Why was my doctor so reluctant to order an MRI? On Good Friday, I injured my foot. I went to my

[raccoon]

podiatrist and she took an X-ray. I asked her for an MRI, but she said she had to do X-ray first.

I had a close relative who, a few years ago, finally found out after several doctors, an X-ray, and FINALLY an MRI, found out she had a hairline fracture of a foot bone.

Anyway, my X-ray didn't reveal anything, so I followed a conservative treatment plan, ice, ibuprofen, etc. It wasn't getting a whole lot better so I went back. She was going to give me a cortisone shot. I asked again about an MRI. She said the insurance company might balk at paying for it but we'd cross that bridge when we got to it.

I had the MRI on Wednesday and it revealed an acute stress fracture of a bone in my foot.

So we finally got to the crux of the problem.

My thoughts are that she's had experiences with insurance companies not wanting to pay for MRI's. They are expensive--I believe a form I signed there said $2500--so I can imagine that if insurance doesn't want to pay it, then patients come back and (understandably) complain about the cost.

Your thoughts?

[neeksgeek]

1. Yes.

I had the exact problem but with neck x-rays. Doctor #1 took x-rays, saw nothing, and declared my neck not injured. Problem continued. Went to another doctor.

Doctor #2 immediately wanted to do an MRI, said she would have to ask my insurance, and I quote, "mommy may I take an MRI?"

Anyway, insurance was approved, we did the MRI and sure enough, spotted the problem.

[JayhawkSD]

2. I think doctors suffer from patients....

...who practice medicine without a license.

[kcr]

20. Who knew pain and suffering was called "practicing medicine?"

That's not how I understood the definition. Hmm.

[LanternWaste]

22. Many people think many things...

Many people think many things... especially when attempting to look clever.

[gopiscrap]

3. once again health care for profilt

doesn't give a shit about you as a person, just the bottom line. Same goes for insurance companies, they just want to make money, don't care if you're in pain or die.

All I can say is: UNIVERSAL SINGLE PAYER!!!

[PoliticAverse]

10. Single payer doesn't magically reduce how much an MRI machine costs. X-Rays are cheap

and available quickly usually.

You can see the MRI wait times for Ontario Canada here:
http://www.ontariowaittimes.com/Surgerydi/en/Data.aspx?view=0&Type=0&Modality=3&ModalityType=4&city=toronto&pc=&dist=0&hosptID=0&str=&period=0&expand=0

[gopiscrap]

11. actually it does because it takes the profit mark up out of it

[PoliticAverse]

12. The Canadian government doesn't manufacture its own MRI machines...

they buy or lease them from private, profit making companies as do US based hospitals.

[mopinko]

4. same thing happened to my daughter.

one of many, many instances of having to suffer for a while before getting the proper dx procedure.

[Laffy Kat]

5. I work in radiology.

For suspected fractures, ordering an XR before an MRI is pretty much protocol. Xrays a lot less expensive, too. Hope your foot heals quickly.

[DemocratSinceBirth]

16. My favorite radiology story.

My buddy broke his fibula when he missed some steps at Tampa Stadium. We went to the most prominent orthopedic practice in Orlando. The orthopedist told my buddy it sounds like you tore your ACL and ordered an MRI. The MRI revealed he broke his fibula.

[Laffy Kat]

24. LOL. We actually saw a retired physician (surgeon) the other night.

He was older but in great shape except for having injured himself skiing. He arrived on crutches but was doing some weight-bearing. He was sure it was his ACL. His doctor/buddy ordered an MRI w/o examining him. The MRI tech. completed the study and immediately paged his doctor. We sent him, via wheelchair, directly to the ER in the hospital we are attached to. He'd been walking around and weight-bearing on an unstable leg with two fractures. What's so strange is that he injured himself a couple of weeks before he presented. He must have been in horrible, horrible pain. You'd never know it.

