Back to Learning Portfolio

The MRI Lie: A Matter of Economics

grelsamer01.jpg

Dr Ronald Grelsamer

Knee Surgeon

Dr Ronald P. Grelsamer, M.D., board certified by the American Board of Orthopaedic Surgery in 1987, is associate professor of orthopaedics at Mount Sinai Hospital in New York. He is listed in New York Magazine's "Best Doctors of New York," and in Castle Connolly's directory of "American Top Doctors…

February 7, 2005

Dr Ronald Grelsamer exposes some problems in the MRI business.

Unnecessary MRI (magnetic resonance imaging) testing and resultant surgeries are driving up the cost of health care in the United States.

While personalized patient care and physician reimbursements are plummeting, health insurance coverage continues to soar. The cost of radiology, which is expected to keep growing at an annual rate of 20% or higher, is now outpacing the cost of prescription drugs for the first time. At a projected $100 billion annually, diagnostic imaging is one of the fastest growing concern areas in our health care.

Data from IMV Medical Information Division - an Illinois market-research company - strongly suggests that efficient radiology benefit management could cut America's imaging expenditures by $20 billion to $30 billion annually. They concede that about 1/3 of advanced imaging tests are either inappropriate or don't contribute to a physician's diagnosis or ultimate health outcomes.

The Accuracy Of The Knee MRI Is One Of The Greatest Myths Of Our Time!

While MRI testing is an extraordinary diagnostic tool in certain areas, its accuracy for knee pain and arthritis is arguably one of the greatest myths of our time. In my experience, the odds of coming across a false-positive MRI range from 10 to 100 percent, depending on the knowledge and integrity of the radiologist. The MRI provides nothing more than thin, flat slices of a complex, colorful three-dimensional structure, so it is subject to interpretation and can miss conditions such as arthritis, partial ACL ligament tears, and kneecap mal-alignment.

In The Hands Of The Wrong Orthopedist, The MRI Becomes A License To Operate!

  • Grades I, II and III cartilage 'tears' - At the dawn of this new millennium, one is at greater risk of being misdiagnosed with a torn cartilage than at any other time in history. Since the MRI shows only thin shadows of complex structures, small abnormalities might be missed. While a Grade III tear may or may not require surgery, a Grade I or II never does! By reporting grade I and II changes as tears, a radiologist allows the unscrupulous orthopaedic surgeon to recommend a surgical procedure. Seeing the word 'tear' on the MRI report, most patients readily agree to surgery.
  • MRIs can over-read common knee conditions - Other knee pain causes such as nagging tendonitis, which is an inflammation of the tendon, and runner's knee, which is an irritation of the so-called iliotibial band, running along the outside of leg and knee, can be misread on MRIs as torn cartilage. These conditions can be treated without surgery.

X-Rays, costing 1/10 of an MRI, can diagnose arthritis, and "LK-SSS (Limited Knowledge, Suspect Scruples) doctors"

A severe arthritic flare-up will eventually quiet down on its own. A competent physician will prescribe old-fashioned x-rays, usually sufficient to diagnose arthritis or knee mal-alignment, at 1/10 the cost of an MRI. If a patient is over forty years of age, the doctor should make certain the frontal x-rays are taken in a standing position. However, an 'LK-SS Doctor' - which is how I describe a surgeon with limited knowledge and suspect scruples - uncertain about a diagnosis, and possibly motivated by revenues created by expensive, in-office MRI equipment, might be quick to prescribe an MRI, followed by surgery for a 'torn' meniscus. When the patient's pain persists after the operation, the LK-SS surgeon identifies the problem as arthritis, which should have been detected preoperatively through x-rays and a good physical examination, but was not detectable on an MRI.

Treat Patients, Not Tests

Unfortunately, less emphasis is being placed on patient history and physical exams. Taking the time to really listen to a patient is becoming a lost art. Too often patients, not making the connection between the proliferation of technology and rising health care and insurance costs, feel shortchanged if no MRI is prescribed. The reality is that MRIs, which can run between $500 and $1500 a scan, depending on circumstances, inflate our insurance premiums, and the insurance companies' ability to pay for other tests and treatments.

What is the answer? - Education! The key to improving health care while holding down prices is twofold: encouraging consumers to be more involved in decisions regarding their own care, and reminding doctors to combine cutting-edge technology with old-fashioned, personalized service.