Most patients who come to see me have already had an MRI scan of their problem- lumbar or cervical. And I love to have and read MRI scans. But I order fewer MRI scans than most doctors, for several reasons. The first reason is that I actually practice medicine the way it is supposed to be practiced, which is unusual, nowadays.
You see, most spinal problems are benign and mechanical. They are not dangerous problems and they will improve IF the doctor provides effective treatment. Since I worked for 18 years in an orthopedic, physical medicine and physical therapy clinic, I know how ineffective most treatments are for neck and back problems. That’s one reason doctors order so many MRI scans- because patients don’t improve quickly, and because doctors anticipate that patients won’t improve quickly.
Of course, medicolegal reasons are also a large part of why doctors order so many MRI scans.
Another reason, is that it’s fascinating to see a person’s anatomy.
And there are, of course, very legitimate reasons to order MRI scans. If the doctor is concerned about some developmental or anomalous anatomy that’s a fine reason to order one, though for that purpose, an x-ray suffices.
Concern for a possible malignant lesion is probably the best reason.
But let me tell you why I order so many fewer MRI scans than most doctors. My treatment is so much more effective than other treatments, that most patients start to improve with the first treatment. That helps me to quickly confirm the benign nature of the problem and negates the need for an MRI scan.
One criticism I have of medicine, generally, is that we spend too much money on profitable diagnostic tests, which don’t help patients improve. And we spend too little money doing effective treatment, which is what patients really want.
When I treat patients, 70% will start to improve with the first treatment I do. That is very different than most doctors, physical therapists and chiropractors. That’s why I order fewer MRI scans than other doctors.
A corollary of the fact that my treatment is more effective, is that my treatment is cheaper than other treatment. That’s because I can get your problem better, faster than other treatments. That means fewer treatments, hence less money.
Of course, it’s also true that for many neck and back problems, other treatments will not be effective. That also means that you’ll be sent for injections and surgery more often.