Diagnostic Tests

Depending on your complaints, your physician may initiate diagnostic tests. The important word is MAY. Not all presentations of pain necessitate testing. Sometimes, just waiting has it virtues.

For example, it is very common for a person to have significant acute pain, not controlled by the usual medications. The exam may not indicate a significant life or limb threatening problem, but because of the pain, an MRI of the area is ordered. Without criticizing the insurance company, usually there is a delay in obtaining authorization for an MRI in this scenario. After a few weeks, an MRI is obtained. Regardless of the findings on the MRI, the person is now completely better without any signs of pain.

The question then becomes “was the MRI necessary?” From the insurance companies perspective (or if you are paying cash for this test) “was this a good use of money?”

Then, in this scenario, what if it showed something? But the person does not have any pain. Do we need to do further testing to find out what that is, even though the person no longer has pain?

When ordering these tests, your physician will use his clinical judgment as well as guidelines established by the community. In the past few years, we are now in the era of Evidence Based Medicine. In other words, where is the evidence that this test was necessary? Where is the evidence that this finding means you need to follow this course of treatment?

In the next few years, it is predicted that many of the guidelines for ordering diagnostic tests will be challenged based on the principle of Evidence Based Medicine. There is tremendous controversy over the establishment of the guidelines, as the developers of the guidelines may have different points of view.

How do they differ you ask? What if one guideline is based on efficient use of resources, versus guidelines based on patient safety. They may not necessary come to the same conclusions. This is just an example of the nuanced issues that need to be explored when coming up with guidelines for certain medical conditions.

In this section, typical diagnostic testing for spine conditions will be discussed.

Last modified: October 22, 2019