Specifically with cancer screening, the PSA test and mammograms have come under increasing scrutiny.
I think this type of media attention is long overdue, as the public needs to be aware of the potential downsides of diagnostic tests.
Now comes the MRI.
A recent piece in the New York Times points to a small study by famed sports orthopedist James Andrews, who found when he scanned the shoulders of 31 healthy baseball pitchers,
the pitchers were not injured and had no pain. But the M.R.I.’s found abnormal shoulder cartilage in 90 percent of them and abnormal rotator cuff tendons in 87 percent.
This is an important finding. MRIs are frequently framed as the “most detailed” and “definitive” test available. But, in fact, the test is so sensitive that normal joints cam present with abnormal findings:
… if a healthy, uninjured person goes out for a run, a scan afterward will show fluid in the knee bone. It is inconsequential. But in an injured person, fluid can be a sign of a bone that is stressed or even has a crack and is trying to heal.
“An M.R.I. is unlike any other imaging tool we use,” Dr. Sangeorzan said. “It is a very sensitive tool, but it is not very specific. That’s the problem.” And scans almost always find something abnormal, although most abnormalities are of no consequence.
I applaud these orthopedists, as well as the Times, for bringing this issue to light.
Fixing the problem requires two major changes. The first is reforming how doctors are paid. There are some doctors, but not all, who own MRI machines and profit from them. And with the scans being so sensitive, it can show abnormalities that may lead to surgery, further increasing revenue.
A shift away from fee for service medicine would be effective curbing MRI overuse. And I emphasize that this doesn’t apply to every physician. If I, for instance, order an MRI, I don’t receive any financial gain.
The second change is adjusting patient expectations. Again there are some, but not all, patients who expect a scan and equate an MRI with “being thorough.” In fact, when orthopedic fellows cited in the Times story suggest that patients may not need a scan, patients “look at them like, ‘You don’t know what you’re doing.'”
Doctors can help educate patients away from the mythical benefits of overtesting. But the most effective teacher is the media, which wields significantly more influence. That’s why a story like this in the Times should be applauded, and promoted.