[DemocratSinceBirth]

25. You can see a lot in X Rays including severe atherosclerosis.

[stillsoleft]

6. Same here

Saw dr in dec with shoulder pain, was sent to PT. Finally got MRI on the 9th revealing two big tears so now I have to have surgery. I know I'm not pro Athlete but they get MRIs at halftime. Def an insurance issue

[woodsprite]

7. I don't know why they wait.

My dr did it with my shoulder. Insurance paid out about 8 mo more than they would have if they had fixed it right after injury. It was over 6 mos after the injury before they did an MRI. I probably could have pursued it in court, but I have the functioning of my arm back at almost 100%, so I'm good. About 3 mo before they did the MRI, they did a "manipulation under anesthetic", which means they forced my arm into positions it wouldn't move. I can't help but think that either created or made the tears in the rotator cuff and supraspinatus tendon even worse than they would have been if they had just done an MRI and surgical repair.

[still_one]

8. I suspect because the doctor thought X-Rays were sufficient information initially. When

you followed up, she did the appropriate thing by informing the patient that the insurance company might not approve the MRI, and it would be the patient's responsibility, and you agreed. Since the MRI found something there is no way that the insurance company is going to deny coverage.

[WhiteTara]

9. I tore the rotator cuff on my right shoulder.

I had repair surgery on the same shoulder 3 years ago. I went to my surgeon and he ordered x-rays and an MRI at the same time. I'm not a candidate for shoulder replacement and he told me lots of people live with this. Right now, I'm not so sure how. I have constant pain that radiates into my neck and hand. He gave me a steroid shot which has done nothing. Sigh.

[woodsprite]

28. I'm sorry you're in such pain.

The steroid shot worked wonders for me, but it was during the healing process so it helped with PT after the surgery. It also drew to my attention that I am diabetic because it pushed my blood sugars up to over 400. Scary stuff. I declined an offer of a second shot.

[RedWedge]

13. Because insurance companies often get between you and your doctor.

Which is somehow preferable than the government doing it, for some reason.

[DemocratSinceBirth]

14. That's normal protocol. I hope your foot heals quickly.

[taught_me_patience]

15. For every case like yours, there are probably 50 cases

where a simple xray caught the problem or the course of treatment resolved the problem without the need for an MRI. Imagine the cost to the system if every person who had a sore foot who demanded an MRI got one? We can't have a system like that.

[kcr]

21. Well, yes. When the x-ray actually catches the problem, then there's no need for an MRI

If the x-ray doesn't show anything, then what is the explanation for doing nothing? What does it matter if there are 5 or 50 cases? The x-ray didn't show anything because x-rays won't show everything. If there are still symptoms, then doctors need to find out what's happening, and modern technology is available that will help.

[taught_me_patience]

23. A lot of times doing nothing works

A standard treatment protocol of rest and ice resolves most issues. The doctor, in my opinion, made a serious error in offering a steroid injection. At that time, with continued pain, further radiological diagnosis to get to the root of the problem would have been my preferred course of action.

Side story... the two times I've asked for an MRI proved unnecessary. The first time, I had a torn ACL and I asked the surgeon if I need an MRI and his answer was literally "It's not necessary... you have a torn ACL and only surgery can fix it anyway". The second time I asked for an MRI, I was having a lot of pain in the surgically repaired knee a couple years later. My GP refused the MRI and ordered PT. The pain resolved on its own within a month.

Also, I work for a huge radiology practice... you wouldn't believe the amount of studies that are "inconclusive"... a waste of money.

[Stargazer99]

29. thank you for enlightening those who don't think!

[mythology]

17. MRI cost is highly variable based on where you get it

But in the case of a stress fracture, I question why your doctor didn't suggest you go into a boot at first. I had a recent foot issue with x-rays that didn't show anything. The first suggestion was to get a boot because that's the response for a stress fracture in your foot.

[LeftInTX]

19. I fractured my 5th metatarsal. It was a nasty spiral fracture.

It showed up on X-rays. They didn't put me in a boot. I sure wish they had.
I couldn't bear weight on my foot for 8 weeks and ended up with all sorts of problems.

