I could argue that the MRI is usually a waste of money.
Shoulder strains and rotator cuff tears look just the same on exam initially. The strain will get better with time, if healing is slow, a cortisone shot can be helpful. If you don’t get better over time and with a shot, a diagnostic arthroscope makes more sense than an MRI, they can take a look and fix it at the same time.
If your doc doesn’t give you at least a month to heal prior to ordering a scan, they haven’t given you enough time to recover from a simple strain. If the shoulder still isn’t moving in 3 months, you probably need a scope regardless of what the MRI shows.
MRI scans are over utilized a portion of it is unrealistic expectations on the part of patients, a portion of it is justifying treatment to insurance companies, and an even bigger portion is laziness on the part of physicians. In the good old days, the doctor would sit down and explain the injury and normal healing times and schedule multiple follow up appointments to ensure that progress is being made. Now many busy docs just order an MRI without considering whether it alters treatment or not. The patient leaves thinking they have received the best treatment because they have a very expensive test ordered when in fact, the doc is just scooting them out of the office.
“I could argue that the MRI is usually a waste of money.”
We waste money because we reward primary care physicians for prescribing tests, not making people well. They need to be rewarded for results, not tests. The more tests and drugs they prescribe and more referrals they give to their specialist cronies the more money they make. Health care is not about making people well but making money for the players.
If you’ve ever had a problem you quickly understand that you receive little overall “Project Management” or advocacy from the primary care physician and from someone seriously interested in your recovery. They step aside while the other providers do their tests on their specialty. The incentives need changed. There is little oversight.
End of life care provides huge waste of money for procedures and tests but little incentive for palliative care that makes people feel good. The best care for someone terminal would be drugs (Morphine, marijuana, etc) that keep them high instead of the reality of facing expensive painful treatments or tests that will do nothing. Rarely do they give the patient this option.
BTW as a new Medicare recipient I just went through the shoulder routine you described. First three months of home care and home treatment (exercise, stretching with no results) internet self diagnosis and shoulder muscle atrophy noted before involving physician. My physician ordered an MRI right out of the gate. Diagnosis, arthritis, no serious tear. Offered me PT. No improvement started getting worse. After 4 + weeks cortisone shot. X-ray done to ascertain if any non-MRI resolved bone spurs. 6 more weeks of PT and it has finally started resolving.
I favor bigger co-pays so that the patient has a stake in treatment and a real desire for PT or other services. The patient needs a meaningful out of pocket payment for best treatment and to participate fully.
Basically the system has many institutions especially in big cities that rip it off that have influence in Congress. We need to give big rewards for whistle-blowers, and Medicare needs a major priority on uncovering fraud. Give 10 average citizens with common sense and no political ties a day and they could come up with real solutions. The politicians are bought and paid for....all of them.