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
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.
