I read with interest the story of a patient who was placed on a two-year waiting list for an MRI at our hospital. As a surgeon of musculoskeletal disorders, I am astounded at how often this study is requested by physicians and other health care providers.
The short answer is that an MRI is useful in a small minority of problems. The overuse of this technology adds to the costs and increases the waiting times for both the technology and for patients to access appropriate care.
The two most common disorders that I see of inappropriate use of MRI is in knee pain and in shoulder pain. In a patient with a degenerative knee, who may have a meniscus tear, the diagnosis is easily made with a physical examination and X-rays. The treatment is generally rehab and only a small minority of patients have a problem whose treatment will be changed by an MRI result. Definitely the decision to provide surgery is not defined by anything seen on an MRI in this instance. Similarly, a patient who strains their shoulder in middle age or later almost certainly has a partial or complete rotator cuff tear. Treatment here is also rehab - often with a physiotherapist.
Again, an MRI is rarely needed to direct care.
An MRI is an exceedingly useful diagnostic tool for some disorders of the brain, spine, in cancer care, and other regions and fields of medicine. I am concerned that inappropriate use of this technology leads to delays in diagnosis and treatments where this form of imaging is helpful.
My suggestion for patients is that if their health care provider wants to place them on an extended waiting list for an MRI, they should ask two questions: "How is this study going to help you in treating my problem?" and "If the result of the test is positive, what will you do, and if it is negative, what will you do?"
These are the questions I ask my medical students.
If they cannot explain why an expensive test is being ordered, we don't order the test.
Dr. David Nelson
Prince George
