Saturday, February 04, 2012

The problem with modern medical imaging

There is no question that medical imaging is one of modern medicine's most dramatic success stories. With today's MRIs scans we can image practically every part of the body with
stunning clarity and make diagnoses which were possible only at the time of doing a postmortem in earlier days. However, being able to probe into the body’s hidden recesses and get extremely clear pictures of the interior has actually created its own set of problems.

Let me explain. Let's look at a patient who has a lower back pain. Now if you have a back pain ( which most of us have had at some point in our life ), we learn to live with it. We take painkillers to deal with it when it becomes acute ; and do exercises and yoga and physical therapy to help us to get better. Lots of these problems are self-limited and will get better on their own , no matter what – sometimes with bed rest, sometimes with cold compresses and sometimes with physical therapy. However, when it becomes acute, or when your wife starts worrying that you’re not improving , you go to a doctor .

Your doctor obviously needs to do something more than what you already tried - something more than the standard home remedies , so he sends you for an MRI scan, to make an “accurate diagnosis” . Now the MRI scan will give you beautiful images of your intervertebral discs and the spinal cord – and will invariably show that you have a prolapsed intervertebral disc. Your doctor will be very pleased with himself – “ See ! I made the right diagnosis . This is the reason for your backpain !” Since his job is make a diagnosis , this gives him a thrill, because he's identified the problem with the help of medical imaging . Not only is the doctor happy with himself , his patients are also extremely impressed ! The doctor made the right diagnosis – and the MRI confirmed it. The patient can see for himself , in clear black and white , exactly what his problem is on his own scan.

However , because doctors are so focused on diagnosing problems , they actually don’t realize the downside of all these imaging results. Once the patient has seen a prolapsed intervertebral disc on his MRI scans he now stops focusing on his back pain and starts worrying about this lesion. He treats himself as a patient, someone who’s “ broken “ his back ; or someone has a weak back , and needs to rest – someone who can't play tennis or do the regular physical work out he used to in the past (when he had back pain , but before he had done the MRI scan. ) Once he's done an MRI scan , he now has a mental image that his body is broken , so that it doesn't work properly . He thinks of himself as being an invalid , and can't function properly anymore.

The tragedy is that these medical imaging procedures cause patients to focus on the problem rather than on getting better - and unfortunately, there's very little doctors do about this. Rather than sit and explain to the patient that a lot of these lesions will regress on their own; that they have a dynamic natural history ; that the body can heal itself and that many will get better on their , they will often advise the patient to repeat the scan every six months , to see how well the lesion is healing. Patients will often comply , just to see how well their disease is doing. The reality is that a lot of these lesions seen on the images have no correlation with either the symptoms or the progression of the disease ; and while they make great pictures for the doctor’s album they often don't help the patient at all !


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