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How much more expensvie is an MRI vs an Xray?


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#1 DankNuggs

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Posted 12 January 2012 - 12:48 PM

Curious as to why they refuse the give an MRI. I know its more expensive, but how much? I've broken bones and i've torn ligaments. I'm no expert but i have experience with how those two different types of pain feel.

I rarely go to the doctor, when i go, its because its something serious and debilitating. I get 3 min of evaluation, a worthless xray and physcial therapy referral..


This same process happened when i tore my ACL, i was put into physical therapy for 2 weeks before seeking a second opinion, who then put me in a cast from hip to toe for 2 months...

I got the Mickey D's drivethrough experience that time, and likely this time as well.

When i think about the overall contributions I pay a month to my healthcare its over $600/month, and all i get is a worthless yearly checkup, and denial of needed tests... This is why healthcare sucks and making it more public will only degrade it... Good to know my purpose in this system is merely to exist to subsidize others...


:mad:

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#2 Scary Gary

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Posted 12 January 2012 - 12:55 PM

MRI = 600 to 1200
XRAY = 100 to 300

Prolly bout 4x to 6x.

Depends on how many snapshots they get. An MRI can be many many individual pictures.
XRays usually fewer.
You meddling little sh!t.

#3 DankNuggs

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Posted 12 January 2012 - 01:04 PM

MRI = 600 to 1200
XRAY = 100 to 300

Prolly bout 4x to 6x.

Depends on how many snapshots they get. An MRI can be many many individual pictures.
XRays usually fewer.

Thank you very much... appreciate it.

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#4 MedStudent

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Posted 12 January 2012 - 01:12 PM

MRI's vary very widely. they can be over $3000. X-rays vary a lot too depending on where you get it. emergency rooms will charge a lot more for them as well.
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#5 DankNuggs

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Posted 12 January 2012 - 01:18 PM

MRI's vary very widely. they can be over $3000. X-rays vary a lot too depending on where you get it. emergency rooms will charge a lot more for them as well.

Thanks, i understand im not a professional athlete or anything, but when i get the same schtick from the doc saying she isn't sure what the next best course of action is, then turboreferrals a PT assignment it leads me to believe im not getting the best care i should be getting... What do you have to pay/Where do you have to go to get good health coverage?

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#6 donhaas

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Posted 12 January 2012 - 01:28 PM

When i think about the overall contributions I pay a month to my healthcare its over $600/month, and all i get is a worthless yearly checkup, and denial of needed tests... This is why healthcare sucks and making it more public will only degrade it... Good to know my purpose in this system is merely to exist to subsidize others...

:mad:


There's a reason why the five largest health insurance companies racked up combined profits of $12.2 billion -- up 56% over 2008...

You massively overpaying for no care :doh:


OBUMMER! :mad: :mad: :mad:

#7 DankNuggs

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Posted 12 January 2012 - 01:59 PM

There's a reason why the five largest health insurance companies racked up combined profits of $12.2 billion -- up 56% over 2008...

You massively overpaying for no care :doh:


OBUMMER! :mad: :mad: :mad:

I definitely am, they question is to fix it, do you make it MORE bureaucratic? that bureaucracy has a cost, and its definitely a bigger cost than whatever purported 'savings' they use as justification...


I'm a part of Romneycare, so I'm basking in the glory of its govt mandated awesomeness...

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#8 southcarolina

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Posted 12 January 2012 - 02:00 PM

Thanks, i understand im not a professional athlete or anything, but when i get the same schtick from the doc saying she isn't sure what the next best course of action is, then turboreferrals a PT assignment it leads me to believe im not getting the best care i should be getting... What do you have to pay/Where do you have to go to get good health coverage?


Physical Therapy is a racket, and family doctors are getting kickbacks for all the referrals. Its almost as bad as the sleep apnea racket. BVut iwont get into that now. When i blew out my first disk, i was sent to PT for a month. On my first vist, my therapist took one look at me (big, muscular guy) and said "Touch the floor" and when i couldnt, he said "See youre all big and muscle bound. Youre too inflexible. Thats why you cant touch the floor and why you are in pain."

To which i replied: "No, Two weeks ago i could stand flat footed and touch my PALMS to the floor, Then my back started hurting. Now i cant get my finger tips with in 6 inches of the floor.

