Saturday, October 29, 2011

MRI's and athletic injuries

who am i to question a medical provider's advice and guidance?

i'll tell you who i am: a concerned citizen and health care patron. i use my docs and their skills and i pay my own insurance and deductibles, so i know the costs i incur. and if, as a reasonably intelligent and informed adjunct health care provider, i see the issues on my bills, i know there are way more out there who don't see them. and that leads to rising health care costs.

this news piece talks about the highly sensitive technology of non-invasive scanning - magnetic resonance imaging, or MRI. this allows, without radioactivity, for looking inside the body and seeing soft tissue, not just bone. hence, muscles, ligaments, tendons, organs - all are easy to see before going in to repair damage. at one time, these were so expensive, docs referred to the few hospitals that had them and only in cases where uncertainty about a diagnosis - and i'm going to keep this to orthopedic/sports med concerns - existed. in the old days, docs asked questions, palpated, manipulated and if need be, x-rayed to diagnose. today, they are quick to get an MRI, too. for one thing, many groups own their own unit. if you got it, use it, is the mantra. often times they are used instead of the traditional methods, whereupon things get 'seen' that may or may not be related to the problem at hand. several studies show that, while sensitive, MRI's are not that specific. that means, it shows a lot but not necessarily that what you see is what the problem is. in this piece, it talks about all the bad shoulders in pro pitchers who actually do NOT have pain or problems. hence, just because it's visible does not mean it needs repair. this has been found in spinal disks, too: about 33% of us without back pain have damaged disks. that means that not all back pain is caused by disk damage even if the disk is bad. it takes a good doc or therapist to ascertain the difference and the subsequent value of further treatment options.

when i went to get my hyaluronidase shots last summer for an obviously arthritic knee, my doc pulled out his cool new ultrasound machine. he could show me the joint and found exactly where to inject. as he did so, he noted that this is where he'd have injected anyway. by the third treatment, i had gotten a bill. that less than a minute ultrasound cost over $600!!! i was stunned and brought this to his attention. he subsequently stopped using it on me saving me, my insurer, and the health care system the next $2000. but how many other patients caught this; how many objected to its use; how many more dollars did this doc make doing a procedure he never had to use before to do the procedure he was tasked with?

now, i don't fault him; he's a friend and a conscientious doctor. but his group's business manager saw a cash cow here and suggested he use this new toy. and of course, as this becomes 'standard of care' the insurance industry is bound to reimburse, to the tune of 20-35% of charges, and lawsuits will evolve as some docs resist its use.

perhaps its the nature of the system - each group trying to make dollars while each group's nemesis trying to keep dollars. whatever it is, please be aware of the game, esp if you can do so before you get nailed for the procedure. ask if, indeed, an MRI is going to actually help with the diagnosis or the subsequent procedure. save your money....and mine.

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Dr.Irv