[LeftInTX]

18. That is how they do it

My husband fractured his tibial plate. ER did X-rays, they were normal. They wouldn't do an MRI

I thought he may have torn his ACL.

He followed up with a sports doc who ordered an MRI and they found the fracture. It was a small fracture.

He sustained alot of soft tissue damage which gave him the most grief.


Basically the early treatment for a small fracture and soft tissue injury such as sprain are similar.

I had a spiral fracture on my 5th metatarsal. It showed up on X-ray. Two months later I was still in pain. They did an MRI and it was normal. At that point, my problem was neurological.

When I was growing up, we didn't have MRI's.
I wonder how many people ran around with fractures and never knew it?

The practice does put the burden on the patient to follow up and keep complaining.

[spooky3]

26. (1) MRIs are much cheaper in other countries, such as Japan; (2) I'm glad

the MRI found the problem and that you weren't so claustrophic (as I am) to prevent you from getting one.

I had an "open" MRI, but it was still awful (and noisy), and the image is not as clear as for "closed" MRIs, so the doctor had to refer me to a specialist. Fortunately, it was a problem that eased with time.

Japan controls medical equipment and testing prices, yet, amazingly, the companies are happy to sell to Japanese providers and patients. Does that tell you something about the price gouging in the USA?

Source: T. R. Reid, The Healing of America -- a great book.

[Ilsa]

27. Running into same thing.

X-ray, then a guess, then a recommendation for treatment, come back if not better after X weeks, then we'll look at ordering an MRI.

I think the managed care part of being in-network creates this avoidance of ordering what might be more appropriate.

[Sunlei]

30. much higher profit margins from multi cortisone shots, meds & Dr visitsto treat future foot problems

Not that the Doctor was thinking that but the Insurance Corps sure do especially with low tier insurance with great co-pay revenues.

[MineralMan]

31. What is the treatment plan for your foot?

Typically, they just give you a boot or something to immobilize the foot and wait until it heals. In the old days, if the x-ray didn't show anything, but the pain persisted, that's probably what they'd do, figuring there was a fracture the x-ray didn't show. Either way, the treatment is the same. Perhaps an MRI is not necessary, and using symptoms to do the diagnosis would suffice.

I broke a bone in my foot once. The doctor diagnosed it without even an x-ray, based on the symptoms. It healed without any treatment at all. I used my sense of pain to avoid putting pressure on my foot that caused pain, and limped around until it stopped hurting.

That was before MRIs were even available. Back in the days when doctors used their brains to do diagnosis more often than they relied on even x-rays.

I'm not necessarily big on expensive radiology technology for things that will be treated conservatively, regardless of the findings. Why not just recommend the treatment first, based on symptoms?

More recently, I broke a rib. It hurt like hell, so I went to my Primary Care doc. I told him I thought I had broken the rib. He asked how badly it hurt and what caused it to hurt. Then, he applied a little pressure to the area with his finger. I said, "Ouch! That hurts!" He said, well, it's probably broken. He then told me to avoid doing things that made it hurt for the next few weeks and take a couple of ibuprofens, as needed. Then he patted me on the shoulder and said goodbye. Bottom line was that there really isn't any treatment for it, so his advice would have been the same, whether or not the rib had been imaged. I told him, sarcastically, "Well, thanks a lot." Then I chuckled and went home. Sensible medical care. I love it.

Anyhow, I'm really sorry your foot hurts. That sucks.

[raccoon]

34. To be on the boot for 6 weeks. And take it easy, no vigorous exercise. nt

[MineralMan]

35. That should do it.

I hope the time passes quickly for you.

[raccoon]

32. Update: Now I'm on a boot for 6 weeks. Thanks for your input. nt

[TheBlackAdder]

33. Some doctors partly own MRI centers, pushing clients to them. Insurance might be onto them.

[Catherine Vincent]

36. What about CT Scans?

Over the weekend I visited the ER for back pain and they did an x-ray first and they thought it would be a blood clot after the reading, then further did a CT Scan and it revealed early pneumonia. I take it XRay, CT Scan then MRI is the order insurance companies prefer?