And he said," Well umm....we see inflexibility in a lot of our back pain patients."

I look around. Im the youngest person in there by 30 years,

"You know im 32 years old right."

"Ohh umm....Here do these stretches"

A month later, when the pain hadnt subsided, they finally did an MRI. One ruptured disk, and two herniated next to it. The nurse who read my results actually said to me, "Oh wow. You DO have some damage back there." Ya think?

When i blew out my second disk five years later, and the doctor asked if i wanted PT i emphatically said no. I told him it only made things worse last time (which wasnt completely true) and that i wanted an MRI first. If there wasnt an damage, i would try the PT. But not before.
Come on down to the hotel, baby. I can be what you want me to be. You can choke on your own medication, and i can watch myself on tv. Shut your mouth you big f*cking baby. I cant be what you want me to be. Go on choke on your own medication. I can tell you a lie you'll believe, yeah yeah.

#9 DankNuggs

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Posted 12 January 2012 - 02:12 PM

Physical Therapy is a racket, and family doctors are getting kickbacks for all the referrals. Its almost as bad as the sleep apnea racket. BVut iwont get into that now. When i blew out my first disk, i was sent to PT for a month. On my first vist, my therapist took one look at me (big, muscular guy) and said "Touch the floor" and when i couldnt, he said "See youre all big and muscle bound. Youre too inflexible. Thats why you cant touch the floor and why you are in pain."

To which i replied: "No, Two weeks ago i could stand flat footed and touch my PALMS to the floor, Then my back started hurting. Now i cant get my finger tips with in 6 inches of the floor.

And he said," Well umm....we see inflexibility in a lot of our back pain patients."

I look around. Im the youngest person in there by 30 years,

"You know im 32 years old right."

"Ohh umm....Here do these stretches"

A month later, when the pain hadnt subsided, they finally did an MRI. One ruptured disk, and two herniated next to it. The nurse who read my results actually said to me, "Oh wow. You DO have some damage back there." Ya think?

When i blew out my second disk five years later, and the doctor asked if i wanted PT i emphatically said no. I told him it only made things worse last time (which wasnt completely true) and that i wanted an MRI first. If there wasnt an damage, i would try the PT. But not before.

Wow, sounds eerily similar to the same song and dance i went through when i tore my ACL 10 years ago... I should have caused a scene and not left the office til i got an MRI...

You have to know you are getting screwed and cause a disturbance... Awesome system we have.

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#10 sheadtoo

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Posted 12 January 2012 - 02:21 PM

My first thought is find a better Dr....I go maybe once every 2 years but I shopped until I found one I liked and didn't just kick you out 4 seconds after I got there.

#11 BunnysBastatrds

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Posted 12 January 2012 - 02:23 PM

I had a stress test and an ultrasound done on my heart yesterday. Anybody know the costs for those?

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#12 shovelheadt

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Posted 12 January 2012 - 02:23 PM

Sounds like the back alley abortion doc in Dirty Dancing was better than what some of you use. I'm not so sure it's the plan so much as it is the doctor you're using. My doc never gives me the run around, and I've never felt like I was spinning my wheels.
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#13 DankNuggs

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Posted 12 January 2012 - 02:27 PM

Sounds like the back alley abortion doc in Dirty Dancing was better than what some of you use. I'm not so sure it's the plan so much as it is the doctor you're using. My doc never gives me the run around, and I've never felt like I was spinning my wheels.

Brigham and Womens Hospital Boston I thought was considered one of the best in the world. Just looked it up in USNews as #2 in Boston, that should be pretty good, no?

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#14 sheadtoo

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Posted 12 January 2012 - 03:02 PM

Brigham and Womens Hospital Boston I thought was considered one of the best in the world. Just looked it up in USNews as #2 in Boston, that should be pretty good, no?

Depends on what info they use.....Just cause they get them back out the door doesn't mean sh!t to me. I want good people skills from my Dr. and for them to take a few minutes to listen to what the problem is not just what I told the little skank on the phone

#15 shovelheadt

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Posted 12 January 2012 - 03:08 PM

Brigham and Womens Hospital Boston I thought was considered one of the best in the world. Just looked it up in USNews as #2 in Boston, that should be pretty good, no?


