Patient Expectations Drive Doctors to Order Unnecessary Scans for Low Back Pain

Last updated: 07-28-2020

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Patient Expectations Drive Doctors  to Order Unnecessary Scans for Low Back Pain

Despite knowing (and agreeing with) recommendations to not use imaging for low back pain without “red flag” indicators, doctors are still ordering unnecessary CTs and MRIs for patients. Most do so out of fear of upsetting the patient, and because there is not enough time to discuss the risks and benefits of the images with the patients, according to an October 17, 2016 study of Veteran’s Affairs health care professionals.

The study surveyed 579 VA clinicians, and included a hypothetical scenario in which a patient had requested imaging for nonspecific low back pain (without red flag symptoms). Only 3% of the responses thought that the patient would benefit from a CT scan or MRI. Almost 75% of the clinicians worried the patient would not be able to be referred to a specialist without an image, and more than half worried the patient would be upset to not receive the image.

The study confirms a concern highlighted by the American Board of Internal Medicine Foundation’s Choosing Wisely campaign, that the use of unnecessary imaging, such as CTs, MRIs, and X-rays, can lead to other unnecessary tests or procedures, drive up patient costs, and expose the patient to unnecessary radiation.

“Our study showed that almost all clinicians were aware that an imaging test was not indicated for a patient with low back pain without danger signals of severe spinal problems, and agreed with the Choosing Wisely recommendations to not do testing,” said study coauthor Erika D. Sears, MD, MS, of the Veteran’s Affairs Center for Clinical Management Research, in Reuters Health News (“Doctors still order imaging for low back pain, against recommendations” – October 17, 2016).

Patient education is key to avoiding unnecessary and expensive medical interventions and tests. There is a growing body of evidence that demonstrates early physical therapy for low back pain lowers costs. 

“Patients should first have a thorough history and physical exam to rule out the presence of “red flag” symptoms, and are often first referred to physical therapy in the initial treatment period,” Sears said. “Because low back pain tends to come back, staying active through activities such as walking, yoga, and supervised training, is key to warding off recurrence.”

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