My brother called me the other day to tell me that he sprained his ankle 
playing soccer. He went to his primary care MD who did a once-over and then gave him a prescription to get an MRI. This surprised me. Why did he need an MRI? The mechanism of injury combined with his symptoms led to a very clear diagnostic picture. Treatment is very relatively straight forward and the risk of a medical emergency is extremely rare, but instead of prescribing anti-inflammatory meds and physical therapy, the MD sent my brother for an MRI. Why?Everyone’s getting MRIs - it’s just the way things are done these days. Sprain your ankle, complain of shoulder pain, experience LBP - you get an MRI. Are MDs incapable of doing an examination? Are they so afraid of malpractice? Do they have a vested interest (direct or indirect) in the MRI facility? For a typical musculoskeletal injury, an MRI is not not always very helpful. MRIs are extremely sensitive, so they show the slightest inflammation or irritation. They are not very specific, so they don’t distinguish between slight irritation and severe damage. They often lead to false positive results.At a time when insurance premiums are doubling annually for a lot of people and the cost of healthcare continues to rise, maybe MDs should not be so willy-nilly about prescribing expensive tests when a qualified assessment can provide the same diagnosis.
Now a big name has spoken up against MRIs. In a NY Times article, Dr James Andrews, the nation’s pre-eminent orthopedic sports surgeon, said “If you want an excuse to operate on a pitcher’s throwing shoulder, just get an MRI.”Patients often come to PT with MRI reports detailing herniated discs in their neck or back. We have to take these results with a grain of salt, because even healthy people often have positive MRIs, even if they have no symptoms. Other times the positive MRI results are completely unrelated to the pain or symptoms that the patient is experiencing.
So why do so many patients get MRIs? Maybe because that’s the way we’ve always done it....Reminds me of another blog I read recently - The Five Monkeys.