Magnetic resonance imaging (MRI) is a test that uses powerful magnets, radio waves, and a computer to make detailed pictures inside your body.
When do you need an MRI?
Dr. Andy Fine explains, similar to CAT Scans, if you go to an emergency room setting or to a specialist, often times the first thing they will do, before trying to access or diagnose the problem, is get an MRI.
MRIs are done because they are a little more sensitive and specific to find smaller abnormalities than CAT Scans. Sometimes patients presenting with symptoms, such as bad headaches, stroke symptoms, difficulty with speech, dizziness, vertigo, back and/or neck pain, will get MRIs.[dt_quote type=\”pullquote\” layout=\”left\” font_size=\”h5\” size=\”3\”]If you are not a candidate for a procedure, you don\’t need an MRI.[/dt_quote]This may be the appropriate action, if the person has already been worked up and is a candidate for a procedure. If you are not a candidate for a procedure, you don\’t need an MRI.
The findings of MRIs are often inconsistent with the symptoms of the patient.
Then, because MRIs are even more sensitive than CAT Scans and even more expensive (up to $3000), you will find all kinds of nodules and minor abnormalities. These findings might have nothing to do with any kind of problem but will also need to be worked up and potentially biopsied. One mistakingly ordered MRI could not only result in a complication causing severe health problems, but you could also have stress and unnecessary testings. The abnormalities could be from years ago, even decades ago, and is something incidental to your symptoms. This is where going to a primary care person is key. They want to spend the time to find the underlying cause of your symptoms and not just order tests indiscriminately.
[dt_quote type=\”pullquote\” layout=\”left\” font_size=\”h5\” size=\”3\”]MRIs, like any other test we might order in medicine, should only be done if you are going to act on it.[/dt_quote]There are many things to do before getting an MRI; from accessing whether you have an allergy or infection to whether you respond to injections, therapy or medications. MRIs, like any other test we might order in medicine, should only be done if you are going to act on it.
A problem with MRIs of the neck/back is everybody has abnormalities show up on MRIs of the spine. If I compare two MRIs and they are identical, I can not tell if they\’ve never had any pain ever or if they are somebody struggling with bad pain for years. Since we know these scans are not very accurate with correlating with symptoms, we need to make sure we\’ve maximized everything non-surgically before we start recommending procedures. Essentially, everybody older than say 50, will have degenerative disc disease, degenerative arthritis and bone spurs on an MRI of their neck or back. It doesn\’t mean they\’ll ever have or have had back/neck pain, but it will show up on there. Getting an MRI doesn\’t really help us with diagnosing or treatment because everybody else has the same. As a result, we are trying to be more and more judicious about ordering these tests.
In conclusion, we could probably cut about 30% of health care costs, out of pocket and to the government, if we follow appropriate guidelines as physicians. Cut back on ordering excessive imaging and interventional procedures that don\’t turn out to be any more helpful to patients than doing non-invasive procedures. Combine with the administrative costs of running all these different systems – all the paperwork involved, authorizing medications, filling out forms and everything being not connected is causing all these administrative costs. These are the cost drivers accounting for about 15% of all these healthcare costs. Imagine, your premium for your family is $1000 a month but we could cut that to $850 or even $700, if we could eliminate administrative and other additional costs.
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