I'm a belt and suspenders type. Physical exam, MRI, X-ray. Multiple diagnostic tools.
This is exactly the problem with American healthcare. The majority of people demand this sort of standard. The best example I've seen lately is the cartoon of the guy sitting on the exam table with an arrow through his head. The doctor says, "Right off I'd say you have an arrow through your head, but just to be sure I'm going to order a bunch of tests." Technology is overused to a horrible degree. Canada has a fraction of the CT and MRI scanners that we do, and their outcomes are at least as good as ours. I'm pretty sure that the same could be said for most of the developed countries in the world. It's MRIs, PET scans, nuclear scans, exotic serologies, and on and on. Chemistry profiles...don't let me get started on chemistry profiles, those panels of 20 or 25 tests that are so often merely as screening tests, despite the fact that it's been shown that they are MORE likely to show normal people who are merely outliers than to reveal unexpected pathology, and thousands and thousands are done every day. And on and on.
1. It is a GENERAL problem-solving trait that having multiple independend indications for a diagnosis (particularly when multple problems can be the cause) is helpful. Thus MRI is not perfect. Neither is X ray. Neithe is examination. TOGETHER, they are more powerful than on their own.
2. Of course, irellevant tests do NOT help the diagnosis (blood tests for an arrow through the head). MRI, X-ray and physical exam, for a musuloskelatal issue sure don't seem like blood tests for an arrow through the head to me. For TWO reasons.
A. The tests are not unlikely to give helpful related information.
B. We often do NOT have a conclusive indication of what the problem is by visual examination.
3. "gold standard" This is a better point. Sure...there are cases where we have to make economic tradeoffs and basically decide that a lower standard of care is worht the tradeoff. Of course even if we make these kinds of decisions, I want the doc at least
A. thinking logically. IOW, he may say, not worth the money to do test X, because of the cost versus the information. But I don't want him just putting his brain on hold and not even thinking in the manner of corrrelating information.
B. I want to know about these tradeoffs. Maybe I would pay for it. And I sure as heck don't want the guy incentivized by my insurance company to get little kickbacks for not ordering tests.
4. Gold standard continued: this is why I really hope/think/pray/want MRIs to come down in price. I want them to become like X-rays. There is SOOOOO much information available from them that is very pertinent to ortho diagnosis. You are getting me motivated to go invent a room temperature superconductor and then go after GEs ass with a doctor's office MRI!
5. "Technology is overused." It's a general statement and hard to evaluate. I've heard it, for decades now. I really haven't studied it or done the work to look at social science studies of it. At least in my personal experience (admittedly healthy young male) have not had this experience....really more the opposite of going decades without seeing a doc and of not having them push tests at me when I had athletic injuries. I wonder if this is more of an issue with other patient populations or internal medicine issues and not really related to the ortho type conditions we are discussing here?
6. "Technology is overused." My doc had a little placard on the wall talking about over-ordered imaging. And I've heard the colloquial comments. However, my experience is that the MRI changed the diagnosis twice. Both times, I had to insist on it. First time, we discovered grade 4 chondro (loss of cartilage down to the bone), when ortho diagnosed tendonitis. Second time, surgeon and primary care doc said my already operated shoulder had tendonitis and the labrum was fine, would not authorize a contrast agent MRI...I had to find a doc to order it. Did so. And it successfully resolved the labrum (which a non-contrast agent had not) and showed the anterior labrum "missing".
7. It's not like I think technology shows us everything. that's why I said, multiple tests. I want to put it all together. But I sure as heck don't want to rely on the "white labcoat appeal to authority". Sorry. The mechanic explains the car problems to me. Same with dishwasher repair. Same with my freaking body.
8. Canada outcomes: Outcome is a broad brush. Are ALL outcomes the same or better up there? Also, the patient populations are not identical.
9. If a test has a higher false positive reading, then we should just take that into account with a Bayesian consideration of the results. I can handle the if-then statistics logic. Can the docs?