Maybe it's different in larger areas. My first visit for any issue would not be to a hospital. It's to a family doc that I've known for 10 years. It's to the point with her where I don't even have to come in sometimes because she trusts me. One phone call, one prescription dialed in for me.
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#16 DankNuggs

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Posted 12 January 2012 - 03:17 PM

Maybe it's different in larger areas. My first visit for any issue would not be to a hospital. It's to a family doc that I've known for 10 years. It's to the point with her where I don't even have to come in sometimes because she trusts me. One phone call, one prescription dialed in for me.

I think i'd rather have a well known family type doctor situation... because HC in massachusetts is so F-ed up, doctors don't stay in the system here... they leave to practice in places where the govt doesn't force them to take pennies for treating medicaid holders... I've had 3 PCP's in the last 5 years... They keep leaving the state..

So i have to start all over with a new dr who doesn't know me, has no history...etc...

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#17 Scary Gary

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Posted 12 January 2012 - 03:18 PM

I've had multiple MRI's. Most expensive....2k (neck)...least expensive $260 (elbow), mid level shoulder $700.
You meddling little sh!t.

#18 penultimatestraw

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Posted 12 January 2012 - 10:56 PM

Physical Therapy is a racket, and family doctors are getting kickbacks for all the referrals. Its almost as bad as the sleep apnea racket. BVut iwont get into that now. When i blew out my first disk, i was sent to PT for a month. On my first vist, my therapist took one look at me (big, muscular guy) and said "Touch the floor" and when i couldnt, he said "See youre all big and muscle bound. Youre too inflexible. Thats why you cant touch the floor and why you are in pain."

To which i replied: "No, Two weeks ago i could stand flat footed and touch my PALMS to the floor, Then my back started hurting. Now i cant get my finger tips with in 6 inches of the floor.

And he said," Well umm....we see inflexibility in a lot of our back pain patients."

I look around. Im the youngest person in there by 30 years,

"You know im 32 years old right."

"Ohh umm....Here do these stretches"

A month later, when the pain hadnt subsided, they finally did an MRI. One ruptured disk, and two herniated next to it. The nurse who read my results actually said to me, "Oh wow. You DO have some damage back there." Ya think?

When i blew out my second disk five years later, and the doctor asked if i wanted PT i emphatically said no. I told him it only made things worse last time (which wasnt completely true) and that i wanted an MRI first. If there wasnt an damage, i would try the PT. But not before.

MRI is rarely needed for the diagnosis and treatment of back pain. A good exam will tell you if you have a nerve problem (usually from a ruptured disk) or not. Almost everybody over age 30 will have abnormalities in their lumbar disks on MRI, BTW. In the absence of severe neurologic symptoms - strength/sensory changes, incontinence, impotence, the treatment is the same anyway - physical therapy and pain meds. And lose weight for most. Surgery is indicated only for severe neurologic compromise or pain refractory to meds. And surgical outcomes are mixed in comparison to PT, which can be performed without the risks associated with surgery. Doctors don't get kickbacks from PT or evaluation of sleep apnea - if they do, that is illegal.

Although slightly different, the evaluation of knee pain can usually arrive at a diagnosis with the history and exam alone, or at least exclude serious things that might warrant an MRI (tendon/ligamentous injury, bone infection). X-ray is decent for diagnosing broken bones (which rarely occur spontaneously in younger people) and some types of arthritis.

Patients demand tests inappropriately in many instances, and doctors sometimes give in. Giving in may mean prescribing unnecessary antibiotics/other medications(common) or ordering inappropriate tests, like knee/back x-rays and sometimes MRIs. It's one of many reasons our healthcare system is broken. It would help if patients knew the pros/cons of the tests and had some share in paying for them. With insurance co-pays being set, there is no disincentive to demand more expensive tests (MRIs, stress tests (another highly over-ordered test)).

There is a reason doctors go to school a long time. There certainly are sh!tty ones, like in any other profession, but they probably know a lot more about the appropriate diagnosis and treatment of disease than a Google search.

