hidden threat to public safety in medicine.

      Gene Uzawa Dorio, MD | Physician
    • It’s time to replace the 0 to 10 pain intensity scale with a better measure

      Mark Sullivan, MD and Jane Ballantyne, MD | Conditions
    • Breaking point: the 5 reasons American doctors are dreaming of walking away from medicine

      Amol Shrikhande, MD | Physician
    • Unveiling the hidden damage: the secretive world of medical boards

      Alan Lindemann, MD | Physician
    • Revolutionize your practice: the value-based care model that reduces physician burnout

      Chandravadan Patel, MD | Physician
    • Breaking the cycle of racism in health care: a call for anti-racist action

      Tomi Mitchell, MD | Policy
  • Recent Posts

    • Boxing legends Tyson and Foreman: powerful lessons for a resilient and evolving health care future

      Harvey Castro, MD, MBA | Physician
    • 7 ways to beat burnout: a guide for health care professionals to reduce stress and reclaim their passion

      Marie Livesey, DO | Physician
    • The unjust reality of racial disparities in pediatric kidney transplants

      Lien Morcate | Conditions
    • The pros and cons of taking a gap year during medical school

      Med School Insiders | Education, Sponsored
    • A family physician’s journey on the OIG list and the struggle to return to practice [PODCAST]

      The Podcast by KevinMD | Podcast
    • Heartwarming stories of cancer patients teaching us about life and the human spirit

      Johnathan Yao, MD, MPH | Physician

Subscribe to KevinMD and never miss a story!

Get free updates delivered free to your inbox.


Find jobs at
Careers by KevinMD.com

Search thousands of physician, PA, NP, and CRNA jobs now.

Learn more

View 1 Comments >

Founded in 2004 by Kevin Pho, MD, KevinMD.com is the web’s leading platform where physicians, advanced practitioners, nurses, medical students, and patients share their insight and tell their stories.

Social

  • Like on Facebook
  • Follow on Twitter
  • Connect on Linkedin
  • Subscribe on Youtube
  • Instagram

CME Spotlights

From MedPage Today

Latest News

  • Psoriasis Biosimilars Appear to Match Up to Original Products, With Caveats
  • Are New Dads More Likely to Need Antidepressants?
  • Getting Inspired to Do More
  • Missing Doctor's Body Found; Ketamine for Migraines; Foodborne Illness Outbreaks
  • Catching the Optimal Amount of Z's May Be Protective Against Long COVID

Meeting Coverage

  • New Model Aims to Study Intestinal Fibrosis in Crohn's Disease
  • Hypertension Tied to Worse Survival After Surgery for Upper Tract Urothelial Cancers
  • The Role of Amyloid PET in the Management of Alzheimer's Disease
  • New Inflammation Inhibitor Proves Effective and Safe for Dry Eye Disease
  • No Access to Routine Healthcare Biggest Barrier to HPV Vaccination
  • Most Popular

  • Past Week

    • A patient’s perspective on the diminishing relationship between doctors and patients

      Michele Luckenbaugh | Conditions
    • How chronic illness and disability are portrayed in media and the importance of daily choices for improved quality of life

      Juliet Morgan and Meghan Jobson | Physician
    • The hidden factor in physician burnout: How the climate crisis is contributing to the erosion of well-being

      Elizabeth Cerceo, MD | Physician
    • Why affirmative action is crucial for health equity and social justice in medicine

      Katrina Gipson, MD, MPH | Policy
    • The power of coaching for physicians: transforming thoughts, changing lives

      Kim Downey, PT | Conditions
    • Unlocking the secrets of cancer conferences: an end-of-life counselor’s journey among pharmaceutical giants

      Althea Halchuck, EJD | Conditions
  • Past 6 Months

    • “Is your surgeon really skilled? The hidden threat to public safety in medicine.

      Gene Uzawa Dorio, MD | Physician
    • It’s time to replace the 0 to 10 pain intensity scale with a better measure

      Mark Sullivan, MD and Jane Ballantyne, MD | Conditions
    • Breaking point: the 5 reasons American doctors are dreaming of walking away from medicine

      Amol Shrikhande, MD | Physician
    • Unveiling the hidden damage: the secretive world of medical boards

      Alan Lindemann, MD | Physician
    • Revolutionize your practice: the value-based care model that reduces physician burnout

      Chandravadan Patel, MD | Physician
    • Breaking the cycle of racism in health care: a call for anti-racist action

      Tomi Mitchell, MD | Policy
  • Recent Posts

    • Boxing legends Tyson and Foreman: powerful lessons for a resilient and evolving health care future

      Harvey Castro, MD, MBA | Physician
    • 7 ways to beat burnout: a guide for health care professionals to reduce stress and reclaim their passion

      Marie Livesey, DO | Physician
    • The unjust reality of racial disparities in pediatric kidney transplants

      Lien Morcate | Conditions
    • The pros and cons of taking a gap year during medical school

      Med School Insiders | Education, Sponsored
    • A family physician’s journey on the OIG list and the struggle to return to practice [PODCAST]

      The Podcast by KevinMD | Podcast
    • Heartwarming stories of cancer patients teaching us about life and the human spirit

      Johnathan Yao, MD, MPH | Physician

MedPage Today Professional

An Everyday Health Property Medpage Today
  • Terms of Use | Disclaimer
  • Privacy Policy
  • DMCA Policy
All Content © KevinMD, LLC
Site by Outthink Group

MRI abuse can be dangerous and expensive for patients
1 comments

Comments are moderated before they are published. Please read the comment policy.

Loading Comments...