A 25 year old female with low back pain was INSISTENT on having an MRI done.
She had recently re-started to exercise because she had gained a lot of weight since she left the military a few years ago.
She never previously had trouble with back pain.
I spent a fair amount of time reassuring her (especially after a normal physical exam). She had mechanical low back and did not have any radiating symptoms.
I also spent a fair amount of time talking about the over utilization of x-rays, lifetime radiation exposure, unnecessary MRI's and even threw in some issues such as the cost to society, bankrupting of our health care system, unrealistic expectations of society, etc, etc.
I was on a roll...
After much negotiation, however, we did agree to do plain x-rays, after making sure she wasn't pregnant.
I let her know I would call her with the results (I also let her know that I predicted the x-rays would be normal).
The x-rays revealed a congenital defect of the lower back, degenerative changes and spondylolisthesis.
Although these findings were not the cause of her acute back pain (given the normal physical exam), it was still a call I didn't really enjoy making because she did, in fact, have an abnormal x-ray.
I was really wishing I had not spent so much time on my soapbox!