Tuesday, May 22, 2012

Slipping off my soapbox

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!

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