I love MRI. It’s amazing to me how there’s often more information on these studies that can help my patients than is written about by the reading radiologist. Having said that, MRI is also an abused tool that has been ascribed mythical status by patients and physicians that it often doesn’t deserve. It’s also made physicians lazy. Let me explain.
What Is MRI?
Magnetic resonance imaging (MRI) provides body images by way of a magnetic field. How this works is that certain types of atoms in the body are first aligned by a large and extremely powerful magnet. When the magnet is turned off, these atoms then rearrange back into their original orientation, generating a radio pulse that is interpreted by software in the MRI machine. An image of the complex data is then assembled by the computer. The stronger the MRI magnet, the sharper the image it generates.
MRI Has Made Physicians Lazy
Most physicians I know have never taken the time to learn how to read an MRI image. Instead, they rely on reading the radiologist’s report. This is a huge problem, as what the radiologist dictates or focuses on may or may not be what the doctor needs to learn from the image.
More concerning is that the advent of MRI has dramatically reduced history and physical exam time. Why? Your doctor believes that he or she can rely on the MRI report to diagnose your condition. While sometimes this may be true, oftentimes it’s not. Hence, we too often see patients who get everything from the wrong medication to the wrong surgery simply because a doctor got lazy and didn’t want to spend time talking with and examining the patient.
We physicians have also infected our patients with this “MRI disease”. Meaning that because we have become too lazy to spend time examining our patients with our hands, they believe that it’s not needed anymore. That the miracle MRI oracle will tell all. Let me show you how this thinking can harm patients.
An Example of Why Diagnosis by MRI Can Be Dangerous to Your Health
We’ve known for almost a decade now that middle-aged and older people can have meniscus tears and no pain. In fact, based on the Framingham Osteoarthritis Study, just as many people with knee pain as without had meniscus tears on their MRI. However, if you’re a middle-aged person on a ski vacation and your knee begins to hurt and continues to be a problem, you will eventually get an MRI. At that point, based on the research, if a meniscus tear is seen, there’s a 50/50 chance that this tear had been there for years and has nothing to do with why your knee hurts. Despite this research, in the community where I practice, there’s almost a 100% chance of you getting offered knee meniscus surgery based solely on that MRI finding and a cursory exam.
How can this hurt patients? The other day I was asked to look at a case where the patient perished as a result of the meniscus surgery that she likely never needed in the first place, all because the doctor and patient put way too much emphasis on the MRI image.
Surgery in the Absence of Symptoms?
So just how bad is our MRI disease? Meaning, is there any research that supports that patients put way too much emphasis on their MRI findings? You bet there is…
The new study consisted of anonymous surveys of 211 patients with a degenerative condition in the cervical spine. Researchers sought to determine what patients with these specific conditions believe about things such as MRI findings and their importance, risks, alternative treatments, and the effectiveness of treatments. The results as they pertain to MRI? The majority of respondents (67%) believed MRI results were more important than other clinical results, and a surprising 47% were not only willing to have surgery based on solely on the MRI findings but were willing to have surgery in the absence of (or with very few) symptoms to support the MRI finding.
Findings on MRI May Not Explain Your Symptoms
So what’s wrong with a patient wanting neck surgery when the MRI shows something awful? After all, why wouldn’t you want to just get it “fixed” and be done with it? Because what’s on your MRI image may be the same thing that’s on your next door neighbor’s MRI, even though he’s never had a day of neck pain and will never have any neck problems.
For example, studies have found that stenosis seen on an MRI doesn’t provide an accurate diagnosis for low-back pain. This is an MRI finding where the hole in the spinal canal (where the spinal cord and nerves travel) gets too small due to arthritis and a bulging disc. Meaning, your older next door neighbor without back pain is likely to have an MRI with stenosis that looks just like the one your doctor claims shows that you need surgery.
In addition, shoulder pain cannot be accurately diagnosed based only on MRI findings. Meaning I’ve seen many, many patients who have one shoulder that looks awful on MRI and doesn’t hurt much while the other one looks better on imaging and is keeping them up at night.
The upshot? MRI has been a Godsend and a curse. It has both saved and ruined countless lives. So what’s the solution? It’s as simple as it was in Sir William Osler’s day:
“Listen to your patient; he is telling you the diagnosis.”
Meaning that through history, exam, and time, a diagnosis is made. While the MRI can be an important piece of the puzzle, making it the whole picture is a prescription for potential disaster.