#19 penultimatestraw

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Posted 13 January 2012 - 02:02 AM

A couple links on unnecessary surgical procedures - realize when you ask for MRI, the real question is: "Is there anything present that warrants surgery?" Otherwise it's always PT and pain meds.
My link

Too many complex back surgeries are being done and people are suffering as a result, according to a study in the current issue of the Journal of the American Medical Association. The general tendency noted in the study — that many patients and doctors think more medical care is always better — has implications for the new health overhaul law.

Back pain associated with aging can be treated in one of numerous ways: rest and physical therapy, surgery to remove the bony growths that can push on nerves, fusing two vertebrae together, or fusing many vertebrae together.

In the past few years, several studies have failed to show a big advantage for surgery — especially for complex surgery. Researchers from Oregon Health and Science University and several other places looked at Medicare billing records to see whether the rates or type of back surgeries went down as a result.

They found the number of surgeries has gone down very slightly. But when they looked specifically at complex surgeries, they found a big difference.

"The most complex type of back surgery has increased dramatically between 2002 and 2007, with a 15-fold increase," says co-author Richard Deyo. In 2002, the rate of complex surgery was 1.4 per 100,000 people in Medicare. It jumped to 19.9 per 100,000 just five years later.

Deyo and his colleagues also checked the rate of complications. "This more complex form of surgery is associated with a higher risk of life threatening complications," he says. Among people who just had the bony growths removed (a surgery called decompression), 2.3 percent had problems associated with their treatment, such as a heart attack, stroke or pneumonia. The complication rate was 5.6 percent among people who had multiple vertebrae fused together.

Deyo says there's no reason to think people suddenly started developing the spinal deformities that justify the complex surgeries. He offers several possibilities for the upswing. "Many surgeons genuinely believe that the more invasive procedures offer some benefits," he says. "But certainly there are important financial incentives at play as well." Surgical fees for simple decompressions are about $600 to $1,000. The complex surgeries earn surgeons as much as 10 times more. He says another possible factor is the tendency for both doctors and patients to go for a new, more expensive approach just because it sounds better.

Orthopedist Eugene Carragee, a professor at Stanford University School of Medicine, wrote an editorial accompanying the research, saying that financial incentives are part of the problem. There's also a problem with how new technologies are introduced, he says. In surgery, someone can just introduce a new procedure.

"The burden of proof in the system as it is now is that researchers have to go out to try and prove that what this guy wants to do doesn't work, and that's a backwards kind of thinking," he says.

It's far better to have to prove that something works before it becomes common practice, he says.

My link

BACKGROUND
The efficacy of arthroscopic surgery for the treatment of osteoarthritis of the knee is unknown.

METHODS
We conducted a single-center, randomized, controlled trial of arthroscopic surgery in patients with moderate-to-severe osteoarthritis of the knee. Patients were randomly assigned to surgical lavage and arthroscopic débridement together with optimized physical and medical therapy or to treatment with physical and medical therapy alone. The primary outcome was the total Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) score (range, 0 to 2400; higher scores indicate more severe symptoms) at 2 years of follow-up. Secondary outcomes included the Short Form-36 (SF-36) Physical Component Summary score (range, 0 to 100; higher scores indicate better quality of life).

RESULTS
Of the 92 patients assigned to surgery, 6 did not undergo surgery. Of the 86 patients assigned to control treatment, all received only physical and medical therapy. After 2 years, the mean (±SD) WOMAC score for the surgery group was 874±624, as compared with 897±583 for the control group (absolute difference [surgery-group score minus control-group score], −23±605; 95% confidence interval [CI], −208 to 161; P=0.22 after adjustment for baseline score and grade of severity). The SF-36 Physical Component Summary scores were 37.0±11.4 and 37.2±10.6, respectively (absolute difference, −0.2±11.1; 95% CI, −3.6 to 3.2; P=0.93). Analyses of WOMAC scores at interim visits and other secondary outcomes also failed to show superiority of surgery.

CONCLUSIONS
Arthroscopic surgery for osteoarthritis of the knee provides no additional benefit to optimized physical and medical therapy.



#20 IGotWorms

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Posted 13 January 2012 - 02:05 AM

When i think about the overall contributions I pay a month to my healthcare its over $600/month, and all i get is a worthless yearly checkup, and denial of needed tests... This is why healthcare sucks and making it more public will only degrade it... Good to know my purpose in this system is merely to exist to subsidize others...


