Thursday, May 12, 2011

Can inappropriate MRI use be stopped?

A physician reader of AFP submitted the following post.

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I enjoyed reading and cannot agree more with the editorial in the April 15, 2011 issue on the appropriate use of magnetic resonance imaging for evaluating common musculoskeletal conditions. In many ways, the overuse of MRI is like the overuse of antibiotics for viral syndromes. Everyone knows we shouldn’t do it, but nobody seems to be able to stop.

Almost every specialist I refer to orders an MRI, often requiring them before they will even schedule a consult. Patients come in demanding an MRI after watching a professional sports event in which the sideline reporter let folks know what the MRI showed on the star who was injured during the game.

I’ve had many patients come in letting me know that their personal trainer, therapist, or next door neighbor as well as their neurologist, chiropractor or other health care professional had advised them to come in and request an MRI.

The radiologists where I practice review all MRI requests for appropriateness based on the clinical history and reported physical findings. This review process has significantly cut down on the number of MRIs that are being done at our facility, although the number of complaints has risen. In contrast, there are no financial disincentives to performing inappropriate MRIs in fee-for-service health systems.

William T. Sheahan, MD
Orlando VA Medical Center
Orlando, Florida

2 comments:

  1. For a related piece on the clinical significance of MRI findings in chronic knee pain, see the AFP Journal Club in the May 15th issue: http://www.aafp.org/afp/2011/0515/p1160.html
    The bottom line is, as Dr. Andrea Darby-Stewart writes, "Don't order any test unless you have a good idea of how the test will change the probability of disease. Will it be enough to make a diagnosis? If not, you don't need it."

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  2. Perhaps there could be a way to financially dis-incentivize the physician ordering the MRI (as opposed to the current system, which can subtly incentivize the doctor for ordering the test.)

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