A friend of mine was experiencing a great deal of elbow and arm pain. She had an MRI, which showed a completely torn off ligament and instability of the bone. She took the scan and report to three surgeons. Two of the surgeons immediately recommended elbow ligament reconstruction. The third surgeon, however, did a physical exam on my friend—something the other two had not done—and he recommended a lesser operation, elbow arthrotomy. When she questioned why he was not recommending elbow ligament reconstruction, he said, “I treat the patient not the MRI.” His point was that although the scan clearly showed instability of the bone, my friend did not exhibit those symptoms during the physical exam.
This anecdote points to a problem that I suspect is more common than we might think. That is, physicians relying too heavily on the results of an MRI instead of the patient’s history and a thorough physical exam. In other words, overdependence on the MRI can be an issue. In fact, it can lead to unneeded surgery. Shouldn’t the “total package” be taken into consideration before a surgical procedure is decided upon? After all, MRI results can be confusing at times. It is shocking to think that some surgeons will wheel patients into the OR solely on the basis of a scan.
A recent article in The New York Times (October 28, 2011) points out how scans can be misinterpreted and can result in misdiagnoses that lead to unnecessary treatments. According to reporter Gina Kolata, a well-known sports medicine orthopedist wanted to test out his theory that MRIs might be misleading. According to the report, “He scanned the shoulders of 31 perfectly healthy professional baseball pitchers. The pitchers were not injured and had no pain. But the MRIs found abnormal shoulder cartilage in 90 percent of them and abnormal rotator cuffs in 87 percent.”
Clearly, not every MRI that shows an abnormality means that abnormality must be acted upon. In fact, many experts say that MRI scans almost always find something abnormal, but most abnormalities are of no consequence.
How heavily a doctor relies on an MRI to make the diagnosis and recommend a treatment is one concern. But whether they should order one in the first place is yet another concern. In radiology, we are so accustomed to hearing about the overutilization of CT scans. But according to The New York Times report, it seems that many sports medicine specialists are concerned about “the vast overuse of magnetic resonance imaging in their specialty.”
MRI is a tempting tool. Sports medicine physicians interviewed for the Times report cite a number of factors that they believe contribute to the proliferation of MRI scans in their field. For example, doctors fear malpractice charges if they fail to scan a patient and miss a diagnosis. There is also the reality of today’s consumer-driven health care system—very often, patients demand an MRI. And, finally, there is the fact that MRI scans can be a profit center for physicians who own the equipment.
No doubt, MRI is a very valuable tool. Even so, physicians need to be vigilant in their decisions about when to order an MRI and how much weight to place on results when determining treatment. The MRI should be a guide to what is physically wrong, but not a guarantee. Ultimately, the doctor must treat the specific patient, not the scan.
Marianne Matthews
Editor
