Should I worry over my back x-ray? The diagnosis sounds scary!

Patients often ask great questions with very personal feelings.  What I mean is that history and math professors may get great questions but a student is less anxious over what the answer might be.  One of the best parts of being a doctor is explaining something to a patient about their body.  It can mean  encouragement from great fear to relief or bringing comfort and illumination to a challenging outlook of injury.  We care about what is happening to our body.

A patient recently told me: "I had a MRI last week and got the results today. I have a herniated disk, and arthritis.  I am being referred to a specialist. I guess what is your take on both of those? I was in such shock when they told me the news I couldnt comprehend anything they were saying."

I've spoken about the value of xrays before (http://bit.ly/b0hhcX), and I would speak of MRI testing similarly.  These tests are valuable tools when utilized to support an overall clinical picture.  They are often misleading and unhelpful tools for pain.  As the New York Times recently offered, "magnetic resonance imaging seldom sheds light -- indeed, in many studies the scans have picked up spinal abnormalities in many people who have never reported back pain" (http://nyti.ms/eENwWu). Unfortunately, many physicians will see an MRI report with degenerative changes and refer to a specialist for significant interventions (surgery, narcotic medications, injections) when prevention would be more productive to the patient.

Doctors are often driven to interventions while patients would more often benefit from preventions or restorative care.  Our health care system does not incentivize preventative medicine nor is there a reward for saving patient's time and money.  Our system promotes number and frequency of treatments, the costlier to the patient, the better for the industry.  What would happen if a doctor was paid from the overall health of their patients or how much activity the patients were able to enjoy in a year?  What a dream that might be!

When a patient hears "degenerative disc disease", "arthritis", "herniated discs", "misalignment", "subluxations", and other less helpful, common diagnoses, I would encourage a response of "what treatment is best for my body?".  A patient needs to ask, "What is most likely to restore my ability to move and live?".  The momentum of research indicates for low back pain: surgery, drugs, and bed rest are least likely to help while physical therapy, soft-tissue therapy, chiropractic techniques, and rehabilitative exercises are far more productive, safer, and less costly.

In meeting the reality of our system today, patients cannot change economic forces behind surgery and pharmaceutical medicine, but each can ask their physician, "what is the safest and most productive option for my body?"