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• Good doctor, bad doctor: who images more?
  Nitin K. Sethi
  Published on: 14 April 2016

• Published on: 14 April 2016

  Good doctor, bad doctor: who images more?

  • Nitin K. Sethi, Assistant Professor of Neurology

  Dr. Al-Shahi Salman in his editorial writes about the dangers of acting on incidental findings on brain MRI. He says primary prevention by avoiding MRI in the first place is the best approach. Unfortunately today in the United States avoiding imaging is easier said than done. The pressure to do a quick MRI is omnipresent. Thus almost every patient who walks into the emergency room with a headache, a new onset seizure or even...

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  Dr. Al-Shahi Salman in his editorial writes about the dangers of acting on incidental findings on brain MRI. He says primary prevention by avoiding MRI in the first place is the best approach. Unfortunately today in the United States avoiding imaging is easier said than done. The pressure to do a quick MRI is omnipresent. Thus almost every patient who walks into the emergency room with a headache, a new onset seizure or even vague non-localizing subjective complaints like dizziness and light headedness invariably gets scanned. Residents in training and even experienced physicians request neuroimaging because they do not want to miss anything. The thought of an expensive medico legal litigation case looms large in the physician mind. What if the patient has a malignant brain tumor and I dismiss it as a primary headache? Years of medical training in rational decision making are thrown to the wind and good doctors end up requesting unnecessary scans. The patients too are at fault and frequently equate a good doctor with one who scans for every complaint. Such doctors are perceived to be thorough and unlikely to miss anything. In our current world a doctor who images a patient with headache only in the presence of red flags such as focal neurological findings on examination or an atypical history is perceived to be a bad doctor. That I am afraid is the reality.

  References

  1. Al-Shahi Salman R. Brain MRI roulette. Pract Neurol.2010 Aug; 10(4):188-90.

  Conflict of Interest:

  None declared

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  Conflict of Interest:
  None declared.

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