MRI waits need new diagnosis
We’re looking for answers in all the wrong places
Over the years, I’ve listened to many stories from friends and acquaintances about their experiences going to a family doctor, emergency room or medical clinic for help.
What has been most striking to me over the past decade is how often people are now told there is nothing that can be investigated, managed or treated until they have an MRI scan.
Most wait months for such scans, often with their lives on hold and in great discomfort. Others pull out their credit cards and go to a private MRI centre to try to get things moving along — or an employer pays.
High-tech MRI scans seem to have become a prerequisite for any other investigation, advice, referral to a specialist or specialty clinic, or even obtaining a prescription for pain pills.
But, are MRI scans really all they are cracked up to be?
Would more public or privately financed scans solve the problem of seemingly endless barriers and delays obtaining a tentative diagnosis and plan for managing a medical problem? Would more scans shorten wait lists for specialists, surgery or other treatment options — or even wait lists for MRIs?
While our first inclination is probably to say yes, a closer look at the issues and experience to date in Alberta casts serious doubt on this initial conclusion.
If simply adding more MRI capacity through either public or private payment solved the real problem, we should be in great shape now in Alberta. We’ve done both.
Between 2001 and 2002, an infusion of federal dollars led to a 62-per-cent increase in the number of publicly funded MRIs in Alberta — from 12,276 to 19,937. At the same time, the number of Albertans waiting for an MRI rose 123 per cent — from 7,053 to 15,718.
According to a recent Calgary Herald story, more than 177,400 MRIs were done last year on scanners operated by or under contract to the province’s health authority. Yet Albertans face the longest wait lists for public MRI scans among all the provinces reporting to the Canadian Institute of Health Information.
In 1993, Canada’s first private MRI centre opened its doors in Calgary. Since then, 10 more have opened in the province, some also offering private-pay CT scans which, unlike MRI
If simply adding more MRI capacity through either public or private payment solved the real problem, we should be in great shape now.
scans, expose individuals to high doses of radiation.
To keep their doors open, a number of these centres market highly controversial “preventive” MRI and CT screening exams (looking for signs of hidden disease in well people) to both corporate health programs and the general public.
A high incidence of questionable findings in these types of exams — often referred to as “incidentalomas” — commonly leads to referrals to specialists and more invasive procedures to rule out any problems.
Sometimes, harm results from complications of these procedures. The extra demand on health system resources also creates longer waits for specialists and procedures for people with symptoms.
All this begs the question: are we looking for answers in all the wrong places?
Dr. Nick Mohtadi, an orthopedic sports medicine specialist and expert witness at the recent Alberta preferential access inquiry, provided some important clues in his testimony.
He referenced research he and his colleagues have done identifying the typically long and circuitous path of Albertans with acute knee injuries in their quest for a diagnosis and treatment plan. He also talked about the problems their research found in relation to routine referrals for MRIs, as well as some of the unexpected drivers.
In his view, MRIs are of little value in diagnosing or making a treatment decision for knee injuries in the absence of a proper history and examination, and in most (but not all) cases, a proper history and examination eliminates the need for an MRI.
His testimony also referenced a publicly funded pilot project in Calgary called the Acute Knee Injury Clinic, where patients with an acute knee injury can self-refer for an almost immediate assessment by a specially trained physiotherapist and receive a treatment plan, as well as a referral to a specialist or MRI if necessary.
This has dramatically reduced the typical delay, hassle and length of incapacity for these types of patients — and reduced MRI referrals by 60 per cent.
Perhaps our focus on MRI capacity is the problem, not the solution.