I wish I had a dollar for each patient I’ve spared from an unneeded MRI, CT scan, X-ray, or other diagnostic test.
Though occasionally one of these tests is needed, my local radiology lab would go broke if they were counting on me for referrals.
Still, that doesn’t mean I like shooting in the dark and taking undue risks with my patients’ health. Fortunately, I have three diagnostic methods to rely on.
The first is the consultation, where the patient tells the doctor what’s going on. If you listen during the consultation you can piece together a lot.
The second is the good old-fashioned physical examination. That’s when I get my hands on you, checking your painful spots and evaluating your joints, muscles and posture.
But the third diagnostic method is the most important – a trial of therapy. With this diagnostic tool, you start a reasonable plan of action and then closely monitor the results you get, modifying along the way as needed.
If you have a treatment method with a very (very) low risk of negative effects (such as chiropractic, one of the safest treatments around) the best diagnostic test is often a trial of therapy.
That’s because you get double the bang for your buck. While you’re determining whether or not a particular treatment approach can help you get better, you’re actually – tada! – getting better.
By contrast, new research continues to emerge to show that there’s rarely much to gain in taking MRIs when you have back pain.
That’s an area I’m very familiar with. But recent research also debunks
- the overuse of tests for your heart
- too-frequent colonoscopies
- endless prostate screenings
- over-prescribing of mammography, and
- the use of other fancy medical technology.
So why has there been such a surge in expensive diagnostic tests over the past decades?
To understand the phenomenon, let’s go way, way back.
To an article in the Canadian Medical Association Journal titled “A framework for clinical evaluation of diagnostic technologies.”
The article makes the important distinction between a diagnostic test being accurate versus a test providing some benefit.
Accurate is important, to be sure. But useful is more important. After all, you don’t need to launch a weather balloon to measure the barometric pressure in the upper atmosphere to two decimal places if all you want to know is whether to put on a sweater when you go out.
The authors (Guyatt, Tugwell, Feeny, Haynes, and Drummond, for those keeping score at home) speculate as to why doctors gravitate to certain technologies even if the benefits are questionable.
Here are some excerpts:
“Diagnostic technologies have not been adequately assessed to determine whether their application improves health.
“We believe the standards for evaluating new techniques have not been sufficiently rigorous and that inadequate evaluation has led to overutilization of diagnostic techniques.
“Accurate diagnostic tests may influence neither therapy nor patient outcome, and yet may still receive wholehearted support from the medical community.
“This may be because physicians and policy-makers are convinced of [their] benefit even in the absence of adequate data, because they see the demonstration of accuracy as sufficient reason for dissemination [of a technology] irrespective of benefit, or because the CT scans ability to reduce the physician’s anxiety and increase his or her confidence may favor rapid diffusion and official endorsement.
“Although one may think of more sinister possibilities (such as the increased power and status, and the financial advantages, acquired by the medical profession as it adopts more and more mysterious and apparently powerful gadgetry, or the unregulated promotional efforts of the companies responsible for developing the new technology) we suspect that the third explanation may be the most important.”
Unfortunately, since 1986, little has changed for the better.
Let me paraphrase their conclusion for you:
Doctors overuse sophisticated diagnostic technology, even when it hasn’t been shown to be beneficial, because it reduces physician anxiety and increases physician confidence.
Despite the brilliant scientific advances of the past decades, doctors are aware of how superficial our knowledge of health still is. Under these circumstances, it’s stressful to take responsibility for patients’ well-being. And to be effective practitioners, doctors have to find a way to control their stress.
The illusory certainty of high-tech diagnosis is one antidote.
Do doctors of chiropractic deal with their anxiety differently?
Doctors of chiropractic share the same stresses that allopathic physicians have. And chiropractors try to find ways to reduce their anxiety too.
But there is a fundamental difference.
Unlike the allopathic model of medicine, the central focus of chiropractic is the unshakeable knowledge that the forces that control and regulate our bodies, although still largely unexplained by current science, shape our health for the good.
We’re designed to be healthy automatically – to fight off infection, heal injured tissues, optimally regulate our hormones, learn new movement skills, adapt to disabilities as they arise, make optimal use of absorbed nutrients, and much more.
Rather than fear the unknown, and paper over the gaps in our scientific knowledge, doctors of chiropractic are trained to expect health from their patients.
Being steeped in this aspect of scientific reality gives doctors of chiropractic a natural immunity from anxiety and an in-born confidence in the health potential of our patients.
That’s the designed-by-nature bottom line.
If you have enough pain and the doctor suggests a MRI or other scan, it can be a big assist for the doctor to assess how bad the physical makeup of the back is. Is the back totally deteriorated? Is the back impinging on nerves,and where? Only a MRI will give you this info, and it saves time for the patient when you go from specialist to specialist seeking relief for back pain. The doctor looks at the MRI results and from that can he/she/they can tell what kind of physical shape your back is in. There’s simply no other way to ascertain that.
Thanks for your response, George. I don’t strictly disagree with what you’re saying, but I do feel your remarks somewhat miss the point. The point is that the information about your back’s functional ability is as meaningful, or more meaningful, than what shows up on the MRI. The doctors who are enthralled by the MRI would have you think that what shows up on the scan constitutes the “physical shape your back is in”. But that isn’t true. The level of pain a person is in and the level of physical disability a person has are significant measures of an individual’s problem, but they do not correlate with the severity of MRI findings. If you’re trying to make sense out of back pain, there are far more important indicators to pay attention to than the MRI.