Hold up there buddy. You think the current system sucks, right? So what's the harm in changing it? Do you really think it can actually get worse? :lol:



P.S. I ruptured a disc in my back a few years ago and had no problem getting an MRI. But it really didn't do much good. I guess it was kind of nice to actually SEE what it was that was creating all this pain for me, but at the end of the day it made no difference whatsoever as to how the problem was treated.

#21 penultimatestraw

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Posted 13 January 2012 - 07:10 AM

P.S. I ruptured a disc in my back a few years ago and had no problem getting an MRI. But it really didn't do much good. I guess it was kind of nice to actually SEE what it was that was creating all this pain for me, but at the end of the day it made no difference whatsoever as to how the problem was treated.

This is usually the case. If patients had a greater stake in their health care payments, they might not be as enthusiastic to see their bulging disc. The racket in medicine involves physicians who own their own scanners, then frequently use them without clear indication. PT referrals, not so much.

#22 DankNuggs

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Posted 13 January 2012 - 10:54 AM

MRI is rarely needed for the diagnosis and treatment of back pain. A good exam will tell you if you have a nerve problem (usually from a ruptured disk) or not. Almost everybody over age 30 will have abnormalities in their lumbar disks on MRI, BTW. In the absence of severe neurologic symptoms - strength/sensory changes, incontinence, impotence, the treatment is the same anyway - physical therapy and pain meds. And lose weight for most. Surgery is indicated only for severe neurologic compromise or pain refractory to meds. And surgical outcomes are mixed in comparison to PT, which can be performed without the risks associated with surgery. Doctors don't get kickbacks from PT or evaluation of sleep apnea - if they do, that is illegal.

Although slightly different, the evaluation of knee pain can usually arrive at a diagnosis with the history and exam alone, or at least exclude serious things that might warrant an MRI (tendon/ligamentous injury, bone infection). X-ray is decent for diagnosing broken bones (which rarely occur spontaneously in younger people) and some types of arthritis.

Patients demand tests inappropriately in many instances, and doctors sometimes give in. Giving in may mean prescribing unnecessary antibiotics/other medications(common) or ordering inappropriate tests, like knee/back x-rays and sometimes MRIs. It's one of many reasons our healthcare system is broken. It would help if patients knew the pros/cons of the tests and had some share in paying for them. With insurance co-pays being set, there is no disincentive to demand more expensive tests (MRIs, stress tests (another highly over-ordered test)).

There is a reason doctors go to school a long time. There certainly are sh!tty ones, like in any other profession, but they probably know a lot more about the appropriate diagnosis and treatment of disease than a Google search.

Thats a wonderful diatribe... Like i said, i've torn my acl, and was initially misdiagnosed and put into PT. I've been through this before. I know the pros and cons of an MRI

Pros: Figure out if i tore a ligament
Cons: costs the hospital some money (that I paid for through ridiculous premiums).

I'm going to look into a second opinion and possibly a new PCP... enough is enough. I pay too much to get quack Dr. service...

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#23 penultimatestraw

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Posted 13 January 2012 - 11:05 AM

Thats a wonderful diatribe... Like i said, i've torn my acl, and was initially misdiagnosed and put into PT. I've been through this before. I know the pros and cons of an MRI

Pros: Figure out if i tore a ligament
Cons: costs the hospital some money (that I paid for through ridiculous premiums).

I'm going to look into a second opinion and possibly a new PCP... enough is enough. I pay too much to get quack Dr. service...

If you think your judgement is better than your PCP (whether it is or not), it is time to move on. A competent PCP should be able to make clinical decisions better than the average person with zero/little medical training, even if they've been injured before.

The hospital isn't losing money on the MRI, so that's not a con. Your insurance may also be the limiting factor, as many prohibit expensive tests like MRI without preapproval. The major downside besides wasted $ is finding something incidentally that gets you an unwarranted procedure, like arthroscopy.

You may be right, of course, so keep us updated when the MRI results are available.

#24 Recliner Pilot

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Posted 13 January 2012 - 07:23 PM

There's a reason why the five largest health insurance companies racked up combined profits of $12.2 billion -- up 56% over 2008...


Obama promised to fix that......along with a lot of other things. :rolleyes:

Obama really inherited a mess for his second term. 


