What do Rafeal Soriano (New York Yankees), Brett Favre (Minnesota Vikings), and Matthew Stafford (Detroit Lions) have in common? They all rely (or have relied) on the services of a renowned orthopaedic and sports physician, Dr. James Andrews, from Gulf Breeze Florida. His clinic, The Andrews Institute, founded in concert with Baptist Health Care, works with students and professionals, as well as effects research and provides education to patients and physicians. His newest research is bound to throw sports professionals for a loop- and probably many of us ‘regular’ folks, as well.
Dr. Andrews scanned (via Magnetic Resonance Imaging – MRI) the shoulders of 31 perfectly healthy pitchers. Folks who had no complaints. And discovered that some 87% of the scans demonstrated abnormal rotator cuff tendons and abnormal shoulder cartilage in 90%. Which would normally lead to a scheduled procedure for the pitcher.
Dr. Andrew Green (Brown University)reported in 2006 a study of 101 patients with medium term shoulder pain, for which 43 had MRI performed by the referring physician and 58 did not. His group then diagnosed the patients via medical history, physical exam and X-rays. The follow-up (one year later) indicated that outcomes between the two groups of patients was virtually identical- the scan information did not afford his group any better results to improvement.
So, it seems, not only are MRI’s scheduled by physicians as part of the prevalent CYA medicine practiced in the United States, but they can be used as an excuse to provide a costly operation for someone who may not need it. Please do not take this statement to claim that I am against MRI. No- they have valid use to help discriminate among diagnoses that may fit a patient’s history and symptoms and certainly are capable of detecting tumors.
But, MRI machines are typically owned by physicians and can be used to rake in extra dough- and satisfy patients who want to know why they are not getting a scan. (This latter fact is among the reasons why everyone’s health insurance premiums rise- the overuse of diagnostic tests that can charged to the insurance company- and don’t necessarily make anyone healthier. Note that MRI scans average $ 1100 (where the doc get $ 150 and the facility [which he also may own] gets $ 950).
For example, I have many friends who routinely train for marathons. Running 25 miles, biking 50 miles every single day. Given that it’s cold and humid outside, they may complain about an ache or pain in the knee after that run. An MRI scan, provided after that run, will depict fluid in the knee. Which probably means nothing- unless he really is injured- and then further tests will be necessary to see if there is stress on the bone or it has a crack that is healing.
The MRI is similar in concept to the cholesterol tests we administer. It’s extremely sensitive, highly accurate, but not specific. (For a discussion about cholesterol testing and what really should be done, reread my post here.) You can bet that if you have an MRI exam, the results will not come back “normal”. That’s just the way it is.
So, for most sports medicine injuries, the crack specialists know that a complete medical history (a plug for health care information systems here), a physical exam, and, perhaps, an X-ray will suffice. MRI’s are not the only culprit, but when injuries involve muscles and tendons (‘soft tissue injuries’) this is among the first tests to be administered. Maybe it’s time to reassess.
Interesting, Roy. I read an article in the Nov issue of Whole Living that suggests doing headstands could be a cure for rotator-cuff injuries. Interesting and they gave you suggestions of how to modify the headstand so you don’t injure yourself in that process. I had surgery on my AC joint a couple of years ago and sadly I’ll never pitch again (even though I never pitched before). I injured mine gardening. It’s a dangerous world out there. I didn’t try headstands to help the situation, but might if the other one starts acting up.
Bonnie:
So, let me see if I can even DO a headstand. Given my “capabilities”, i would assume that my rotator cuff injury would no longer be my primary issue- the cracked skull, twisted spine, or broken arm would be a more crucial item to be addressed 🙂
And, I love the comment about pitching…
Roy
Wow. Thanks, Roy.
Debi:
MRI is something I am learning more about- but mostly in the fMRI area, where it serves research.
I do have many friends who run and bike (I do, too- but these folks almost do it as part of their religion)- who complain about aches and pains. Then, go to docs, and get all kinds of tests. Now, I wonder if some of those therapeutic regimes demanded had any merit…
Thanks for dropping in!
Roy
When I worked for an insurance carrier, we had a situation where the physicians in one state owned the labs and had ridiculously high numbers of lab tests. The local Blue Cross/Blue Shield started denying the claims as a conflict of interest where the physicians referred patients to the labs they owned. Needless to say, Blue Cross lost out on the case brought against them by the physicians.
My company hired a local consultant to review for medical necessity. We had to keep his identity secret as he would receive death threats – seriously. We denied large portions of the claims as not medically necessary. We sent letters to the insured explaining the denials and their right for appeal. 99.9% of these claims were for services that were at least a year old.
We’d never hear back from the patients. You know what that means – they weren’t charged for those tests. Finally, after a year and a half of creating customized letters of denial for these claims, I received a call from a patient. She was one of those organized types who had her receipt from her visit the year before for a routine pap. She was charged $25 (looong time ago) and the claim we received was for charges in excess of $2,000.
Never happens, right? 😉
Oh, Cathy, I would never put it past ANY individual to be corrupt. (I have two posts, and counting, in the queue about this phenomenon.)
And, that is reprehensible. However, that is not the same- or as costly to us all- as the rampant use of technology, when it is not required- and, especially, when it is being performed as part of a defensive medical strategy.
Roy
Very true-I went a bit off topic-it was the idea of the doctors owning the MRIs that reminded me of the situation. Although definitely not fraudulent, the motivation behind it is at least questionable.
Granted!
Cathy- that’s why we need more regulation and not less.
Roy
How synchronistic! I just spent the weekend with my daughter who was hospitalized with a viral infection. Before it was determined that the nature of her infection was viral, not bacterial, they pumped her full of antibiotics, different kinds too. They gave her an MRI with iodine, a spinal tap, a chest x-ray and blood tests. Thank goodness we have insurance. But I wondered if the rush to do all that was in the interest of CYA or her health. After I drove four hours to be with her in the hospital, it wasn’t until noon the next day that I ever saw a doctor to get questions answered. I was not impressed with “business-as-usual.”
On the other hand, I am grateful they administered fluids and got her blood pressure back up and that she is on the mend. Fortunately she didn’t have any reactions to the medicines they pumped in either.
Thanks for dropping in, Loran!
It is becoming more typical now to load patients with drugs when they are clearly ill and as we determine the cause- to insure that the infection does not grow.
And, if it were a viral infection, are you sure they gave antibiotics? They only kill microbes, not viri! Hopefully, your daughter will be her normal self very soon.
Roy
One day we will take back our power and realize that everything has a price including pushing our bodies. It is a tough one when the doctor says. I know at least one person who refuses to go to a doctor because he does not trust them.
Roberta- the not going to the doctor is not the right response. But, there’s no accounting for illogic.
The trick is to demand information- you are entitled to it- and you need it to make the proper choices.
Roy
Hi Roy,
I enjoyed this post a lot–I always enjoy studies of characteristics associated with practice patterns. It is interesting to see this from the sports medicine perspective. One of the things to consider with all of this is the risks to patients who might receive unnecessary care. Like most medical procedures, MRIs carry risks.
Touche, Kristen!
Thanks for bringing the points home, with your additions!
Thanks for dropping in.
Roy
Profound discussion! But it’s pretty much interesting to know about the inadequate of MRI!! If it has no particular uses but satisfy the patients then it should be consider once again indeed and soon. I’m pleased to get the overview of an important fact from expert. Thanks Roy!
Thanks, MarisonJhon, for your comments and interests. And, I’m glad you’ve learned something, too!