when hi tech goes wrong

Monday, July 2, 2012

The ability to peer inside the body with technology defines the state of medicine as it’s practiced today. Instead of relying on the supposedly crude skills of physical examination, patients would rather rely on the certainty of a picture developed with CT scans and MRI. The problem arises when a picture isn’t worth a thousand words and it confuses what’s really going on. That seems to be the cruel truth that has befallen Jared Sullinger, rising college basketball star, whose NBA stock fell because of an MRI gone wild.

The NBA draft gives teams and their fans the hope of finding their next messiah to lead them to a championship. There is much at stake in drafting the “right” player, aside from the multimillion dollar salaries on the line. A great player can positively affect game attendance, souvenir sales, television contracts and the financial health and well-being of a franchise. Athletes at this level undergo extensive physical examinations looking for any potential body flaw that could lead to injury and the inability to lead their new team to destiny. The poking and prodding extends beyond the routine sports physical and in Mr. Sullinger’s case, included an MRI of his back. The NBA team doctors were concerned that occasional tightness in his quads and hamstrings might be due to a structural problem in his back and demanded an MRI to peer inside .What they found was that he had bulging discs in his back. Never mind that they weren’t correlated with any physical symptoms, the radiology finding was enough to scare off more than half of the teams in the NBA.

Low back pain is the number one cause of work related disability in the US. One fifth of Americans have a yearly episode of back pain. It is the cause of six million ER visits. It is the third most expensive disease to care for, following heart disease and cancer, but enough numbers. Low back pain is often muscular but sometimes it is because one of the nerve roots that leave the spinal canal becomes irritated and inflamed. This can cause pain and numbness that radiates into the buttock and down the leg in the distribution of the sciatic nerve. The pain can be debilitating and if the nerve continues to be injured, the muscles that it controls can become weak and stop working. The nerve can be irritated in a number of ways including having an intervertebral disc (the shock absorber between the vertebral bones that make up the backbone) bulge and compress the nerve. When symptoms become severe or do not respond to routine treatment like rest, anti-inflammatory medications, physical therapy or chiropractic care, an MRI may be done to look for the reason why the nerve is compressed.

Interestingly, just because there are bulging discs does not mean that there will ever be any sciatic nerve compression, irritation, symptoms or disability. Numerous radiology studies a decade ago used MRI to look at the anatomy of patients who had no back complaints and more than 40% of patients who were healthy had bulging discs. This comes as no surprise to doctors who know that radiologists describe many unexplained finding sin all manners of x-rays. The formal x-ray report usually has a disclaimer dictated by the radiologist that goes something like: significance is uncertain and clinical correlation is advised. Translated into regular English, it means that something was seen and who knows what it means.

In today’s test happy world, the decision to order an x-ray or blood test for less than appropriate clinical reasons can lead to a cascade of events that can be costly, time consuming and stressful for the patient. Sometimes re is good fortune and an unknown illness can be found before it has caused significant damage to the body. That is the purpose of screening mammograms, colonoscopies and eye tests for glaucoma. But unneeded tests may also uncover inconsequential findings that take time and effort to prove that they are inconsequential.

For Mr. Sullinger, those teams who chose to pass on his talent had management who trusted an MRI rather than a physical examination. The team doctors chose to treat the results of a picture and not what they saw with their eyes and felt with their hands. Hopefully, a long career will prove Sullinger’s critics wrong and lay testament to the fact that doctors should treat the patient and not the test.

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