#25 MTSkiBum

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Posted 13 January 2012 - 07:52 PM

I had an mri earlier this year.

It was 1650 before insurance and 800 after.
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#26 IGotWorms

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Posted 14 January 2012 - 02:03 AM

I had an mri earlier this year.

It was 1650 before insurance and 800 after.


You need better insurance.

#27 jerryskids

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Posted 14 January 2012 - 08:04 AM

My knee locked up one Saturday. I had an MRI Monday and saw a leading Ortho with the results on Tuesday. How? I'm good friends with a doctor who pushed me through the system.

The key to expeditious medical care, as with most things in life, is not what you know, but who you know. :thumbsup:
Truth is, you could shove Obama's knowledge of small business operations and job creation up an gnats butt and it would rattle around like a marble in an empty supertanker. -- Neil Boortz

#28 penultimatestraw

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Posted 14 January 2012 - 10:52 AM

My knee locked up one Saturday. I had an MRI Monday and saw a leading Ortho with the results on Tuesday. How? I'm good friends with a doctor who pushed me through the system.

The key to expeditious medical care, as with most things in life, is not what you know, but who you know. :thumbsup:

This is also true, though there are plenty of examples of unnecessary tests being ordered with complications as a result of "VIP" care - not mention the additional cost incurred.

#29 jerryskids

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Posted 14 January 2012 - 11:06 AM

This is also true, though there are plenty of examples of unnecessary tests being ordered with complications as a result of "VIP" care - not mention the additional cost incurred.


I imagine that is true. In my case I was leaving that Wednesday on a 10-day trip which was supposed to involve golfing at the Ocean Course at Kiawah Island. I said "locked" but more accurately, it wouldn't fully extend. Something was clearly wrong, anyway. It was a locked buckethandle tear of the medial meniscus. Had arthro after the trip (didn't golf though :( ). The doc couldn't repair it so he removed it; he likened it to cotton candy. Ten years later and, knock on wood, no problems yet.

Personally, I tend to not seek medical help unless I know something is wrong, and even with my broken foot I only went at my wife's suggestion. Had the xray been negative and a few weeks later I was still in a lot of pain, I'd have pushed for more tests. I'm an engineer and I like to know the answers to problems. When a doc says "it's probably" or, more likely, he talks like he knows the answer but my bullshiot meter goes off, I get suspicious.
Truth is, you could shove Obama's knowledge of small business operations and job creation up an gnats butt and it would rattle around like a marble in an empty supertanker. -- Neil Boortz

#30 penultimatestraw

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Posted 14 January 2012 - 11:47 AM

I imagine that is true. In my case I was leaving that Wednesday on a 10-day trip which was supposed to involve golfing at the Ocean Course at Kiawah Island. I said "locked" but more accurately, it wouldn't fully extend. Something was clearly wrong, anyway. It was a locked buckethandle tear of the medial meniscus. Had arthro after the trip (didn't golf though :( ). The doc couldn't repair it so he removed it; he likened it to cotton candy. Ten years later and, knock on wood, no problems yet.

Personally, I tend to not seek medical help unless I know something is wrong, and even with my broken foot I only went at my wife's suggestion. Had the xray been negative and a few weeks later I was still in a lot of pain, I'd have pushed for more tests. I'm an engineer and I like to know the answers to problems. When a doc says "it's probably" or, more likely, he talks like he knows the answer but my bullshiot meter goes off, I get suspicious.

Unlike engineering, medicine is an inexact science. Some would say an art. Doctors are taught to look for the most common and life-threatening causes of a symptom, as well as those that can be treated. If management isn't altered with a definitive diagnosis (as with MRIs for most back pain), you really have to ask yourself why a test must be performed. How much is "peace of mind" worth? What harm can be caused by these unnecessary tests?

This attitude is taken to an extreme with end-of-life care, where tons of scans, EEGs, and other tests are done when it is clear there is virtually no chance of a meaningful recovery. The US spends a big chunk of its healthcare dollar on futile testing, in part because our entitled society thinks they have a right to have "everything" done.

