HCR -- Overuse of MRI and CT Scan

By John Ballard

I am a 78-year-old American man in robust general health and with good comprehensive health insurance all my adult life and I have never had an MRI.

How does that grab you?
Crusty of curmudgeon, you say?
What if he is George Lundberg, MedPage Today Editor-at-Large and former editor of the Journal of the American Medical Association?

He doesn't mince words.

Until 2010, I had also never had a CT scan. And I�m proud of that.

Why the CT? I had my first tooth implant, and my oral surgeon said he could be more certain of exact placement with the precise measurements of a CT scan. Okay. That seemed reasonable and it worked out well.

Why am I proud? Because I despise the American medical tradition that �more is better.�

I hate unnecessary testing and unnecessary treatment.

And I am ashamed of the American medical tradition of practicing defensively.

I can imagine the scenario of 100,000 U.S. MDs sitting in the Rose Bowl. In scampers under the goal posts one attorney waving a piece of paper and piping, �Here comes a lawsuit.� And 100,000 U.S. MDs immediately order MRIs on everyone to thwart that one lawyer.

Of course, conveniently, their institutions, their colleagues, and oftentimes they themselves earn substantial money from those 100,000 defensive MRIs.

Not on me, you won�t. Not unless there is some really good reason that will likely influence a shared medical decision.

I know that when you throw a screening or diagnostic test at someone, there will always be a risk and a cost, and that cost could easily include a harmful false positive. You don�t know whether there will be any benefit.

And don�t give me any of that �standard of practice� hokum.

You know better than I that you and your colleagues, often not based on unbiased best evidence, and functioning as a cartel, create that �standard of practice.�

MRIs, and CT scans, are wonderful, even spectacular inventions. Their products can even be great art forms. And the MRI does not even give the patient toxic radiation. It all comes down to how they are used.

Don�t ever do anything just because you can. And also, not only to cover your posterior.

But as the U.S. use of MRIs and CT scans is phased down, let�s remember to be compassionate about all those workers whose skills may not be as needed anymore. Plan for appropriate retraining for them in some useful field.

This is a card-carrying expert talking.

I know we have doctors in Congress, too. All I can say about that is that one of them is Ron Paul, another is the representative from my own Congressional district and yet another one is from a few miles away where Lockheed has been the principle employer for at least two or three generations. Nuff said.

Regarding Congress, it was Grooucho Marx who said "I wouldn't want to be a member of any club that would have me as a member."