scary scanners
Bad news for hypochondriacs: Study finds that MRIs are often overused indiagnosing sports injuries
The US has the most expensive healthcare system in the world, literally lapping the costs of all other industrialized countries. About one quarter of our healthcare costs—$700 billion annually (5% of GDP)—comes from unnecessary care, tests and procedures that generate huge profits to providers while adding nothing nothing to our overall health or being deadly.
Over-treatment has been estimated to result in about 30,000 deaths a year. If this number doesn't mean a whole lot to you, think of 2 jumbo jets crashing to the ground each and every week all year long—get the picture?
Patients also bear some of the responsibility for over-treatment. We often go to the doctor and demand they use the latest gadgets or procedures; instead of asking what the test will accomplish, we're only interested in whether insurance will cover it. Magnetic Resonance Imaging (MRI) is among the most overused devices in our health care system. American doctors order about 10 million each year, more than any other country. And guess what? About 250,000 of them are unnecessary. But, doctors get paid by procedure and they average about $1700 a scan. Do the math.
Much of the over-use of MRIs comes at the expense of athletic professionals and weekend warriors. How many times do you hear, during the course of a football telecast, that so-and-so who just hobbled off the field will have an MRI in the morning? We're so used to this that, when we strain a shoulder playing softball or sprain a knee while jogging, we expect and demand an MRI.
You may want to get more information about MRIs before entering the MRI tunnel. Questioning the value of MRIs in sports injuries, the all-star sports orthopedist Dr. James Andrews scanned professional baseball pitchers with no injuries, pain or discomfort. Eighty to ninety percent of them showed evidence of rotator cuff injury or abnormal shoulder cartilage that would require surgery—if they only went by the scan, without taking a detailed medical history or performing a physical exam.
MRIs are great for detecting tumors, but in other situations, like sports injuries, it may be overkill. The problem with MRIs is that it is a very sensitive but non-specific tool. In some instances, it detects small inconsequential defects—like Dr. Andrews observed in his scans of baseball pitchers. These defects caused no functional limitations. Yet, if the scan was the only determinant of therapy, it would most lead to unnecessary surgery, with all the risks and painful rehabilitation. In sports medicine, where injuries are to tendons or muscles, a careful medical history and physical exam with an x-ray is sometimes all that's necessary, instead of surgery, some ibuprofen or physical therapy.
You should probably think twice before demanding an MRI when you suffer a sports-related injury until you have all the information to make an informed decision. Also, before you consent to one, ask your whether it's right for your situation. It's your health and often times more is not better when it comes to healthcare.
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Note: Dr. Kreisberg is not a medical doctor and you should not make any decisions that may affect your health without first consulting your physician.