#31 jerryskids

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Posted 14 January 2012 - 12:09 PM

Unlike engineering, medicine is an inexact science. Some would say an art. Doctors are taught to look for the most common and life-threatening causes of a symptom, as well as those that can be treated. If management isn't altered with a definitive diagnosis (as with MRIs for most back pain), you really have to ask yourself why a test must be performed. How much is "peace of mind" worth? What harm can be caused by these unnecessary tests?

This attitude is taken to an extreme with end-of-life care, where tons of scans, EEGs, and other tests are done when it is clear there is virtually no chance of a meaningful recovery. The US spends a big chunk of its healthcare dollar on futile testing, in part because our entitled society thinks they have a right to have "everything" done.

Actually, engineering is an inexact science and more of an art. It is a holistic approach to a problem. Science is an exact science. And my experience with medical care is that it is often NOT an art, but rather a pre-established decision tree. I've outlined what happened with my mother and won't rehash it here.

You can argue that the decision trees are based on best-in-class empirical results, but they are decision trees nonetheless. If A then B else C... I'm fine with that if things are progressing, but if not, it is time to change course.

I agree with the end of life problem.
Truth is, you could shove Obama's knowledge of small business operations and job creation up an gnats butt and it would rattle around like a marble in an empty supertanker. -- Neil Boortz

#32 penultimatestraw

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Posted 14 January 2012 - 12:21 PM

Actually, engineering is an inexact science and more of an art. It is a holistic approach to a problem. Science is an exact science. :shocking: And my experience with medical care is that it is often NOT an art, but rather a pre-established decision tree. I've outlined what happened with my mother and won't rehash it here.

You can argue that the decision trees are based on best-in-class empirical results, but they are decision trees nonetheless. If A then B else C... I'm fine with that if things are progressing, but if not, it is time to change course.

I agree with the end of life problem.

I don't think you're giving your doctors enough credit. Some of medicine is algorithmic (based on the best available evidence) and mindless, but most doctors I know put a lot of mental effort into their clinical decisions. Questions from patients should be welcome, but the idea that those with little medical knowledge/training know more than those who devote their lives to it is pretty ridiculous.

As I said before, there are sh!tty doctors, but there should be implicit trust in the physician's expertise in most cases to have a productive doctor:patient relationship. This does not mean you should not advocate for yourself/loved ones, but at some point you need to respect their decisions, or get another doctor.

#33 southcarolina

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Posted 15 January 2012 - 07:14 AM

MRI is rarely needed for the diagnosis and treatment of back pain. A good exam will tell you if you have a nerve problem (usually from a ruptured disk) or not. Almost everybody over age 30 will have abnormalities in their lumbar disks on MRI, BTW. In the absence of severe neurologic symptoms - strength/sensory changes, incontinence, impotence, the treatment is the same anyway - physical therapy and pain meds. And lose weight for most. Surgery is indicated only for severe neurologic compromise or pain refractory to meds. And surgical outcomes are mixed in comparison to PT, which can be performed without the risks associated with surgery. Doctors don't get kickbacks from PT or evaluation of sleep apnea - if they do, that is illegal.

Although slightly different, the evaluation of knee pain can usually arrive at a diagnosis with the history and exam alone, or at least exclude serious things that might warrant an MRI (tendon/ligamentous injury, bone infection). X-ray is decent for diagnosing broken bones (which rarely occur spontaneously in younger people) and some types of arthritis.

Patients demand tests inappropriately in many instances, and doctors sometimes give in. Giving in may mean prescribing unnecessary antibiotics/other medications(common) or ordering inappropriate tests, like knee/back x-rays and sometimes MRIs. It's one of many reasons our healthcare system is broken. It would help if patients knew the pros/cons of the tests and had some share in paying for them. With insurance co-pays being set, there is no disincentive to demand more expensive tests (MRIs, stress tests (another highly over-ordered test)).

There is a reason doctors go to school a long time. There certainly are sh!tty ones, like in any other profession, but they probably know a lot more about the appropriate diagnosis and treatment of disease than a Google search.


In my haste to be snarky, i didnt express myself well. The kickbacks comment was meant as a joke.I have no doubt that the vast majority of physical therapists do a good job, and that PT is both warrented and helpful a large percentage of the time. It was not my intention to offend.

