Tuesday, November 25, 2008
Aside from a love of the game, reading the Monday morning sports section requires an increasing knowledge of medicine. CT and MRI scans are done within hours of the injury and reported in detail. The speed of the testing may cause us to wonder why the elite athlete is given such easy access to complex and expensive testing. The answer may be that the athlete isn’t so special.
The use of advanced body imaging like has grown dramatically as the technology has become better at looking at the body. According to research from an insurance company in Washington state, the number of CTs and MRIs performed tripled in the last ten years and Medicare has doubled the amount of money it pays for these tests.
The ability to peer into the body and make a diagnosis is a two edged sword. Once upon a time, diagnosis was made by taking a history from the patient and performing a physical exam. Time was used as a tool to observe and decide if the diagnosis was correct, but that philosophy and approach has changed as technology has improved.
Appendicitis is a great example. Before CT, it was acceptable for the surgeon to be wrong 15-20% of the time and remove normal appendixes. The damage caused by a potentially unnecessary operation was balanced against the risk of allowing an appendix to rupture or burst and cause major abdominal infection. When CT was first available, the question was whether a CT was required to confirm the diagnosis. Now the question is framed differently. “When does a CT not have to be done?” The risks of CT including radiation exposure and contrast dye may outweigh the need for the test in certain situations. For the patient, it’s nice to know that the operation recommended, is one that is needed.
The athlete is no different. The MRI complemented the physical exam and allowed a diagnosis to be made almost immediately. Decisions about whether surgery was needed and what the outcome might be were planned before any cutting occurred. In the pre-MRI world, exploratory surgery would be performed to sort out the problem. Repair might occur at the same time or another operation would have to be planned to repair the damage found.
The elite athlete may get special access to the machines but there may be good reason. A pro football player has a career that lasts less than 4 years, perhaps 60 games. Not so long ago, a knee injury might have kept a player out for half a season. If that translated into the real world where the people are on the job for 40 years, it would be the equivalent of losing 5 or 6 years of work.
As medicine gets more technical and it seems less hands on, patients often a wish to return to the simpler days. But there is a big plus to all the testing; diagnosis gets more specific and hopefully treatment gets better. And for sports fans, it means we can see the stars recover from injury and return to play that much quicker.