I'm a doctor. Here's why I wouldn't get a full-body MRI scan

Posted by bookofjoe 11 hours ago

Comments

Comment by 0fr 11 hours ago

Comment by bookofjoe 11 hours ago

Comment by FireBeyond 10 hours ago

I feel like imaging and physicians really amped up on pushing this over the last decade or two. Most of the big DI companies (GE, Philips, Siemens) had very friendly financing targeted heavily at physicians. They had "matching" services ("Find other providers in your area who'd also like to own a DI facility"). They'd help with consultants to facilitate getting your Certificate of Need (i.e. how not to piss off the other facilities in your area who get to say whether or not they'd reduce their investment in serving the area if you open up).

And the not unsurprising conclusion of all this? Physicians who own a DI facility or stake in one (and realize this doesn't have to be just radiologists, but any physician) refer their patients to imaging at rates far above expectations.

But now, line must go up, so we're doing this "scan your whole body and let's see what we can do to give you a touch-up", and ever-so-helpfully we have a whole network of providers lined up for referrals (that's if we don't just handle things in-house). I will be similarly unsurprised if many of the outcomes from this raft of scanning are procedures that are medically unnecessary.

Comment by nomel 9 hours ago

> I will be similarly unsurprised if many of the outcomes from this raft of scanning are procedures that are medically unnecessary.

I have trouble comprehending this perspective. The point of defect detection is detecting defects. The IDEAL outcome is that nothing shows up. That's not a failure of the test! in this case, the next desired outcome is that something caught can be addressed, so your life isn't terminated early.

Is it worth doing? That depends on the circumstances, of course. If you have high risk genetics or exposure, and you have some strange symptoms, many people would gladly fork over money for something that effects the remainder of their lives. If you're just doing it because you're paranoid, maybe once every 10 years is reasonable, especially in upper ages, if you can afford it.

Comment by FireBeyond 8 hours ago

My thoughts there are that there are a couple of factors at play - false positives, which might lead to interventions, even exploratory, that are not zero-risk. Even without risk, not zero-cost. And as such you end up with "you had no symptoms or concerns about condition X until you had this not-recommended MRI, and then treatment was ordered about condition X that was actually a false positive". Insurance doesn't view full body MRIs as medically necessary preventative screenings and this is generally accurate (though I'm also not naive enough to believe that a non-insignificant part of their objection might be cost).

Comment by nomel 7 hours ago

> false positives, which might lead to interventions, even exploratory, that are not zero-risk

Do you have an example in mind for this? Non-zero risk interventions are pretty rare if only one signal is present. If that signal was deemed worthy to result in a non-zero risk intervention, then you're completely ignoring the risk associated with ignoring that signal, which is what justified that non-zero intervention!

> Insurance doesn't view

This suggests a very fundamental misunderstanding of healthcare, treatments, and what insurance companies exist for. They are not about health policy or well being. They are about derisking profit loss. Their recommendations are to reduce cost, and nothing more. Doctors understand this, and will tell you this very plainly, as you fight to get required treatments covered.

Comment by FireBeyond 2 hours ago

> Do you have an example in mind for this?

Liver lesions, often benign cysts. Other cysts too (kidney, ovarian). Will often require targeted contrast MRI, and needle biopsy - which has notable risks for bleeding, often minor, but 3-4% can require surgery or even transfusion.

Bile leakage or infection can also result, or injuries to the gallbladder, bowel, bile ducts.

Comment by FireBeyond 5 hours ago

> This suggests a very fundamental misunderstanding of healthcare, treatments, and what insurance companies exist for. They are not about health policy or well being. They are about derisking profit loss. Their recommendations are to reduce cost, and nothing more. Doctors understand this, and will tell you this very plainly, as you fight to get required treatments covered.

I am someone who has worked for providers, worked as a paramedic, and worked for a company whose customers were health insurers, as we built claim benefits management systems for them, so literally the logic to calculate deductibles, handle accumulators, provider negotiated rates.

The issue is not my misunderstanding, it is that "health insurance" in the US is the worst of all worlds - health insurance when convenient (to the insurer), amortized healthcare when convenient. It used to be that about the biggest offering that health insurers could give you was better provider-negotiated rates, but that era is largely behind us with the vertical integration of supply chains, and a health insurance industry that can only make more money when prices go up (if your profits for premium administration are capped at 15%, the only way that number goes up is if premiums go up, because healthcare costs more - this is compounded by the fact that it's in everyone in the system's interests for it to cost more except the actual consumer).

Everything has had to be fought for - otherwise, to your point, why are actual clinical "annual exams"/"wellness" visits covered at zero cost, but incentives for weight loss (as in obesity reduction, even pre GLP-1s) or cardiac health are near zero while a gastric bypass is covered in toto.