I had a bad personal experience with my family doctor and the subsequent specialists and therapists he sent me to after my initial back injury.And i guess i should specify that the original injury happened in my early 20's and my first surgery in my early 30's. so the pain was controlled with anti-inflamatories for around ten years before it got bad enough to do surgery. But before he would order an MRI, i first was sent to a different doctor who tried to convince me i had some rare degenerative hip muscle disease. Then when the pain started getting severe, and my lower calf and foot started going numb, i got sent to PT, which is where my original post in this thread occurred. I completed all the PT visits my insurance would pay for and the pain wasnt any better.

Its at this point i should interject that i apparently have a superhuman tolerance for pain. I cut my arm at work once and needed 17 stitches. While the doctor was stiching me up, she kept marvelling at how i wasnt flinching when she stitched. To the point that she was calling people in to my room to see. I mean i thought that was what a local anesthetic was for. When i had my first microdiskotomy, the nurse told me the next morning i was the only patient they had ever had for that procedure that didnt ask for pain meds after the surgery. Hell my real pain was gone...whats a little 2 inch incision in my back?

My point is, that in the end i realized what my family doctors trigger was. I kept gritting my teeth, leaving for work 20 minutes earlier than i used to so i could have enough time to get out of my truck and hobble into the building.And as long as i kept going to work, my doctor kept on assuming the pain couldnt be that bad. And then once i had had enough, and quit going to work, i got an MRI within a week. And thats why they were surprised when the MRI showed such significant damage....my surgeon took out a picee of the disk about the size of the last joint of a mans pinky finger....maybe an inch or so. So, in part, its my own fault for being such a dumbass and dragging myself to work in a factory for two months in severe pain.

Which was really the point of my original post that probably got lost in all my editing and snarkyness and junk. That im a dumbass.

Sleep apnea doctors on the other hand, are all quacks :cheers:
Come on down to the hotel, baby. I can be what you want me to be. You can choke on your own medication, and i can watch myself on tv. Shut your mouth you big f*cking baby. I cant be what you want me to be. Go on choke on your own medication. I can tell you a lie you'll believe, yeah yeah.

#34 penultimatestraw

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Posted 15 January 2012 - 07:34 AM

In my haste to be snarky, i didnt express myself well. The kickbacks comment was meant as a joke.I have no doubt that the vast majority of physical therapists do a good job, and that PT is both warrented and helpful a large percentage of the time. It was not my intention to offend.

I had a bad personal experience with my family doctor and the subsequent specialists and therapists he sent me to after my initial back injury.And i guess i should specify that the original injury happened in my early 20's and my first surgery in my early 30's. so the pain was controlled with anti-inflamatories for around ten years before it got bad enough to do surgery. But before he would order an MRI, i first was sent to a different doctor who tried to convince me i had some rare degenerative hip muscle disease. Then when the pain started getting severe, and my lower calf and foot started going numb, i got sent to PT, which is where my original post in this thread occurred. I completed all the PT visits my insurance would pay for and the pain wasnt any better.

Its at this point i should interject that i apparently have a superhuman tolerance for pain. I cut my arm at work once and needed 17 stitches. While the doctor was stiching me up, she kept marvelling at how i wasnt flinching when she stitched. To the point that she was calling people in to my room to see. I mean i thought that was what a local anesthetic was for. When i had my first microdiskotomy, the nurse told me the next morning i was the only patient they had ever had for that procedure that didnt ask for pain meds after the surgery. Hell my real pain was gone...whats a little 2 inch incision in my back?

My point is, that in the end i realized what my family doctors trigger was. I kept gritting my teeth, leaving for work 20 minutes earlier than i used to so i could have enough time to get out of my truck and hobble into the building.And as long as i kept going to work, my doctor kept on assuming the pain couldnt be that bad. And then once i had had enough, and quit going to work, i got an MRI within a week. And thats why they were surprised when the MRI showed such significant damage....my surgeon took out a picee of the disk about the size of the last joint of a mans pinky finger....maybe an inch or so. So, in part, its my own fault for being such a dumbass and dragging myself to work in a factory for two months in severe pain.

Which was really the point of my original post that probably got lost in all my editing and snarkyness and junk. That im a dumbass.

Sleep apnea doctors on the other hand, are all quacks :cheers:

Not offended at all. In the future, you should probably see a superhumanist to better meet your needs :bandana: