“Doctor, haven’t you looked at my MRI?”
This is a question that frequently comes up while visiting a doctor’s office. Most patients who have experienced an orthopedic issue at one time or another will probably undergo an MRI to better clarify the cause of the problem.
However, diagnostic studies such as MRI’s are not always the answer and in many ways can lead to more tests, anxiety, and potentially unnecessary and ineffective treatment. For example, numerous medical studies have been published detailing how MRI’s reveal many “abnormalities” which most likely are considered typical age-appropriate changes and most likely don’t need aggressive treatment.
In a landmark study published in the New England Journal of Medicine in 1994, Jensen and his colleagues performed MRI’s of the lumbar spine in close to 100 people who had NEVER had any complaints of back pain. Remarkably over 50% had disc bulges, 30% had disc protrusions, and even 1% had massive disc extrusions, all without having any pain. Similarly another classic MRI study revealed that the majority of patients will have an “abnormality” seen on MRI of the knee such as a meniscus tear or arthritis but have no pain. As expected, many of these “findings” become more common with advancing age.
So what are we to conclude with this quagmire of MRI information? The most important factor is considering what every good physician learns in medical school. A good physician should obtain an accurate history and physical and correlate that to the imaging study like the MRI.
“The mystery is in the history” is a good rule of thumb to live by when talking to patients and helping them to sort out what the actual problem is. It is vitally important to correlate the patient’s history and physical examination to imaging tests like MRI and CT scans. In this way, the normal age-related changes seen on these imaging tests can be addressed appropriately and patients will ultimately have better outcomes.
So remember the important question is not “has the doctor seen my MRI?” but more importantly “has the doctor listened and examined me? “
Paul Lento, MD is a triple board certified Physical Medicine and Rehabilitation physician at SOA. He has earned the national honor as a Castle Connelly “Top Doc” four years in a row. Sarasota Orthopedic Associates offers same/next day appointments at our three locations in Sarasota, Lakewood Ranch, and Venice. For more information visit our website at www.SOA.md or call us at 941-951-BONE.
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